Any dental office can face a variety of medical emergencies; therefore, the health care professional and the staff should always be prepared to deal with these emergencies in their office. Preparedness of the dental office staff and their prompt recognition of these emergencies will be the most important factor in dealing with the emergencies in any dental office. Health care professionals should follow the recommendations in this article to maintain a guideline for their staff and office and conduct regular emergency drills to examine the equipment and preparedness of their staff.
Key points
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The health care professional and the staff should always be prepared to use emergency drugs to deal with emergency situations in their dental office.
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Preparedness of the dental office staff and their prompt recognition of emergencies will be the most important factor in managing the emergencies in any dental office.
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Health care professionals should follow the recommendations in this article to maintain a guideline for their staff and office and conduct regular emergency drills to examine the equipment and preparedness of their staff.
Introduction
Medical emergencies in the dental office are an unavoidable part of the profession. Even though precautions to prevent such events are undertaken, these events are inevitable and the dental practitioner must be prepared. Malamed reported in his book that 96.6% of respondents of a survey among practicing dentists had a medical emergency occur in the office.
Emergencies can range from relatively benign conditions to life-threatening situations. Syncope and hyperventilation are two of the most common complications seen in the dental office. One must keep in mind that even these seemingly mild issues can escalate and cause significant morbidity. Although uncommon, major emergencies, including cardiac, pulmonary, and neurologic events, can occur. The dentist must be able to manage such situations until emergency medical responders arrive to the clinic.
Lastly, urgent or emergent situations can occur at any point during the patients’ visit to the dental office. The patients’ anxiety about the procedure can cause an event in the waiting room or even intraoperatively. Medications administered can also cause adverse reactions intraoperatively or even postoperatively.
This article aims to provide the dental practitioner with an overview of emergency adjuncts and medications. It is advisable for dental practitioners to also have formal training to manage emergencies, including basic life support and advance cardiac life support.
Emergency Equipment
Most essential emergency equipment in the dental office includes basic devices used for management of airway emergencies ( Box 1 ). Dental office staff should be prepared at all times to provide 100% oxygen through a portable source, such as an E cylinder or an installed oxygen portal on the wall with use of a face mask, nasal cannula, or use of nonrebreather mask. Oral airway equipment, such as nasopharyngeal and oropharyngeal airway devices, can also be very useful in managing airway obstructions in case of airway emergencies. Dental professionals and office staff should routinely run emergency drills in their dental office ( Box 2 ). It is the responsibility of the dental professional to assure that all the emergency equipment and oxygen tanks are full and operational at all times. Running emergency drills in the dental office will assure that the staff is prepared to deal with emergencies and the equipment are functioning properly.
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Portable or installed oxygen portals with nasal cannula
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Bag-valve-mask device
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Nonrebreather mask with reservoir
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Automated external defibrillator
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Oropharyngeal and nasopharyngeal airways
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Stethoscope and sphygmomanometer
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Yankauer suction tips
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Magill forceps
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Stethoscope
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Sphygmomanometer with small, medium, and large cuff sizes
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Wall clock with second hand
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Everyone in the dental office should have specific assigned duties.
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Contingency plans are in place in case a staff member is absent.
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Everyone has received appropriate training in the management of medical emergencies.
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Everyone is trained in basic life support.
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The dental office should be equipped with emergency equipment and supplies that are appropriate for that practice.
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Unannounced emergency drills should be conducted every few months.
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Emergency telephone numbers should be placed near each phone.
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Oxygen tanks and oxygen delivery systems should be checked regularly.
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All emergency medications are checked monthly and replaced if expired or to be expired.
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All emergency supplies are restocked immediately after use.
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One staff member is assigned to review this checklist regularly.
Other tools used in the dental office for management of emergencies are those used to assess patients’ vital signs. A pulse oximeter, sphygmomanometer, and stethoscope should be readily available in every dental office. If the dental office is equipped with a monitor, the heart rate, blood pressure, and oxygen saturation can be assessed simultaneously. Practitioners should keep in mind that both adult- and child-sized cuffs should be available for use with the sphygmomanometer.
In addition to the aforementioned equipment, it is recommended that dental practitioners are trained and proficient in starting an intravenous (IV) line. Necessary equipment includes IV lines, IV catheters of varying gauges, alcohol gauze, and tourniquets. IV fluids of 1000 mL bags with normal saline 0.9%, dextrose 50%, or lactated ringers should be part of the emergency armamentarium.
The American Heart Association now requires every health care professional office to be equipped with an automated external defibrillator (AED). It is the responsibility of the general dentist in charge to assure that his or her staff is trained to operate an AED. This training involves taking basic life support courses and having a current certificate.
Introduction
Medical emergencies in the dental office are an unavoidable part of the profession. Even though precautions to prevent such events are undertaken, these events are inevitable and the dental practitioner must be prepared. Malamed reported in his book that 96.6% of respondents of a survey among practicing dentists had a medical emergency occur in the office.
Emergencies can range from relatively benign conditions to life-threatening situations. Syncope and hyperventilation are two of the most common complications seen in the dental office. One must keep in mind that even these seemingly mild issues can escalate and cause significant morbidity. Although uncommon, major emergencies, including cardiac, pulmonary, and neurologic events, can occur. The dentist must be able to manage such situations until emergency medical responders arrive to the clinic.
Lastly, urgent or emergent situations can occur at any point during the patients’ visit to the dental office. The patients’ anxiety about the procedure can cause an event in the waiting room or even intraoperatively. Medications administered can also cause adverse reactions intraoperatively or even postoperatively.
This article aims to provide the dental practitioner with an overview of emergency adjuncts and medications. It is advisable for dental practitioners to also have formal training to manage emergencies, including basic life support and advance cardiac life support.
Emergency Equipment
Most essential emergency equipment in the dental office includes basic devices used for management of airway emergencies ( Box 1 ). Dental office staff should be prepared at all times to provide 100% oxygen through a portable source, such as an E cylinder or an installed oxygen portal on the wall with use of a face mask, nasal cannula, or use of nonrebreather mask. Oral airway equipment, such as nasopharyngeal and oropharyngeal airway devices, can also be very useful in managing airway obstructions in case of airway emergencies. Dental professionals and office staff should routinely run emergency drills in their dental office ( Box 2 ). It is the responsibility of the dental professional to assure that all the emergency equipment and oxygen tanks are full and operational at all times. Running emergency drills in the dental office will assure that the staff is prepared to deal with emergencies and the equipment are functioning properly.
