Preparing the Dental Office for Medical Emergencies

Modern dental offices must be equipped to initiate prompt emergency care should the sudden need arise. With the elderly population in dental practices increasing, these emergencies will undoubtedly occur. This article discusses the basic emergency equipment the average dental office should possess to allow for an adequate initial response. It also discusses the policies and personnel needed for dealing with emergencies. Among the basic emergency equipment, an office should have syringes, an Ambu bag, a portable oxygen system, a sphygmomanometer (child and adult sizes), and an EKG/defibrillator. Emergency drugs that should be stocked include aromatic ammonia, aspirin, and nitroglycerine. The dentist should also develop a protocol and policy for his/her staff to follow when a medical emergency arise.

When planning to open a private office that is patient oriented, employee friendly, and doctor centered, knowledge in many nonclinical areas such as patient billing, infection control, accounting, and so forth is, of course, mandatory. However, an area that is most critical but sometimes overlooked by dentists when establishing new offices is preparation for the management of office medical emergencies. Although such office medical emergencies are infrequent, the dentist will often be held legally responsible for any untoward outcome allegedly resulting from causation or mismanagement of those medical emergencies. With the elderly population growing, the number of patients who are on multiple medications for underlying medical conditions will certainly be increasing.

This article does not focus on the diagnosis and management of specific medical and dental emergencies, or on a detailed pharmacologic discussion of the drugs used, but rather, on the policies, equipment, and personnel needed to prepare for dealing with emergencies, should they occur. No discussion of techniques or the underlying physiology is discussed because this information is readily available elsewhere .

Office equipment

Dental offices should be prepared to provide basic airway management, which includes the ability to administer 100% oxygen through a portable O 2 source. One “E” oxygen tank, when full, will last approximately 60 minutes when given at a 10 L per minute flow rate. The dentist must frequently check to ascertain the O 2 tank status, even if two tanks are available for backup. Oxygen can be delivered by way of a nasal cannula, face mask, or face mask with reservoir. It is the author’s opinion that all offices should have an Ambu bag and a full face mask, merely to allow the dentist to provide positive pressure ventilation should the need rise. A nasal and oral airway should also be part of most dentists’ airway management kit.

Stethoscope and sphygmomanometer (with child- and adult-size cuffs) and an assortment of syringes and needles should also be considered as part of the dental office’s basic emergency equipment. The one device that has now become ubiquitous in its presence in almost all public places is the automatic external defibrillator (AED). The survival rate in cardiac arrests approaches 30% if early defibrillation is administered, accompanied by advance cardiac life support. The AED also eliminates the need for training in rhythm recognition but it does require the dentist and key staff to be trained in its use by participating in the American Heart Association’s basic cardiopulmonary resuscitation course. See Box 1 .

Box 1

  • Tourniquets

  • Syringes

  • Ambu bag

  • Oropharyngeal and nasopharyngeal airways

  • Normal saline 0.9%, 1000-mL bags

  • 18-and 20-gauge angiocatheters

  • Yankauer suction tip

  • Portable oxygen system (E cylinder size)

  • Stethoscope

  • Sphygmomanometer (child and adult sizes)

  • EKG/defibrillator (AED)

  • Sterile water for injection

Basic emergency equipment

Emergency drugs

General dentists and dental specialists should develop an emergency box that is dedicated to emergencies and stocked with the following key basic resuscitation drugs. Those offices providing intravenous sedation will certainly have more comprehensive emergency drugs available.

  • Aromatic ammonia: Syncope is the most common medical emergency in the dental office. Vaporable aromatic ammonia is available and, when cracked or crushed, it releases a noxious odor that stimulates the respiratory and vasomotor centers of the medulla. When combined with placing the patient in a Trendelenburg’s position and providing supplemental oxygen, most patients will return to consciousness.

  • Aspirin: The American Heart Association recommends that patients experiencing an acute myocardial infarction chew an aspirin. Chewing a buffered aspirin (325 mg) for 30 seconds and then swallowing it with water is thought to have a rapid and sustained effect.

  • Nitroglycerine: Nitroglycerine is recommended for relief of angina in patients who have a past history, and for those with a new onset of angina with a suspected myocardial infarction. Nitroglycerin is available as a 0.4-mg metered aerosol. The spray does not require special storage and has a 3-year shelf life; the tablet form requires special storage in light-resistant containers and loses its potency in 12 weeks. Administration of this drug is safe, with headaches, dizziness, and flushing as possible side effects.

  • Inhaled beta 2 -agonists: Bronchodilators are the main drug groups used for the treatment of wheezing and bronchospasm. Selective beta 2 -agonists are the preferred drugs because they minimize the side effects, including tachycardia, hypertension, angina, restlessness, and flushing. Albuterol is the preferred choice because it is the most selective of the beta 2 -agonists and it comes in a metered dose inhaler.

  • Epinephrine: Epinephrine is a sympathomimetic drug that acts on alpha adrenergic and beta adrenergic receptors with primary effects being bronchodilation, vasoconstriction, and increased rate and force of cardiac contraction, along with stabilization of mast cells (involved in severe allergic reactions.) See Box 2 .

Oct 29, 2016 | Posted by in General Dentistry | Comments Off on Preparing the Dental Office for Medical Emergencies
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