Manage the mayhem of medical emergencies – Martin OatesFeatured Products Promotional Features
Posted by: The Probe 6th February 2018
Medical emergencies can occur anywhere at any time. Most people will have witnessed or been involved in an accident at some point in their life and quite often, it is deemed as a medical emergency – knowing how to act in this instance could potentially save someone’s life. It is therefore vital for the entire dental team to be prepared to take action should such an emergency arise in or around the practice.
Knowledge is key
A study conducted over a ten-year period found that, on average, a practitioner may experience an emergency in a general dental practice once every four and a half years.[i] Although this demonstrates the unpredictability of medical emergencies, dental professionals must be as well equipped to perform the appropriate care in that circumstance as they are in executing routine dental treatments. Training proved to be invaluable to dental practitioner Brian Needham, as he saved the life of a patient suffering from a heart attack in his practice earlier this year.[ii]
The General Dental Council (GDC) state that it is essential for all members of staff in the dental practice to be adequately trained in dealing with medical emergencies, including with resuscitation techniques, and evidence must be kept of any relevant courses.[iii] All staff are recommended to complete a course of basic life support training once a year.
The dental team can assess who may be most at risk of a medical emergency by reviewing the medical records of patients. Imagine that a patient suddenly collapses in the waiting room of your practice – they are breathing but unconscious. You and your staff know that this patient is diabetic. With this information, you deduct that the patient is suffering from a hyperglycaemic attack and a glucagon injection from the drug kit you have can be administered in response. You have just saved someone’s life.
In the event of a medical emergency, the Resuscitation Council (RC) guidelines advise to stay calm and ensure that you and your staff are safe before examining the patient through the ABCDE approach to assess if they ‘look unwell’:[iv]
- Airway – assess that there is no obstruction to their airway
- Breathing – check that the rhythm of their breathing is normal
- Circulation – has their circulatory state been compromised? A hint will be in the fact that their tongue and lips will turn blue
- Disability – make a swift initial assessment of the patient’s consciousness
- Exposure – you may need to loosen or remove the patient’s clothing to adequately treat the patient
Lie the patient flat, if you can, and raise their legs – most can recover from a collapse, particularly if they faint, but be ready to call an ambulance if they do not do so immediately. If the patient’s condition deteriorates, you or a member of your team may be required to supply them with oxygen – having the equipment for this ready to hand should be normal practice protocol.
Utilising drugs and equipment
It is crucial that practices have a kit where all drugs that can be used in a medical emergency are stowed together in a purposely designed storage bag or container. All members of staff must know where it is kept. These drug kits may contain some prescription-only medicines that dental care practitioners (DCP) will not be expected to administer, but there will be others they can. Practising the procedures of a medical emergency as part of a team will allow you to identify roles and responsibilities in regards to attaining the drug kit, contacting an ambulance and assisting in cardiopulmonary resuscitation (CPR).
The RC state that primary dental care facilities have an obligation to provide a high-quality resuscitation service, which includes immediate access to an automated external defibrillator (AED). This is a vital piece of equipment that must be used within the first few minutes of cardiorespiratory arrest in order to revive the patient. The Zoll AED Plus from Dental Express (a trading division of Surgery Express LLP) is the only machine that can track your progress as CPR commences. Real-time feedback and visual prompts will guide you through the process so you can be confident in your application. You must decide where is the most appropriate area of the practice to place the defibrillator so it is easily accessible.
Take time to reflect
Following treatment for any medical emergency, it is very important to produce an accurate and comprehensive account of everything that occurred in the patient’s records. Reflect and debrief as a team because it will enable you and your staff to learn from what happened during the emergency, what role each member played and what steps can be taken to improve your clinical practice. Remember, this knowledge could save a life.
[i] Atherton, G., McCaul, J. and Williams, S. (1999). Medical Emergencies in General Dental Practice. Part 1: Prevalence over a 10 year period. British Dental Journal. 186 (2) January pp. 72-79.
[ii] Di Salvo, M. (2017). Heart attack victim saved by dentist when he suffered cardiac arrest in waiting room. http://www.mirror.co.uk/news/uk-news/heart-attack-victim-saved-dentist-9606715. [Last accessed: 13.11.17].
[iii] General Dental Council (2017). Medical emergencies. https://www.gdc-uk.org/professionals/standards/medical-emergencies. [Last accessed: 09.11.17].
[iv] Resuscitation Council UK (2017). Quality standards for cardiopulmonary resuscitation practice and training. https://www.resus.org.uk/quality-standards/primary-dental-care-quality-standards-for-cpr/#search=”dental“. [Last accessed: 09.11.17].
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