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May 2009 | Dentalproductsreport.com
Web exclusive

Don’t kill your patients

Are you prepared for a medical emergency?

By Renee Knight, Senior Editor

Calling 911 isn’t enough.
When a medical emergency happens in your office, your team members need to know how to handle it. Chaos and panic won’t help your patient; that’s why it’s so important to have a plan in place, a plan that lays out what each team member is responsible for during an emergency—whether you’re dealing with an allergic reaction or a diabetic with low blood sugar. “It’s not a question of if, it’s a question of when,” said Roland Guy, President of Critical Care Solutions “They are rare, but they do happen. Chances are sometime in your career you’re going to encounter a patient having a medical emergency. It’s important that the hygienists and the rest of the office have a plan, that they have duties assigned. Who’s going to get blood pressure, who’s putting the patient on oxygen. You can’t leave everything up to the dentist.”

Find the right people for the job

When putting together your medical emergency plan and assigning roles. Start by surveying your employees for people with the following qualifications or training certifications:

  • First Aid
  • Basic Life Support (BLS) or Cardiopulmonary Resuscitation (CPR)
  • Automated External Defibrillator (AED) Training
  • Advanced Cardiac Life Support (ACLS)
  • Pediatric Advanced Life Support (PALS)
  • Twinject or EpiPen® use
  • IV (Intravenous) or IM (Intramuscular) Administration

    •  

    Once all team members with medical certification/training are identified, assign each person a specific role within the medical emergency plan. Every member must thoroughly understand and know their role, as well as how they should interact within the team during an emergency, said Dr. John Roberson and Dr. Chris Rothman, co-founders of the Institute of Medical Emergency Preparedness.

    “A lot will be happening during a life-threatening event and if you’re not prepared, you will panic,” Dr. Roberson said. “When you panic, you will forget. But when you and your staff are prepared, even though it is stressful, hopefully all of you will be thinking on the same page."

To prepare, your office should have what Drs. John Roberson and Chris Rothman, Co-Founders of the Institute of Medical Emergency Preparedness, calls the “Six Links of Survival” for every medical emergency: doctor training; staff training; a medical emergency plan; an emergency drug kit; proper equipment and mock drills. Taking the time to focus on each of these elements will keep your staff from panicking during an emergency situation and will help save lives.

Here’s a rundown of some of the emergencies that can come up in the dental office and what you and your team members can do about them.

Allergic reaction

This is the one emergency staff members need to be very aggressive with, Guy said. Medication needs to be given to the patient as quickly as possible.

Anaphylaxis is a systemic response to an antigen and can cause swelling of the airway, which can quickly swell to the point where the patient can’t breathe. And in a dental office, there are plenty of things people can be allergic to including bonding agents, mint flavoring in local anesthetics, latex gloves and even plants and perfume. People can be allergic to anything, and you don’t know where a patient has been and what they’ve been in contact with before walking into your office.

How to spot it. Any time a patient complains of shortness of breath or wheezing, think anaphylactic, especially if it’s sudden. Look at the back of the patient’s throat and if you see any swelling, call 911 immediately and administer emergency medications.

Tip:

Always begins with the as, bs and cs—airway, breathing and circulation, said Roland Guy, President of Critical Care Solutions.

What you can do. Start with epinephrine using the Epi-Pen or Twinject, then move on to the antihistamine Benadryl and then Albuterol, which is inhaled. The preferred way to give Albuterol is with a nebulizer; the small inhalers in your emergency kit likely aren’t big enough.

“Fortunately this is a rare emergency, but it’s the one emergency that all medications need to be given as quickly as possible,” Guy said. “I’ve found so many dentists who just don’t know what to give so the hygienist needs to be able to tell the dentist this is what you need to do. The hygienist needs to recognize the symptoms and encourage the dentist to give the medications. You need to do what’s right for the patient.”

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