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In the realm of dental health care, being prepared for medical emergencies is not just an added benefit—it’s a necessity. Dental providers are occasionally the first responders to critical patient incidents that occur unexpectedly during dental procedures. Understanding and implementing an effective medical emergency management protocol ensures the safety and well-being of patients and promotes a secure and trusting environment.
Understanding medical emergencies in dental settings
A medical emergency is any unexpected event that poses an immediate health risk to an individual. In dental settings, emergencies can arise due to stress, underlying medical conditions, or reactions to medications or procedures. Common risk factors include age, medical history, and the nature of the treatment. Recognizing these risks and having an emergency protocol in place is crucial. To execute a medical emergency response, consider a protocol that includes the following steps: activating the emergency medical system, obtaining the necessary medical equipment, performing prehospital provider protocols, documenting, and conducting a post-incident huddle for debriefing.
Assessing severity
Assessing the severity of a medical emergency is a skill that can greatly impact patient outcomes. When faced with a potential emergency, dental health-care providers must act swiftly to evaluate the situation, prioritizing the initial assessment of the patient’s responsiveness, airway, breathing, and circulation—the foundational ABCs of emergency medicine. This rapid evaluation helps to determine the urgency of the situation and guides the immediate actions required to stabilize the patient. Checking responsiveness involves speaking to the patient or gently tapping them to see if they react, while ensuring the airway is clear. Assessing breathing and circulation involves observing chest movements and checking the pulse, respectively. This quick but thorough assessment allows providers to identify life-threatening conditions early and initiate appropriate emergency protocols or call for advanced medical support when necessary.
Collaboration with EMS
In the critical moments of a medical emergency, the decision to call emergency medical services (EMS) and how effectively one communicates with these responders can be pivotal in ensuring a patient’s well-being. Smooth collaboration and detailed briefings about the patient’s condition and the steps already taken are essential for a successful handover when every second counts. Providing a comprehensive medical history is crucial, as it informs EMS of any existing conditions or allergies that could influence treatment decisions. Documenting the exact time the emergency began guides the administration of timely and appropriate care, especially in cases such as strokes where treatment within four hours can drastically improve recovery chances. EMS often employs precise protocols and timing when administering medications during emergencies, underscoring the importance of accurate information and swift action to enhance patient outcomes.
Emergency equipment and medications
Every dental office should be equipped with key emergency equipment and medications, including an automated external defibrillator (AED), oxygen supplies, epinephrine injectors, and glucose supplements. Dental teams should be proficient in using this equipment and administering necessary medications. To streamline emergency response, it’s advisable to organize a central medical emergency station—be it a cabinet, cart, or shelf—where all essential items are readily available. This setup eliminates the need for a frantic search during an emergency. Visible signage directing to this station, coupled with comprehensive training for staff on how to use these resources, is essential. A well-trained team equipped with accessible tools significantly enhances the ability to manage emergencies effectively, ensuring patient safety.
Implementing prehospital provider protocols
Evaluating the situation quickly and accurately is vital. Initial assessment should include checking the patient’s ABCs, then implementing the emergency protocol as soon as possible. The following are the most common types of medical emergencies in dental settings:
Choking: Observe the patient for difficulty breathing or inability to speak. If these signs are present, perform abdominal thrusts until the object is dislodged. If the patient becomes unconscious, place the patient on the floor and begin CPR. Activate EMS as soon as possible, as any patient who experiences choking should be examined by a physician.
Anaphylaxis: Be on the lookout for signs like swelling, hives, or difficulty breathing. Once signs are present, contact EMS immediately, put the patient in a supine position, and administer an EpiPen. Monitor, and if symptoms persist, administer an additional EpiPen every 5–10 minutes. Provide oxygen and monitor vital signs continually until EMS arrives.
Hypo/hypertension: Monitor the patient’s blood pressure. For low blood pressure, have the patient lie down and elevate their legs. Provide oxygen and monitor vital signs. For high blood pressure, monitor vital signs and provide oxygen if needed. If blood pressure returns to normal, standard of care denotes that a patient should be referred to their physician for post-emergency follow-up care and a medical release should be obtained. In both cases, if blood pressure does not return to normal, immediately contact EMS and continue to monitor vital signs. In rare cases, if the patient becomes unconscious and there is no pulse or breathing detected, begin CPR until EMS arrives.
Asthma attack: Assist the patient in using their inhaler if they have one and ensure they are in an upright position to maximize airflow. If the patient does not have a bronchodilator, administer two puffs of albuterol, then oxygen if needed. Contact EMS and monitor vital signs until they arrive.
Cardiac episode: Call EMS at the first sign of chest pain or discomfort and monitor vital signs until they arrive. If symptoms worsen, administer oxygen, provide 325 mg of chewable aspirin, and continue to monitor. If the patient becomes unresponsive, begin CPR with an AED.
Diabetic episode: Provide a sugar source if any signs of hypoglycemia appear. In a conscious patient, provide 15 grams of glucose gel or other form of glucose. Maintain the airway and monitor vital signs. The patient should be referred to their physician for post-emergency follow-up care. In an unconscious patient, activate EMS immediately, administer a dextrose solution injection if on hand, and monitor until EMS arrives.
Opioid overdose: Immediately activate EMS, and if the patient becomes unconscious, begin CPR. Administer one dose of naloxone, monitor for two to three minutes, and if no response, continue to administer naloxone every two to three minutes until the patient responds or EMS arrives. Patient should be referred to their physician for post-emergency follow-up.
Stroke: Use the FAST test (face drooping, arm weakness, speech difficulties, time to call EMS) as a quick screening tool and activate EMS immediately. The patient should be advised to go with EMS to have further testing in a hospital setting.
Seizure: Activate EMS at the first sign of a seizure. Keep the patient safe from injury, do not restrain them, and clear the area of any hard or sharp objects. Administer oxygen if needed and monitor vital signs until EMS arrives.
Syncope (fainting): Have the patient lie down in a safe area and elevate their legs to encourage bloodflow to the brain. Monitor vital signs and administer oxygen if needed. If unconsciousness persists, activate EMS, use ammonia inhalants (“smelling salts”) if the patient doesn’t have a history of ammonia allergy, and monitor vital signs.
Documentation and debriefing
For dental health-care providers, meticulous documentation of a patient’s medical emergency is not just a procedural necessity; it’s a cornerstone of quality care and legal diligence. Recording every detail provides a clear narrative of the incident, the response actions taken, and the rationale behind those decisions. This information is invaluable for legal protection, insurance claims, and improving patient safety protocols. Equally critical is the post-emergency debriefing huddle. This gathering serves multiple purposes: it offers a platform to analyze the effectiveness of the emergency response, it helps to identify areas for improvement to prevent future incidents, and it supports the emotional and mental well-being of team members involved. Such debriefings reinforce a culture of continuous learning and psychological safety within the dental practice, ensuring both staff and patient welfare are prioritized.
The capacity to manage medical emergencies effectively is a fundamental aspect of dental health care. By adhering to the outlined objectives and steps, dental health-care providers can ensure they are prepared to handle any situation, ultimately safeguarding their patients’ health and reinforcing the integrity of their practice.
Editor's note: This article appeared in the June 2024 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
