Quality Resource Guide
l
Medical Emergencies: Preparation and Management 5th Edition
2
www.metdental.com
Introduction
Medical emergencies can and do happen in
the
practice
of
dentistry.
Recent
surveys
of dentists in Australia,
1
New Zealand,
2
the
United Kingdom
3
and U.S.A.
4,5
demonstrate
that, though rare, potentially life-threatening
situations do develop in the dental office.
Table 1
lists the thirteen most common emergencies
found in a survey of 4309 dentists practicing
in North America. These constituted 98.7% of
the 30,608 emergencies reported.
4
Table 2
lists the incidence of medical emergencies in an
American Dental Association survey of dental
offices in the 12 months prior to March, 2018.
5
Dental offices must be prepared to promptly
recognize
and
effectively
manage
medical
emergencies. Though no ‘national standard’
for emergency preparation exists in the USA,
specialty
groups,
such
as
the
American
Association of Oral & Maxillofacial Surgeons,
6
the American Academy of Pediatric Dentistry,
7
and the American Association of Periodontists
8
have developed guidelines for their membership.
The states of Massachusetts
9
and West Virginia
10
require all dentists practicing in the state to
maintain a ‘minimal’ kit of emergency drugs and
equipment in their office.
A medical emergency in the dental office
environment may be defined as an event occurring
to the patient in the chair that causes the doctor
to stop ‘doing’ dentistry because they (the doctor)
are now more concerned with the patient’s life
than the patient’s teeth.
It is the obligation of the Healthcare Provider to
the ’victim’ of the medical emergency to try to keep
the victim alive until they either recover or until
help arrives on scene to take over management,
provided that they are better qualified to handle
the situation.
Prevention
Prevention
of
an
emergency
is
more
desirable than managing it once it occurs.
Approximately 75% of medical emergencies
are preventable. Thorough evaluation of the
medical history, recording vital signs, assessment
of medical risk (ASA classification), and use of
treatment modifications, as needed, can prevent
‘stress-induced’ emergencies.
Table 3
lists other Quality Resource Guides
discussing dental management of higher-risk
patients.
Preparation
Preparation of the dental office and staff to
recognize and manage medical emergencies is
essential to a successful outcome.
Table 4
is
an example for an office preparation plan listing
the components involved in adequate preparation.
Each dental office should develop their own detailed
and specific plan fitting their circumstances.
1. Basic Life Support
Without doubt basic life support (BLS) is THE single
most important element in successful management
of medical emergencies. Though not all state
dental boards mandate BLS (also known as ‘CPR’)
to maintain dental licensure, the drug package
insert accompanying all local anesthetic drugs
states.
11
“Dental practitioners and/or clinicians who employ
local anesthetic agents should be well versed in
diagnosis and management of emergencies that
may arise from their use. Resuscitative equipment,
oxygen, and other resuscitative drugs should be
available for immediate use.”
Resuscitative equipment has been interpreted in
courts to be the ability to perform BLS. Training in
the use of all resuscitative equipment is essential
for proper utilization.
BLS Healthcare Provider (BLS-HCP) is the
minimum level of training required. Though states
mandating current-BLS cards for dental licensure
require successfully completing a course every
two years, multiple studies have demonstrated
Table 1 - Reported Medical Emergencies
Situation
# Reported
Synope
15,407
Mild allergic reaction
2,583
Angina pectoris
2,552
Postural hypotension
2,475
Seizures
1,595
Asthmatic attack
(bronchospasm)
1,392
Hyperventilation
1,326
Epinephrine reaction
913
Insulin shock (hypoglycemia)
890
Cardiac arrest
331
Anaphylactic reaction
304
Myocardial infarction
289
Local anesthetic overdose
204
Table 2 - Incidence of Medical
Emergencies within previous 12 months
5
Emergency Situation
% Reporting
Synope
37.77
Epinephrine reaction
37.43
Postural hypotension
33.92
Mild/moderate allergic
reaction
15.79
Physical injury requiring first
aid
15.20
Hyperventilation
11.70
Seizure
11.11
Other, please specify
5.85
Insulin shock (hypoglycemia)
2.92
Asthmatic attack
(bronchospasm)
1.75
Local anesthetic overdose
1.17
Angina pectoris
1.17
Anaphylactic reaction
0.58
Cardiac arrest
0.58