Management of Medical Emergencies in Dental Practice

Management of Medical Emergencies

• Medical emergencies can happen at any time in general dental practice, and at least two people should be available to deal with them when treatment is planned.
• Dental practitioners are expected to be competent in managing common medical emergencies, and all members of staff should know their role in medical emergencies, practise regularly together in a simulated medical emergency.

Expectations

• A process to assess patients at risk should be in place at all dental practices.
• The 'ABCDE' approach should be used to assess acutely ill patients.
• Specific emergency drugs and equipment should be available immediately.
• All clinical areas should have immediate access to an Automated External Defibrillator (AED).
• Training in BLS and use of AED should be updated annually.

Incidence

• The commonest medical emergencies in dental practice are vasovagal syncope (63%), angina (12%), hypoglycaemia (10%), seizures (10%), choking (5%), and anaphylaxis.
• Medical emergencies occur more frequently, with 57% of dentists reporting up to 3 emergencies and 36% of dentists reporting up to 10 emergencies in a 12-month period.

Risk Assessment

• Medical and drug history should be taken by the dental practitioner to identify patients at risk.
• Modification of the planned treatment or referral to the hospital may be appropriate.

Training

• Training in CPR should include recognition of cardiac and respiratory arrest, summoning help, starting CPR, and using AED within 3 minutes.
• Staff should update their skills at least annually.
• Resuscitation training is fundamental and should be a part of the induction for new members of staff.

COVID Update

• Follow 2021 guidelines for resuscitation for those working in healthcare settings.
• Use of FFP3 masks or respirators as well as eye protection is recommended when performing chest compressions for patients with suspected or confirmed COVID-19.

ABCE Approach

• A - Airway: Look, listen, and feel for airway noises, head position, foreign body, fluid, oedema, and respiratory rate and effort.
• B - Breathing: Check for breathing, subcutaneous emphysema, and symmetry of chest movement.
• C - Circulation: Check heart rate, blood pressure, capillary refill time, bleeding, and skin colour.
• D - Disability: Check AVPU, GCS, pupils, diseases, blood glucose, and neuro exam.
• E - Exposure: Perform a general examination, revealing other symptoms, and thermomanagement.

FAINT

• Symptoms and signs: dizziness, slow pulse rate, low BP, pallor, sweating, nausea, vomiting, and loss of consciousness.
• Management: Lay patient flat, raise legs, loosen tight clothing, give 15L oxygen, and check for 'signs of life' and start CPR if unresponsive.

Hyperventilation

• Symptoms and signs: lightheadedness, generalised paraesthesia, fast breathing, and panic.
• Management: Reduce anxiety and reassure, return CO2 level in blood to normal by rebreathing from cupped hands or reservoir bag.

Postural Hypotension

• Symptoms and signs: lightheadedness, dizziness, loss of consciousness on upright standing position from supine.
• Management: Lay flat, give oxygen 15L/min, and sit up very slowly, particularly if patient is on ß-blockers.

Choking and Aspiration

• Symptoms and signs: coughing, spluttering, difficulty breathing, noisy breathing, wheeze or stridor, and cyanosis.
• Management: Encourage patient to cough vigorously, deliver sharp back blows, and follow with abdominal thrusts if foreign body has not been dislodged. Start CPR if patient becomes unconscious.