Basic Guide to Medical Emergencies in the Dental Practice

Phil Jevon is Resuscitation Officer/Clinical Skills Lead at Manor Hospital, Walsall. He is a Resuscitation Council (UK) ALS, EPLS, ILS, PILS, NLS Instructor and is an Honorary Clinical Lecturer at the Birmingham School of Medicine

Foreword ix

Acknowledgements x

About the companion website xi

1 An overview of the management of medical emergencies and resuscitation in the dental practice 1

Introduction 1

Concept of the chain of survival 2

Incidence of medical emergencies in dental practice 3

General dental council guidelines on medical emergencies 4

Resuscitation Council (UK) quality standards 5

ABCDE assessment of the sick patient 6

Medical risk assessment in general dental practice 7

Principles of safer handling during cardiopulmonary resuscitation 8

Procedure for calling 999 for an ambulance 10

Importance of human factors and teamwork 11

Conclusion 13

References 13

2 Resuscitation equipment in the dental practice 15

Introduction 15

Recommended minimum resuscitation equipment in the dental practice 16

Checking resuscitation equipment and drugs 20

Checking resuscitation equipment following use 22

Care, handling and storage of oxygen cylinders 23

Conclusion 25

References 25

3 ABCDE: Recognition and treatment of the acutely ill patient 26

Introduction 26

Clinical signs of acute illness and deterioration 27

The ABCDE approach 27

General principles of the ABCDE approach 28

The ABCDE approach to the sick patient 28

Principles of pulse oximetry 34

Procedure for administering oxygen to the acutely ill patient 38

Procedure for recording blood pressure 41

Medical emergencies in the dental practice poster 44

Conclusion 46

References 46

4 Respiratory disorders 48

Introduction 48

Management of acute asthma attack 49

Management of hyperventilation 55

Management of exacerbation of chronic obstructive pulmonary disease 56

Procedure for using an inhaler 57

Procedure for using a spacer device 61

Conclusion 64

References 64

5 Cardiovascular disorders 66

Introduction 66

Management of angina 67

Management of myocardial infarction 69

Management of palpitations 73

Management of syncope 74

Conclusion 76

References 77

6 Endocrine disorders 78

Introduction 78

Management of hypoglycaemia 78

Procedure for blood glucose measurement using a glucometer 83

Management of adrenal insufficiency 85

Conclusion 86

References 86

7 Neurological disorders 88

Introduction 88

Management of a generalised tonic–clonic seizure 88

Management of stroke 93

Management of altered level of consciousness 96

Procedure for placing a patient in the recovery position 97

Spinal injury 101

Conclusion 102

References 102

8 Anaphylaxis 104

Introduction 104

Definition 105

Incidence 105

Pathophysiology 105

Causes 106

Clinical features and diagnosis 107

Treatment 109

Risk assessment 113

Conclusion 114

References 115

9 Cardiopulmonary resuscitation in the dental practice 117

Introduction 117

Resuscitation Council (UK) automated external defi brillation algorithm 118

Procedure for cardiopulmonary resuscitation in the dental chair 118

Procedure for performing chest compressions 126

Conclusion 129

References 130

10 Airway management and ventilation 131

Introduction 131

Causes of airway obstruction 132

Recognition of airway obstruction 132

Simple techniques to open and clear the airway 133

Use of oropharyngeal airway 135

Principles of ventilation 138

Treatment of foreign body airway obstruction 147

Conclusion 150

References 150

11 Automated external defibrillation 152

Introduction 152

Ventricular fi brillation 153

Physiology of defi brillation 153

Factors affecting successful defi brillation 154

Safety issues and defi brillation 155

Procedure for automated external defi brillation 155

Conclusion 158

References 158

12 Paediatric emergencies 160

Introduction 160

ABCDE assessment of a sick child 161

Principles of paediatric resuscitation 162

Placing a child into the recovery position 170

Management of foreign body airway obstruction 170

Conclusion 173

References 173

13 An overview of emergency drugs in the dental practice 175

Introduction 175

Adrenaline 176

Aspirin 179

Glucagon 180

Glyceryl trinitrate spray 181

Midazolam 182

Oral glucose solution/tablets/gel/powder 185

Salbutamol inhaler 185

Conclusion 187

References 187

14 Principles of first aid in the dental practice 189

Introduction 189

Priorities of first aid 190

Responsibilities when providing first aid 190

Assessment of the casualty 190

Wounds and bleeding 195

Minor burns and scalds 200

Poisoning, stings and bites 200

Importance of record keeping 202

Summary 203

References 203

15 Professional, ethical and legal issues 204

Introduction 204

The scope of a dental professional’s accountability 205

The fifth sphere of accountability 217

Legal requirements for consent and acting in a patient’s best interests 218

Duty of confidence owed to patients by dental professionals 226

Conclusion 231

References 232

Index 235