Emergency Preparedness: Do you have a plan in place?
The most dreaded of all medical emergencies is the occurrence of cardiac arrest in the dental office.
The 2015 guidelines can be implemented with the team and equipment I have delineated.
If a patient becomes unresponsive or has abnormal breathing, you should assume the patient may be having a cardiac arrest and activate the emergency team. The second assistant should activate the EMS.
The patient should be moved to the floor, where a firm surface allows for effective cardiac compression.
The dental professional should initiate compression immediately while awaiting the emergency equipment to arrive on the scene. Compression, Airway and Breathing (CAB) supplanted the previous Airway, Breathing and Compression (ABC) algorithm in 2015 because there is data that shows delaying first compression is associated with a worse outcome. As soon as additional members of the team arrive, the dental professional should be at the head of the patient and responsible for managing the airway and for providing oversight of the proceedings. The first assistant will assume the responsibility of chest compression.
Compressions should be at a rate of 100 to 120 compressions per minute and should be 2 inches (5 cm) deep to be effective, but not greater than 2.4 inches (6 cm) to avoid complications.
The team should progress to AED deployment as soon as the emergency equipment is brought in by the second assistant. Early defibrillation has been shown to be critical in successful and meaningful resuscitation.
With the emergency equipment recommended in Figure 2, the dental professional should place an oral pharyngeal airway (OPA). Proper airway can be completed by picking the airway length that spans from the bottom of the patient’s pinna to the corner of the mouth. The OPA should be inserted upside down and flipped over when it is fully inserted. This minimizes the likelihood of the back of the tongue obstructing the upper airway.
Once the OPA is in place, the first assistant should hand the mask to the dental professional, who then ensures the patient’s chin is gingerly moved up and forward and that the mask fits snugly around the nose and mouth. Positive pressure ventilation using an ambu bag with high flow oxygen should be started. In this situation, there should be 30 compressions and two breaths.
At all times, interruptions to chest compression should be limited to less than 10 seconds.
In a patient with a witnessed arrest, the ability to override the AED is important when the AED reports the patient is in asystole and does not have a shockable rhythm. The hope is the asystole actually represents fine ventricular fibrillation and can be successfully defibrillated by using the manual override option.
The second assistant should assist with equipment retrieval, drug administration and relieving the first assistant in chest compression.
This team approach, combined with using the recommended equipment, should ensure optimal cardiopulmonary resuscitation in the dental office.
Managing medical emergencies in your office
Using these guiding principles, you should be comfortable managing the infrequent medical emergencies in the dental office. Emergency preparedness will save lives.
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