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Introduction
A medical emergency refers to a disease or harm which is acute and presents a great risk to the life of an individual or the long-term health. These emergencies might need help from personnel who must be appropriately and ideally qualified to carry out the exercise, though some of the emergencies might be handled by the persons or victims themselves. Depending on the emergencys grimness and the excellence or quality of any medication provided, it might need the contribution or engagement of several levels of health care, starting from first aider personnel to emergency personnel via professional surgeons. Therefore, any reaction to a medical emergency will strongly rely on the circumstance, the involved sick person and accessibility to resources to assist the victims. In addition, the emergencies are different based on whether it occurred while the patient was in the health care facility under medical care or the victim was under no medical care like at home (5). In this case, the paper will examine how best all the members of the dental team can be involved in the preparation for and delivery of emergency medical care in the dental setting.
Medical emergencies in the dental setting
The dental team should be prepared to handle medical emergencies that might result in their field. Most of the medical emergencies in the dental setting happen mostly during and after the application of local anesthesia, principally during the time of extraction and endodontic of the tooth. Examples of medical emergencies in the dental practice include; syncope, allergic reactions, cardiac arrest, diabetic emergencies, myocardial infarction, bronchospasm, postural hypotension and hyperventilation. Therefore, the degree of medication by the dentist involves the following steps; preparation, prevention and the appropriate management. Prevention of the emergencies is fulfilled by carrying out an exhaustive medical examination or history with suitable changes to dental medication as needed (3).
The dental team which is made up of dentist, nurses, dental hygienist and other health care providers, who have specialized in the field of dentistry, is significant in the precluding of oral illnesses and making sure that the appropriate probable quality of medical services is offered. Thus, in medical emergencies in the dental setting, all the team members need to work together in order to respond immediately to any emergency that might arise during and after extraction and endodontic of tooth (1).
Preparation for medical emergencies
In order for all members of the dental team to be involved in the preparation for and delivery of emergency medical care in the dental setting, they should be well trained in order to increase their competencies. The most significant feature of almost all medical emergencies within the dental care setting is to precluding or rectifying inadequate oxygenation in the heart and brain. Hence, preparation for management of medical emergencies in dental setting must include one making sure that oxygenized blood is circulating in the critical organs (heart and brain). This is dependable with fundamental cardiopulmonary revitalization, in which the expert or personnel should be skilled (4). As a result, this offers one the knowledge and skills to handle multiple medical emergencies that start with the evaluation and airway management if necessary, ventilation and circulation (ABCs). Thus, after addressing the above situations (ABCs), the dental team could consider utilizing emergency drugs. These drugs are divided into two groups; essential drugs and additional emergency drugs. They include; oxygen, epinephrine, nitroglycerin, injectable antihistamine, albuterol or salbutamol, asprin, oral carbohydrate, glucagon, atropine, ephedrine, corticosteroid, morphine, naloxone, nitrous oxide, injectable benzodiazepine and flumazenil (Haas). These drugs should be easily available and modern. They must be kept well in order to facilitate easier recognition. In addition, emergency tools should be easily accessible and should be inspected frequently to ensure they are functioning properly (7).
Equipment which should be carried by the dental team and easily accessible in the dental practice are as follows; oxygen regulator and cylinder appropriate for transporting high oxygen flow, needles and syringes for administering and drawing up drugs. In addition, the team should prepare by having bag mask device which contain oxygen reservoir, fundamental airway adjuncts, tools for blood pressure recording, paper bag, and automatic external defibrillator (2).
Unluckily, in spite the excellent pre-medication evaluation, grounding and alteration of dental process, life-endangering medical emergencies might occur during the exercise of dentistry. Though the happenings of medical emergencies rarely occur in the dental setting, older patients are known to be at a greater risk of developing such emergencies because of their reduced psychological reverse, particularly the cardiovascular system. When a patient is subjugated to stress as a result of fear, pain and anxiety, the system of cardiovascular might not be in a position to fulfill the demands of the body for heightened need for nutrients and oxygen. As a result, the deficiency will result to the establishment of acute cardiovascular ramifications or consequences like life-endangering anginal pain and dysrhythmias (8). Since medical emergencies could occur to anybody; the sick individual, dentist, dental team members, the whole dental office staff should be ready or prepared to respond to the act.
Medical emergencies within the dental setting are mostly as a result of the incapability of the patient to resist the emotional or physical stress or the reaction of the patient to the given drugs by the dentist. In addition, medical emergencies can be as a result of ramification of a system illness of deficiency of assessment of the risk factors of the patient or poor preparation by the personnel or dental team (3). The best and applicable approach or model to deal with medical emergencies could be remembered and implemented through the following acronym; P.R.N. (preparation, recognition and needed management). Preparation of oneself and the dental team to react to the emergencies and having appropriate drugs and equipment in order to react quickly, are the most significant steps which the dentist ought to take. Prevention is the best significant stage of medicating medical emergencies. In case, the medical emergency happens, immediate recognition or diagnosis should be conducted so as to be in a position to provide the necessary treatment or management to safe the life of the patient (6).
Involvement of dental team
In dental setting, patients ought to be examined first by the dentists before any other member of the dental team, apart from the edentulous patients. There are plans in the dental team where two or more members should handle medical emergencies when medication is organized to be conducted. Secondly, all members understand their responsibility in case of medical emergencies and these personnel are well trained and equipped to handle such cases at any time. In addition, they practice together on a regular basis in an imitated emergency in order to understand what they are required to do (9).
All the medical emergency events need a team leader where one individual is entitled to supervise all the procedures of catering for the sick individual and providing directions to the other members of the team. In the dental setting, the leader of the team is the dentist who mostly is entitled to dynamic responsibility in evaluation and treating the sick individual. During an emergency all members have to be involved whereby they should be having recent information concerning medical emergencies. The team leader should have all the contacts of the members of dental team (7). The dentist should be helped by his or her assistant who should be responsible for oxygen application, accountable for important or vital sign and getting the emergency bed or any other responsibility according to the team structure. In addition, the third member should be responsible for getting the emergency bed, preparation of emergency drugs or any role assigned by the team leader. Moreover, the dental office receptionist participates in significant roles and is offered the organizational activities such as making all important calls, recording events and soliciting assistance. This information might be perceived as of secondary significance during a life-endangering emergency, though it is crucial in evaluating the progress of the patient, particularly once the patient gets into a health care facility where emergency department health care provider would require to understand what was conducted and at what time in order he or she could further manage the apparent predicament (2).
Conclusion
In conclusion, in case of any medical emergencies in the dental setting, the dental team should first address the ABCs as they assess the medical history of the patient and gather all situations or information that led to the emergency. In addition, the members of dental team should understand their roles in case of a medical emergency in order to deliver excellent and safe health care to the patient.
Reference List
Cummins RO, editor. American Heart Association. Advanced Cardiac Life Support Provider Manual. 2001.
Fast TB, Martin MD, Ellis TM. Emergency preparedness: a survey of dental practitioners. J Am Dent Assoc. 1986; 112:499501.
Haas DA. Emergency drugs. Dent Clin North America. 2002; 46:815830.
Little JW, Falace DA, Miller CS, Rhodus NL. Dental management of the medically compromised patient, sixth edition. Mosby, St. Louis, Missouri, 2002.
Malamed SF, Robbins KS. Medical emergencies in the dental office, 4th ed. St. Louis: Mosby Inc.; 1992.
Malamed SF. Medical Emergencies in the Dental Office. 5th ed. St Louis: Mosby; 2000. pp. 5891.
Matsuura H. Analysis of systemic complications and deaths during dental treatment in Japan. Anes Prog. 1989; 36:223225.
Minnesota Department of Health. Recognizing Medical Emergencies. A Healthy Roads Media project. 2009. Web.
Seymour RA. Dentistry and the medically compromised patient. J R Coll Surg Edinb Irel. 1:4; 207-214, 2003.
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