A medical emergency in the dental office can be an unexpected event that can include accidental or deliberate bodily injury, central nervous system stimulation and depression, respiratory and circulatory disorders, as well as allergic reactions. Syncopy is by far the most common medical emergency in dentistry that affects the patient. Fortunately, it's also the easiest to handle, according to Dr. Stanley Malamed, professor of anesthesia and medicine at the University of Southern California in Los Angeles.
Malamed noted that the kit and its contents have changed over the years, going from just four drugs to 15 drugs. However, the seven drugs mentioned above have been the recommended standard for about a decade; this number of drugs has changed as medical knowledge has evolved over the years. He pointed out that for every minute that a person suffers cardiac arrest and does not defibrillate, the victim loses approximately 10% of the chance of survival. Since 2000, training on the use of AED and the administration of CPR (basic life support) has been provided together.
However, only one state (Florida) requires dentists to have an AED in their office (starting February 20). The body's response to stress can cause a buildup of blood in the extremities, a physiological process known as the fight or flight response.7 However, a buildup of blood is not helpful, especially when the person is in the dental chair. Because of the position and lack of mobility in the chair, oxygenated blood is pumped to the brain, causing syncope.7 Regardless of the cause, if a dental professional suspects that a patient has a presyncope they should immediately and calmly place them in the Trendelenburg position (the head below the heart and feet raised 10 to 15 degrees). Once they recover, it should be determined if treatment should be stopped.
It is recommended to monitor patients before discharge. In many cases, it's wise to have a friend or family member take them home and monitor them until they return to normal. The team should also be familiar with all emergency medical equipment, supplies, and medications found in the office's emergency kit. While prevention of medical emergencies should be the primary objective, it is nearly impossible to predict and prevent all emergency scenarios.
The revised and updated poster “Medical Emergencies in the Dental Office” is designed as an aide-memoire to help dental teams manage medical emergencies safely and effectively. Effective emergency management requires a team approach and that all personnel play a key role during an emergency. An office could be in a difficult situation from a medical-legal point of view if a patient were harmed during dental treatment due to lack of emergency resuscitation equipment recommended by Reanimation Council (United Kingdom) or of emergency medications recommended by NICE in BNF's dental section. The “Medical Emergencies in Dental Practice” section of National Institute for Clinical Excellence (NICE) 9 of British National Form (BNF) 9 provides guidelines on treatment of most common medical emergencies that may arise in dental office.