Guidance surrounding medicine and dentistry is never static – it can be so hard to keep on top of the changes. Some practitioners delegate this responsibility to staff members or don’t undertake the relevant CPD at all. Dr Annalene Weston, dentolegal adviser at Dental Protection, explores this in the context of a recent case

Medical emergencies can and will happen in dental practice, but are you prepared for them? There are two key things that every practitioner can do to ensure that they are:

Undertake annual CPR updates

The key dental guidance for this comes from the ADA and states that:

“2.1. The management of emergencies and the techniques for resuscitation change from time to time. Dentists should ensure their training and skills remain current. Regular ‘hands-on’ training is recommended for dentists and their staff.

2.2. Dental practices should have a regularly updated written protocol for responding to medical emergencies and all staff should be regularly trained in its use.

2.3. The management of medical emergencies should be based on the current guidelines issued by the Australian Resuscitation Council.”^[1]

A review of the current guidelines from The Australian Resuscitation Council reveals: “Repeated refresher training is needed for individuals who are not performing resuscitation on a regular basis. All those trained in CPR should refresh their CPR skills at least annually.”[^2]

Pleasingly, the Dental Board of Australia recognise this requirement, and include CPR as a “clinically or scientifically based activity” for the purposes of Continuing Professional Development.[³]

Review the updated Oral and Dental Therapeutic Guidelines

Released in December 2019, the ‘clown book’ has had a significant overhaul, which impacts on multiple aspects of dental practice. One question commonly asked by members related to the suggested contents of an emergency drug kit, and this is answered in the new guidance expanding on the 2012 requirements:

Drugs and equipment to support the management of medical emergencies by dentists

Drugs and equipment that may be used for the management of medical emergencies occurring in a dental practice include:

an easily transportable source of oxygen – the simplest and safest way of administering oxygen to a patient who is breathing is via a mask (supplemented with oxygen at 6 to 8 L/minute) or nasal prongs (with oxygen at 2 L/minute). For a patient who is not breathing, use a bag-valve mask or start mouth-to-mask resuscitation

disposable plastic airways to secure the oral airway, and facilitate mouth-to-mouth resuscitation or ventilation with oxygen

adrenaline (epinephrine) for the management of anaphylaxis, in sufficient quantity to give two doses. Adrenaline (epinephrine) is available in preloaded autoinjectors and ampoules. A preloaded autoinjector is preferred, since an ampoule requires dose calculation and has to be drawn up into a syringe

pulse oximeter for measuring arterial oxygen saturation

glucose for the management of hypoglycaemia, as either a readily available glucose-containing food (eg fruit juice, honey) or pure glucose (eg glucose gel or tablets)

glyceryl trinitrate spray for the management of angina or an acute coronary syndrome. Glyceryl trinitrate spray has a longer shelf life than tablets

short-acting bronchodilator inhaler (eg salbutamol) and spacer for the management of an acute asthma attack

aspirin for the management of a suspected acute myocardial infarction

blood pressure monitor for the assessment of patients with cardiovascular symptoms and collapsed patients

blood glucose monitor for the assessment of patients with diabetes

automated external defibrillator for the management of cardiac arrest.

Regularly check drugs and equipment, and replace expired or damaged items.[⁴]

Case study

These guidelines assist practitioners in saving lives.

A member called Dental Protection recently to make a notification regarding an incident at practice. A regular patient, with a documented cardiac issue managed by a pacemaker and medication, attended the practice for the insertion of a crown. Less than 1ml of lignocaine was administered by infiltration and, midway through the procedure, the patient had a cardiac incident and went into defibrillation.

Luckily, the member had recently attended an update on medical emergencies with his staff and had revised the practice protocols and updated their medical kit in accordance with this. As they had all had the opportunity to practise the management of a medical emergency, everyone knew what to do. 000 was called, oxygen was administered and CPR was performed until the paramedics arrived. A pulse was re-established and the patient survived, without brain damage or any other adverse outcome.

Dentolegal adviser’s perspective

This good news story could have so easily been a tragedy. The importance of regular updates of all knowledge relevant to dental practice should not be overlooked and, in this instance, a life was saved.

DO

Keep an eye out for updates to the guidance and standards

Undertake regular CPD in all aspects of practice

Review your practice medical emergency plan

Ensure your staff have regular updates in matters relevant to them too.

DON’T

Forget to schedule your practice CPR refresher

Forget to check the expiry dates of emergency drugs

Forget to maintain any emergency equipment.