The practice of the profession within the office brings, for the health professional, frequent unexpected circumstances for which they must be adequately prepared in order to face them in the most appropriate way possible. The professional of today must incorporate, within the framework of ethics, the cautious attitude that brings together all aspects of the interrogation, disposition of elements and medications, but above all preparation to avoid any unexpected situation.
It should be remembered that the dental visit, in many cases, involves a state of stress that produces tachycardia, tachiapnea, increased blood pressure, increased oxygen consumption at the muscle level and catecholamines. It also implies a decrease in the pain threshold. For this reason, emergencies are very common.
You must differentiate between emergency and urgency. An emergency is a compromised situation that requires immediate attention and is life-threatening. On the other hand, in an emergency there is not necessarily a life risk. Any situation in which, potentially, the life or physical integrity of the patient is endangered. In an unforeseen combination of circumstances that requires immediate action.
The fact that they require immediate action and that they are sporadic makes it more important that the behavior to be followed has been internalized since the treatment is aimed at preserving the life of the patient. It is at the first moment of urgency when solutions can be simpler, as long as you know what you are doing.
It must have sufficient speed of action to foresee a complication and be able to prevent it or, if it develops, solve it. The performance of the health professional is aimed at maintaining the vital functions of the patient. Due to the characteristics of dental clinics, the treatment will be of a basic nature and the number of products to be used, reduced.
The basic responsibility of a dentist lies in:
- The prevention. With the updated clinic. The emergencies appear without more, but we can apply preventative measures in those patients who present basic pathologies that in case of decompensation, can generate an emergency in the consultation.
- The preparation. With a human team and an assignment of tasks
- The basic life support
- Look for helpand transportation. Must have the ability to diagnose and treat medical emergencies. Dental treatment can be a stressful situation for the patient, triggering a medical emergency in the dental office.
- Once the diagnosis has been made and we are ready to give the treatment, we must have an action plan, and we must have the appropriate material.
- Continuing education courses should be taken every two to three years. It is also important to train the office staff and additional doctor.
It is vitally important that all staff are trained to perform basic cardiopulmonary respiration (CPR), a role must also be given to each of the people who make up the staff, so that the care and support that is given to an emergency, be quick and efficient.
To be adequately prepared for the possible appearance of a life-threatening medical emergency for the patient, we must be familiar with the symptoms of each urgent situation, which implies having received training in the matter. In addition, the following should be followed: always treat previously documented patients (updated history), consult with the patient’s general practitioner if there is any doubt about the patient’s condition and whenever we consider it appropriate, carry out interconsultations before carrying out a treatment to a patient with underlying pathology, be alert to any adverse reaction that we observe in patients, know how to recognize medical emergencies, know how to perform basic patient monitoring, control at least cardiac, respiratory and arterial function, consult regularly the equipment of emergencies and drugs, both the professional and his team must be adequately trained in CPR maneuvers, and finally it is convenient to have controlled access to specialized medical assistance, as quickly as possible.
By law it is mandatory to have the following list in the dental office for emergencies:
- Adrenaline 1 mg / ml
- Diphenhydramine 5mg / ml
- Methylprednisolone 125mg
- Atropine 0.5 mg / ml
- Isoproterenol 1mg
- Theophylline 250mg / 5ml
- Nitroglycerin 0.3mg
- Diazepam 5mg / ml
- 50% and 5% dextrose
- Sugar cubes
The regulations on compulsory drugs in the dental office are somewhat outdated and a more current review should be carried out. In addition to all these measures, it is advisable to have a defibrillator, there are some that are capable of performing an electrocardiogram and also determining the precise moment to perform the shock. The defibrillator works when the heart is fibrillated.
So you should know if there are adverse factors in the patient and how to monitor vital signs. It is also important to remember our patient’s habitual medication consumption so as not to supply drugs that may alter their health status, due to drug interactions. Appointments should be made that do not interfere with eating habits, especially in diabetic patients. Be attentive to any strange signs, have the emergency team available, with biologically active drugs and the emergency telephone number at hand, and be familiar with the procedure to follow.
