EDITORIAL MEDICAL EMERGENCIES IN DENTAL PRACTICE PROFESSOR MARK GREENWOOD HONORARY PROFESSOR OF MEDICAL EDUCATION IN DENTISTRY, NEWCASTLE UNIVERSITY

edical emergencies can happen at any time. Dental practitioners need to be up-to-date and confident that they would be able to provide the initial management of a medical emergency should the situation arise. Fortunately, such events are relatively rare in dental practice. It has been suggested that the incidence of medical emergencies in dental practice may be increasing. This could partly be due to the ageing population with the associated increased potential for comorbidities, but the precise reasons for any shift are unclear.

M

In recent years the General Dental Council (GDC) has taken a particular interest in this area of dental practice. Relevant stakeholders, in particular the Resuscitation Council (UK) have worked to rationalise the equipment and drugs that dental practitioners would be expected to be able to use in an emergency situation and to simplify treatment algorithms.1 The most recent guidance from the Resuscitation Council (UK) was released in December 2013 and placed a particular emphasis on the importance of cardiopulmonary resuscitation.

Dental practitioners are generally good at risk assessing patients with underlying medical disorders who present for dental treatment. This is only possible if practitioners have had a sound training in clinical medical sciences (human disease) so that they are able to make an informed judgement on the relevance and potential impact of co-existing medical conditions.

The GDC has issued helpful guidance with regard to what is expected of registrants in the prevention and management of medical emergencies.2 When treatment is planned, there must always be at least two registrants who are trained in medical emergency management available to deal with such a situation, should it arise. The Resuscitation Council (UK) recommends that regular scenario-based training

should take place. Equipment and drugs should be checked on a regular basis and all emergencies and near misses should be recorded and assessed. Actions that went well or badly should be discussed after real or simulated events. In addition, any health and safety issues that may have arisen as a result of an incident, for example during the moving or handling of patients, should be analysed and recorded. It is wise to practice simulated emergencies in different clinical and nonclinical environments on a regular basis to ensure that appropriate mechanisms are put in place to deal with obstacles that would otherwise have caused significant problems. Practice helps to prevent the unexpected, or at least makes it easier to deal with. Until relatively recently, these important issues had received little attention. The management of medical emergencies in dentistry has traditionally been a difficult area to deliver in educational terms. Traditionally, the topic may have been taught by physicians or surgeons who had a limited understanding or knowledge (or in some cases, interest!) of the needs and experience of dental practitioners and who therefore suggested management protocols that were inappropriate or impractical. An example of this could be the former reliance on the intravenous route to deliver emergency drugs. Contemporary management regimens in dentistry for the management of medical emergencies completely avoid the use of the intravenous route. The importance of the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach to the sick patient is stressed in contemporary teaching. This approach is critical to the successful management of all medical emergencies. For example, the hypoglycaemic patient who becomes unconscious and requires

4

P R I M A R Y D E N TA L J O U R N A L

an injection of glucagon (avoiding the intravenous route) may initially remain unconscious as the drug can take time to work. Maintaining the airway during this period is critical. Most dental schools now train students in practical as well as the theoretical aspects of management. The significant change from several years ago is that contemporary dental practitioners are expected to be competent to use all drugs in the drug box should the occasion demand it. Routes of drug administration have been chosen which all dental practitioners should be willing and able to use if required. The curriculum is usually taught by clinicians who not only understand the specific needs of dental practitioners, but who have also had firsthand experience of managing ‘real life’ medical emergency situations. Such clinical experience is invaluable in teachers and trainers and its authenticity is valued by students and postgraduates. An important development in resuscitation practice (which has now found its way into dental practice) has been the introduction of the automated external defibrillators (AEDs). This development is significant in two respects. Firstly, the only successful way of fully resuscitating a patient who has had a ‘shockable’ cardiac arrest is by defibrillation. Basic Life Support is still of critical importance and should be carried out in conjunction with attachment of an AED. Secondly, there is an expectation from the public that an AED should be available in an arrest situation. Most public areas have AEDs available. Clearly, given that this is the case in non-clinical areas it is reasonable that the public would expect AEDs to be available in the dental setting. The machines are safe and easy to use and make a significant difference. The earlier defibrillation is carried out, when appropriate, the better. Given that machines are available for assessing a

VOL 3 NO 1 FEBRUARY 2014

patient’s blood glucose levels, how long will it be before patients expect all dental practices to have one for use if required? The GDC has for several years recognised the importance of staying up-to-date in this area. In medical emergency management, the issue of maintaining knowledge and skills is particularly important as actual events to consolidate experience are relatively rare. This recognition has led to the development of a rolling programme of CPD where 10 hours of training in medical emergencies per five year cycle is expected to have been undertaken to maintain registration. There is a tendency in some dental schools to decrease the amount of teaching in clinical medical science (human disease). While curriculum time is at a premium, the education received in this area is critically important. This is true

not just in developing the skills and knowledge that underpin medical emergency management, but supporting medical knowledge is essential if patients are to be treated in a truly holistic way across all areas of dental practice. Medical emergency management in dentistry has evolved in recent years to a point where practical, defensible and effective methods are taught and employed. The challenge for the future is to maintain and develop this progress, while at the same time recognising the importance of comprehensive training in medicine in dentistry for dental practitioners in its broadest sense.

REFERENCES 1

Resuscitation Council UK. Quality standards for cardiopulmonary resuscitation practice and training. Resuscitation Council UK site. Available at: http://www.resus.org.uk/pages/QSCPR_ Main.htm. Accessed: Dec 2013

2

General Dental Council. Standards for the dental team (2013). GDC website. Available at: http://www.gdcuk.org/Pages/default.aspx Accessed: Dec 2013

5

Medical emergencies in dental practice.

Medical emergencies in dental practice. - PDF Download Free
78KB Sizes 2 Downloads 8 Views