Emergencies & Records - Outcome 7 Flashcards
To ensure a positive outcome during a medical emergency, the following should be followed through:
-Training of personnel
-Team approach
-Scenario practices (simulated emergencies)
-Office preparation
Training of Personnel
- All personnel should have an understanding of commonly encountered medical emergencies in the dental office.
Allergic reactions
Cardiovascular emergencies
Diabetic emergencies
Respiratory emergencies
Seizures
Syncope
Drug overdoses - All personnel should maintain a current Basic Life Support certification – re-certification should take place every year
- Annual continuing education on medical emergencies that commonly occur in a dental office should be taken/reviewed to reinforce previously learned theory
Team Approach
In order for a team approach to be effective specific duties should be assigned to each team member.
- First-person to discover the victim should call for help (dentist and team) and provide emergency first aid as required.
primary survey and treatment as needed
Stays with the victim
Calls for help - The second person should assist the rescuer one with basic life support.
brings equipment
emergency kit
AED
Oxygen - Third-person should gather all the necessary equipment.
assigned various tasks
Office Preparation
- Have emergency equipment available
- Assign individuals to check the emergency kit and oxygen on a regular basis and after every use.
a. ensure appropriate numbers of supplies are present in the kit
b. check drug expiration dates
c. change oxygen tank at 500 p.s.i.
d. utilize a checklist to assist in this procedure - Store the emergency kit and oxygen together.
- Rotate emergency care responsibilities between team members to ensure all rescuers can function in each role.
- Post emergency numbers by all phones, to ensure quick access to the EMS system.
How to Call an Ambulance
- Stay calm.
- Be as accurate as possible when providing patient information.
- Be prepared to answer the following questions:
-Location
-Phone number from which you are calling
-Problem
-Gender of the patient
-Approximate age of the patient
-Conscious/unconscious
-Breathing/Non-breathing - Never hang up the phone until the communication specialist hangs up or informs you to hang up.
- After the call for help has been placed, return to the emergency scene to notify the dentist and rescuers that EMS is on the way.
Your Role Upon Arrival of EMS
- The first rescuer will provide the report to the attending paramedic. Ensure to review all the details from the onset of the emergency until the arrival of EMS.
- The second and third rescuer will provide a detailed written report of the patient’s past history, physical examination findings, and vital signs.
- All of the remaining dental staff members should wait to assist the paramedics as necessary.
Dental Emergency Kit Equipment:
The contents of dental emergency kits can vary depending on the preferences of emergency drugs, products, and equipment that a dentist and their dental team are comfortable with using.
According to the College of Dental Surgeons of Alberta (2019) all dental offices must have an emergency kit.
Drugs in Dental Emergency Kit
Drugs must be inventoried and expiry dates listed.
- Oxygen
- Epinephrine (Injectable) (adult and pediatric)
- Nitroglycerin
- Diphenhydramine
- Bronchodilator (e.g.; Albuterol)
- Acetylsalicylic acid (Aspirin)
- Agents for management of hypoglycemia (e.g.; glucagon/glucose tablets)
- Ammonia inhalant
- Naloxone
The SAIT dental emergency kit contains:
-Apo-Salvent CFC Free Salbutamol Sulphate USP Broncholdilator
-Rho-Nitro Pumpspray
-Diphenhydramine HCL Injection USP (4 vials x 1ml)
-Epinephrine Injection USP (Adrenalin 1:1000) – 2 Ampoules x 1ml
-Sulfate D-Atrophine Sulfate Injection USP (2 Ampoules x 1 ml)
-Rescue Breather
-Ten – BC 1ml TB Syringes
-Children’s Benadryl
-Adult EpiPen
-EpiPen Jr.
-Aspirin (81mg)
-Instaglucose 31g
-Thermometer
-Magill forceps
-Latex free gloves and mask
For medical use, oxygen is stored in…
For medical use, oxygen is stored in steel or aluminum tanks under the pressure of 2000 pounds per square inch (psi)
Indications for the Medical Use of Oxygen
-Critically ill patients (i.e. shock, head injuries, etc.)
-Hypoxemia (deficient oxygen of the blood)
Patients with a decreased level of consciousness.
-Patients with ischemic chest pain
-Patients with respiratory difficulties
-Patients with a decreased level of consciousness.
Components of Medical Oxygen Equipment
Oxygen Tank
-Steel or aluminum tanks filled with oxygen
-Available in different sizes
-Coloured coded green
Gauge Regulator
-Control gas flow.
-Reduces the high tank pressure from 2000 psi to a safe range of 50 psi
Tubing
-Connects the oxygen tank at the gauge regulator to the face mask.
-Allows delivery of oxygen.
Face Mask
Available as a:
-Non-rebreather mask (full mask with bag); or
-Nasal cannula (inserted into nostrils only)
-Simple mask (full mask only)
Oxygen is considered a drug, therefore a dental assistant cannot administer oxygen.
Dental assistant may not:
set, start or adjust flows and or ratios of oxygen, or
place the face mask on a patient
Dental assistants may assist with the administration of oxygen by:
-preparing and checking oxygen equipment,
-selecting mask size and placing the mask on the tubing,
-having the patient put on the mask and adjust the fit,
-tightening the tubing once the mask is comfortable for the patient, and
-assisting with observing, documenting and reporting the patient’s condition
The Hazards of Oxygen
Oxygen supports combustion. Never allow combustible material (oil and grease) to touch the oxygen cylinder, the regulator, fittings, valves, or hoses, and keep the oxygen tanks away from all sources of fire while it is in use.
It must be used with caution with COPD patients (emphysema, chronic bronchitis, etc.). COPD patients have a low breathing stimulus. If large quantities of oxygen are administered to them, their stimulus to breathe will be removed – not allowing them to breathe properly. However, never withhold oxygen just start administering oxygen at low levels and increase as required.
Safe Storage and Use of Oxygen Tanks
-Store oxygen cylinders below 52 degrees Celsius.
-Use proper regulators for oxygen administration.
-Keep all valves closed when not in use.
-Secure all oxygen tanks to a wall or store them in a carrier rack.
-Never place any body part over the cylinder valve when working with it
Postural (Orthostatic) Hypotension
Postural hypotension is a decrease in blood pressure. It occurs due to an abrupt change in position such as suddenly standing or sitting erect. It can also be caused by standing motionless in a fixed position and is common for the elderly and pregnant women. It can cause dizziness, syncope, blurred vision. If postural hypotension does occur treat as syncope.
Signs and Symptoms of Postural Hypotension
-low blood pressure
-altered state of consciousness to possible loss of consciousness
Response Steps for Postural Hypotension
- Place the patient in a subsupine position with the head lower than the feet.
- Establish an airway.
- Slowly move the patient to an upright position.
- Monitor and record vital signs.
- If unresponsive, call for emergency assistance (911).
- Document emergency
Syncope (Fainting) is…
Syncope (Fainting): is a transient loss of consciousness due to reduced blood flow to the brain
Signs and Symptoms of Presyncope
-feeling warm or flushed
-nausea
-rapid heart rate
-perspiration
-pallor (pale skin colour)
-lower blood pressure
Response Steps for Syncope (fainting)
- If the patient has not fainted yet but tells you they feel like fainting: Lie the patient down in the supine position and elevate their legs.
- If fainting has occurred place the patient supine/subsupine position and elevate their legs slightly.
- Complete head tilt/jaw thrust to open airway.
- Loosen binding clothing.
- Evaluate oxygen level. If below 94%, administer 100% oxygen.
- Have ammonia inhalant ready to be administered.
- Monitor and record the patient’s vital signs.
- If unresponsive, call for emergency assistance (911)
- Document emergency
Angina Pectoris is..
Angina pectoris literally means a pain in the chest. More specifically, it is a spasmodic pain in the chest characterized by a sensation of severe constriction or pressure on the anterior chest.
Possible Causes of Angina Pectoris..
This medical emergency is associated with insufficient blood supply to the myocardium and is usually due to the narrowing of coronary arteries (atherosclerosis). Other causes include coronary vasospasms, thrombus or anemia (a condition in which there is an inadequate supply of hemoglobin to carry oxygen). Angina pectoris is usually aggravated by exercise, tension, cold weather, or a large meal.
Signs and Symptoms of Angina Pectoris
-Tightness or squeezing sensation in chest
-Pain radiating to left shoulder
-Pain radiating to the left side of the face, the jaw, and the teeth