Interview: 'AEDs should be present in every healthcare environment'

Dental Tribune Asia Pacific: Medical emergencies in dental offices are rare but eventually happen during a dentist’s career. Have the types of emergency incidents changed during the last couple of years?
Dr Morton Rosenberg: Although it is very difficult to gather data, the perception of most experts is that the incidence of medical emergencies is increasing in the dental office. The types of medical emergencies are still centred on the cardiovascular and respiratory systems.

What are the reasons for the increase?
We have an aging population and we are now treating elderly patients with comprehensive dental needs using techniques that did not exist 15 years. Additional reasons include the growing use of prescription drugs, herbal supplements, and recreational drugs - all have the potential of interacting with each other and interacting with the many drugs dentists now administer, including the popularity and growth of all forms of sedation.

You recently published a new strategy guide on medical emergencies in dental offices. Do you consider the current knowledge out-dated?
Rather than use the term “outdated,” it is important to understand that preparing for a medical emergency is an evolving standard of care. One of the major changes has been the availability and use of automated external defibrillators (AED), which should be present in every healthcare environment. The American Heart Association 2005 guidelines has placed early defibrillation as an integral part of the Basic Life Support (BLS) “chain of survival” for the treatment of cardiac arrest. The immediate availability of an automated external defibrillator has been demonstrated to increase the success of resuscitation.

In the United States, some states (Florida, Washington, Illinois) have mandated the presence of an AED in dental offices.

Other changes include continuing education courses that incorporate task training and high-fidelity human simulators. These stress crisis management for life-like practice in managing medical emergencies and are gaining popularity among dentists and their clinical staffs.

In your opinion, are dentists and dental staff today adequately prepared for most medical emergencies?
Many offices have purchased basic emergency equipment, but it is the combination of a dentist and staff well trained and current in Basic Life Support for Healthcare Providers (BLS-HCP) that will make a difference in outcome. Every office should have the capability, at a minimum, of being able to deliver oxygen under positive pressure.

What medications should be available to manage the more common emergencies?
Oxygen should be in stock, as well as Epinephrine, Diphenhydramine, Nitroglycerin, Bronchodilator, Glucose, Aspirin and aromatic ammonia. These medications should also be checked regularly to ensure they have not exceeded their expiration dates.

Allergic reactions to certain types of medication are an increasing problem in clinical settings. What medications do you consider problematic in that respect?
Without a doubt, antibiotics are always at the top of the list of medications that are administered to many patients in the course of dental treatment and which have the potential of being a trigger for a host of allergic reactions. It is also important for the dentist to understand that there are an increasing number of patients who have issues surrounding latex.

What types of equipment do you further recommend?
The equipment that should be readily available includes portable “E” cylinder of oxygen, oral pharyngeal airways, as well as devices for the administration of supplemental oxygen, including a bag-valve-mask. I further recommend magil forceps, automated external defibrillator (AED), stethoscope, sphygmomanometer and a wall clock with a second hand.

Proper risk assessment and documentation could prevent a lot of these emergencies. What are the first indications that identify a “high risk” patient?
It is only through a detailed medical history, a thorough review of the positive responses by the dentist, focused physical examination and vital signs, and appropriate consultations that patients at high risk for medical issues during dental procedures can be identified.

What are the best strategies for prevention?
The hallmarks of a well-prepared office are meticulous preoperative assessment, appropriate and basic emergency equipment, and dentists and staff current in BLS-HCP. Constant review and, most importantly, unannounced drills will make the office immediately able to recognise, call for help, and address the immediate needs of the dental patient having a medical emergency.

Thank you very much for the interview.