Medical Emergencies in Dental Practice

Thankfully, medical emergencies are not an everyday occurrence within dental practice. However, they do occur with frightening unpredictability, leaving teams of highly-skilled professionals confused and anxious within a matter of seconds. It shouldn’t be this way!   

Our knowledge of medical emergencies and their management has accumulated vastly since the advent of formal Continuing Professional Development (CPD) by our regulatory body, which holds this core subject in great esteem. I believe therefore, that the problem is not a lack of knowledge, for we have all endured the same lectures year-after-year from speakers like me and, let’s be honest, how differently can you manage hypoglycaemia or angina? The problem is much more likely a lack of experience.

As medical emergencies are uncommon we quickly become de-skilled. With the passage of time we also become complacent and thus leave ourselves vulnerable. When faced with an emergency we exhibit the classic fight-or-flight physiological response. This leads to anxiety, irritability and confusion, which culminates in poor execution of good knowledge and skills, and can result in a less-than-perfect outcome. This, for a bunch of perfectionists like us, simply does not sit well. 

So, what is the best advice I can give you?

Well, when my seven-year-old daughter asks me why our dinner does not look like the dishes served on MasterChef, I say ‘sweetie, it’s because they practice every day’. However, what I really want to say is ‘sweetie, it’s because daddy is too lazy’. So it’s simple: don’t be lazy - practice, practice, practice!

1. Practice the management of a collapsed patient and apply the tried and tested acronym DrABCDE: Danger - Response - Airways - Breathing - Circulation- Disability - Exposure
2. Practice the use of emergency drugs – which to use, when and how. The British National Formulary (BNF) is an essential tool for this. Practice how to quickly and safely deliver oxygen, using airways adjuncts if needed, and the safe delivery of intramuscular injections. 
3. Practice cardiopulmonary resuscitation (CPR) and the use of Automatic External Defibrillators (AED) using manikins and role play, whilst applying the latest algorithms provided by the Resuscitation Council UK.
4. Practice periodic, but random, controlled simulation exercises as a team for common medical emergency scenarios and allow time to critically appraise your and your teams’ performance, finding solutions to inefficiency and inadequacies.
5. Create, evolve, personalise and laminate practice protocols for the management of common emergencies in your practice and have them readily accessible.
6. Attend a comprehensive Medical Emergencies course with your team, such as the one I am running at UCL Eastman Dental Institute, in order to update and refresh your skills and gain invaluable experience in dealing with emergencies.

In doing so, you will sharpen your skills and apply your knowledge more efficiently as a team, and will be able to quickly, effectively and comfortably manage any medical emergency that you are faced with.

Medical emergencies, and the anticipation of them, create tremendous fear and anxiety for dental professionals. They leave a mark in our psyche and, in the peace and tranquillity of our beds, we can find ourselves reflecting on the day gone and the day ahead with trepidation. If you apply some of the advice above I am sure you will sleep better at night – I know I do. So, to end on the now famous, but totally antithetical catchphrase from Nick Ross of Crimewatch – “don't have nightmares, do sleep well".

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Dr Vipul Patel is running a new series of Medical Emergencies one-day training courses at UCL Eastman Dental Institute. Find out more