The immediacy and urgency of a medical emergency can strike terror into us and without proper planning and practise it can be a very stressful event. The drawn-out scenario associated with a lawsuit can also loom, but it is the care of the patient that demands rigorous attention to assessment and treatment of the event.
As in most areas of practice, the introduction of systems to deal with the likelihood of this occurrence is essential. While there are many CPR courses available that are fundamental and excellent, they only cover a fraction of the causes of collapse.
In the course of my now almost 24 years in practice I’ve been fortunate to avoid any real emergency. A couple of seizures while in practice in the UK were, at the time, enough to demand a stiff drink after work, and a handful of faints were as much as I’ve encountered thus far.
As a result of being accepted as a trainer under the VDP scheme, a practice visit was needed to ensure I had all the requisite safety features. A quick call to Henry Schein to order the necessary items and the installation of a portable oxygen cylinder, along with the posting of emergency numbers on the surgery and reception walls, saw the basics completed. Within two days of acquiring the oxygen tank a patient fainted in the waiting room and we were able to use this most vital of drugs to aid in her revival.
Howard Farran says, tongue in cheek, that in the ER they give cardiac patients lignocaine and adrenaline, and as we are pumping our patients full of this daily we shouldn’t worry about a cardiac problem in our practice! He further relates how his father had a restaurant business where more of his clients needed hospitalisation than at Howard’s practice; all his father worried about was that the ambulance turned up at the delivery entrance around the back rather than at the front door!
Joking aside, it’s necessary that we possess the drugs, equipment, knowledge and expertise to deal with emergency medical situations when they arise.
I recently received a laminated series of cards showing what we should do in an emergency, which has proved very useful. It breaks each of 12 emergencies down into cause, signs and symptoms, with treatment and prevention on the front and further information, reflection, team training opportunities and a glossary on the back. I believe this would be an excellent resource for any practice.
The 12 most common emergencies are:
1. Toxic reaction to local anaesthetic
4. Adrenal insufficiency
7. Cardiac arrest
8. Angina pectoris
9. Asthma attack
10. Anaphylactic shock
11. Mild allergic reaction
12. Myocardial infarction.
While oxygen remains the single most important drug in the surgery as its use is indicated in 11 of the already mentioned emergencies, cardiac arrest needing cardiac compressions and assisted breathing, there are other necessary drugs such as:
1. Adrenalin 1:1000 (1mg/ml)
2. Glucagon (one unit in sterile water)
3. Salbutamol inhaler (multiple 0.1mg doses)
4. GTN spray (0.4mg/dose)
5. Aspirin (300mg dispersible)
6. Hydrocortisone sodium succinate (100mg/ml)
7. Chlorphenirame maleate (10mg/ml)
8. Diazepam emulsion (10mg/ml)
9. Glucose powder, tablets or gel.
Proper training in the delivery and rationale is necessary and perhaps this is an area in which our local branches of the IDA can assist us, alongside the expertise of the dental hospitals, to avoid the stress induced by the collapse of any of our patients.
A final drug necessary may be a medicinal nip of C2H5OH for those involved in caring for the collapsed, preferably, in my case, a drop of 16-year-old Macallan malt whisky!