CPR & BSL in dental emergency
Most of the medical practices today are required by law to complete a full medical history chart for new patients and update it at each recall appointment. Most of the medical history forms have a medical alert box on the top right corner. If there’s any condition that needs attention from the dentist or dental hygienist it should be written in red so it will be noticeable from other professionals that might look at the patients chart. If a dental emergency arises during the dental treatment the dental clinician should be enable to comply with the medical emergency protocols that he/she has been trained for. In North America it is required for the dental professionals to have a certificate of CPR and first aid in order to practice their profession. This certificates need to be updated every two years where one has to follow a two days training on how to manage emergency situations and how to perform proper BSL & CPR. If patients is found to be a potential candidate for any type of medical emergency during the medical history assessment, then a dental clinician should consider a consultation with the patients physician before completing the treatment plan. The consultation will help determine for example if any reduction of the medication dosage will implicate the condition that the patient is being treated for or any type of information that is not a subject of the dental field and can compromise the dental treatment.
If any dental emergency occurs in a dental clinic
Stop the treatment right away and remove any dental items from the mouth.
Accommodate the patient in a supine position.
Assess if the patient is conscious or unconscious ( ask questions or try to shake him).
If patients unconscious check for breathing by looking at the chest if its rising or not.
Check for the carotid pulse by placing two fingers at the carotid arterial located on the lateral side of the neck
If patient has a pulse but is not breathing
If patient still unconscious activate EMS by calling 911 and start BSL (basic life support).
Tilt patients head backward by placing one hand on the front and the other hand on the chin pushing towards 12 o’clock.
Open patients mouth and check for any possible objects that can obstruct the patients airway.
If the patients is still not breathing start breathing resuscitation mouth to mouth by pinching the nose and occluding his mouth with your mouth (remember to control patients chin with the index finger so mouth to mouth contact is firm and sealed).
For adults blow slowly two breaths every 2 seconds and if you see that the patient is responding and there’s a pulse present reduce the time to two slow breaths every 5 seconds.
For a proper breathing resuscitation one should make sure that the chest is rising and falling during the dental emergency resuscitation.
If the chest doesn’t rise then this is an indication of either an airway obstruction or the positioning of the neck is not appropriate.
If the breathing is not slow or the pressure of the breathing is to high then it will cause a an opening of the esophageal way bringing air to the stomach and provoking vomiting which can make the breathing rescue impossible.
If patient is not breathing and doesn’t have a pulse
Start chest compressions by placing a both hands on top of each other and compressing at the lower part of the sternum where ribs join the sternum ( follow the last rib edge that joints sternum until you feel the sternum notch which is located exactly where the lower sternum extremity is located)
The right amount of time between each compression is the same as the amount of time riqured by the clinician to say one-one thousand. For example : Give the first compression and say 1:100 second compression 2:1000 third compression 3:1000. This way you will remember how many compression you have given and
make sure that each compression is given accurately after the proper amount of time.
The compression should be 2 inches in adults whereas in infants its just required gentle pressure.
Once you have given 15 compression and theres still no signs of the patient recovering give two breaths.
The regular time for reassessing the patient is after 4 cycles of 2 breaths and 15 chest compressions.
Continue this cycle untill medical emergency services arive. During the chest compressions you could get tired thats why its always best to have another partner present when performing basic life support.
Remember every dental emergency could be presented with similar symptoms but different causes, so renewing the license every 1-2 years is necessary and mandatory
Very informative. Its very important to update CPR every year .. We forget that an emergency could happen at any time