Basic guide to medical emergencies in the dental practice

www.ajlobby.com Basic Guide to Medical Emergencies in the Dental Practice www.ajlobby.com www.ajlobby.com BASIC GUIDE TO MEDICAL EMERGENCIES I N T H E D E N TA L P R A C T I C E Second Edition Phil Jevon RN, BSc (Hons), PGCE Medical Education, Walsall Healthcare NHS Trust Walsall, UK Honorary Clinical Lecturer (Medicine), University of Birmingham Birmingham, UK Consulting Editors Celia Strickland, BDS Dental Practitioner, Staffordshire, UK Tessa Meese, Lead DCP Tutor, Health Education, West Midlands, UK; Dental Nurse Manager, Birmingham Dental Hospital, Birmingham, UK; Editor-in-Chief, Dental Nursing Jagtar Singh Pooni, BSc (Hons), MRCP (England), FRCA, Consultant in Anaesthesia & Intensive Care Medicine, New Cross Hospital, Wolverhampton, UK www.ajlobby.com This edition first published 2014 © 2010 by Phil Jevon © 2014 by John Wiley & Sons, Ltd Registered office: John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offices: 9600 Garsington Road, Oxford, OX4 2DQ, UK The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK 111 River Street, Hoboken, NJ 07030-5774, USA For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/ wiley-blackwell The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988 All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher Designations used by companies to distinguish their products are often claimed as trademarks All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners The publisher is not associated with any product or vendor mentioned in this book It is sold on the understanding that the publisher is not engaged in rendering professional services If professional advice or other expert assistance is required, the services of a competent professional should be sought The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions Readers should consult with a specialist where appropriate The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read No warranty may be created or extended by any promotional statements for this work Neither the publisher nor the author shall be liable for any damages arising herefrom Library of Congress Cataloging-in-Publication Data Jevon, Philip, author Basic guide to medical emergencies in the dental practice / Phil Jevon; consulting editors, Celia Strickland, Tessa Meese, Jagtar Singh Pooni — Second edition p ; cm Includes bibliographical references and index ISBN 978-1-118-68883-0 (pbk.) I Strickland, Celia, editor II Meese, Tessa, editor III Pooni, J S (Jagtar Singh), editor IV Title [DNLM: Dental Care—methods Emergency Treatment—methods Emergencies WU 105] RK51.5 617.6’026—dc23 2013043841 A catalogue record for this book is available from the British Library Wiley also publishes its books in a variety of electronic formats Some content that appears in print may not be available in electronic books Cover image: courtesy of Phil Jevon Cover design by Workhaus Set in 10/12.5 pt Sabon LT Std by Aptara Inc., New Delhi, India 2014 www.ajlobby.com Contents Foreword ix Acknowledgements x About the companion website xi An overview of the management of medical emergencies and resuscitation in the dental practice Introduction Concept of the chain of survival Incidence of medical emergencies in dental practice General dental council guidelines on medical emergencies Resuscitation Council (UK) quality standards ABCDE assessment of the sick patient Medical risk assessment in general dental practice Principles of safer handling during cardiopulmonary resuscitation Procedure for calling 999 for an ambulance Importance of human factors and teamwork Conclusion References 1 10 11 13 13 Resuscitation equipment in the dental practice Introduction Recommended minimum resuscitation equipment in the dental practice Checking resuscitation equipment and drugs Checking resuscitation equipment following use Care, handling and storage of oxygen cylinders Conclusion References 16 20 22 23 25 25 ABCDE: Recognition and treatment of the acutely ill patient Introduction Clinical signs of acute illness and deterioration The ABCDE approach General principles of the ABCDE approach The ABCDE approach to the sick patient Principles of pulse oximetry Procedure for administering oxygen to the acutely ill patient Procedure for recording blood pressure 26 26 27 27 28 28 34 38 41 www.ajlobby.com 15 15 vi Contents Medical emergencies in the dental practice poster Conclusion References 44 46 46 Respiratory disorders Introduction Management of acute asthma attack Management of hyperventilation Management of exacerbation of chronic obstructive pulmonary disease Procedure for using an inhaler Procedure for using a spacer device Conclusion References 48 48 49 55 56 57 61 64 64 Cardiovascular disorders Introduction Management of angina Management of myocardial infarction Management of palpitations Management of syncope Conclusion References 66 66 67 69 73 74 76 77 Endocrine disorders Introduction Management of hypoglycaemia Procedure for blood glucose measurement using a glucometer Management of adrenal insufficiency Conclusion References 78 78 78 83 85 86 86 Neurological disorders Introduction Management of a generalised tonic–clonic seizure Management of stroke Management of altered level of consciousness Procedure for placing a patient in the recovery position Spinal injury Conclusion References 88 88 88 93 96 97 101 102 102 Anaphylaxis Introduction Definition Incidence Pathophysiology Causes 104 104 105 105 105 106 www.ajlobby.com Contents vii Clinical features and diagnosis Treatment Risk assessment Conclusion References Cardiopulmonary resuscitation in the dental practice Introduction Resuscitation Council (UK) automated external defibrillation algorithm Procedure for cardiopulmonary resuscitation in the dental chair Procedure for performing chest compressions Conclusion References 107 109 113 114 115 117 117 118 118 126 129 130 10 Airway management and ventilation Introduction Causes of airway obstruction Recognition of airway obstruction Simple techniques to open and clear the airway Use of oropharyngeal airway Principles of ventilation Treatment of foreign body airway obstruction Conclusion References 131 131 132 132 133 135 138 147 150 150 11 Automated external defibrillation Introduction Ventricular fibrillation Physiology of defibrillation Factors affecting successful defibrillation Safety issues and defibrillation Procedure for automated external defibrillation Conclusion References 152 152 153 153 154 155 155 158 158 12 Paediatric emergencies Introduction ABCDE assessment of a sick child Principles of paediatric resuscitation Placing a child into the recovery position Management of foreign body airway obstruction Conclusion References 160 160 161 162 170 170 173 173 13 An overview of emergency drugs in the dental practice Introduction Adrenaline 175 175 176 www.ajlobby.com viii Contents Aspirin Glucagon Glyceryl trinitrate spray Midazolam Oral glucose solution/tablets/gel/powder Salbutamol inhaler Conclusion References 179 180 181 182 185 185 187 187 14 Principles of first aid in the dental practice Introduction Priorities of first aid Responsibilities when providing first aid Assessment of the casualty Wounds and bleeding Minor burns and scalds Poisoning, stings and bites Importance of record keeping Summary References 189 189 190 190 190 195 200 200 202 203 203 15 Professional, ethical and legal issues Introduction The scope of a dental professional’s accountability The fifth sphere of accountability Legal requirements for consent and acting in a patient’s best interests Duty of confidence owed to patients by dental professionals Conclusion References 204 204 205 217 218 226 231 232 Index 235 www.ajlobby.com ... medical emergencies and resuscitation in the dental practice Introduction Concept of the chain of survival Incidence of medical emergencies in dental practice General dental council guidelines on medical. .. proportions to that found in general dental practice (Atherton et al., 2000) With the elderly population in dental practices increasing, medical emergencies in the dental practice will undoubtedly... OF THE MANAGEMENT OF MEDICAL EMERGENCIES An overview of the management of medical emergencies AN OVERVIEW OF THE MANAGEMENT OF MEDICAL EMERGENCIES Basic Guide to Medical Emergencies in the Dental