Medical emergencies in general dental practice in Great Britain. Part 2: Drugs and equipment possessed by GDPs and used in the management of emergencies

Effectiveness of Leg Raise and Leg Fold Maneuver to Prevent Syncope During Extraction of Teeth: A Pilot Study

Objectives The primary objective of this study is to evaluate the effectiveness of leg raise and leg fold maneuvers to prevent syncope during extraction procedures. Methods This study included 30 patients with a previous history of syncope and dental anxiety. Patients were randomly divided into two groups consisting of 15 patients each. Group I (test group) patients were educated about a few physical maneuvers, and instructions were given preoperatively about when to perform them. Group II (control group) underwent extraction conventionally. The blood pressure, saturation, pulse rate, and clinical signs and symptoms of the patients were assessed preoperatively, intraoperatively, and postoperatively. Informed consent was obtained from all the patients. Results There is a significant difference between the control and study groups in terms of the occurrence of syncope and patient comfort. This indicates that the leg raise and leg fold maneuvers reduce the occurrence of syncope during extraction. No participant in the test group experienced syncope post-treatment, while five subjects (33.3%) experienced syncope in the control group. Conclusion Physical counterpressure maneuvers are a risk-free, effective, and low-cost treatment method in patients with vasovagal syncope. Leg raise and leg fold maneuvers improved the hemodynamics of the patients.

The Knowledge and Awareness of Medical Emergencies and Management among Dental Students

Background:

Every dentist should anticipate being confronted with a medical emergency (ME), and one should always be ready to treat the most catastrophic ones.

Aim:

This study aimed to assess the knowledge of dental clinical students of Tamil Nadu in the ME understanding and management to create awareness toward patient care.

Methodology:

A total of 768 dental students, including final-year students and residents from different colleges, took part in the questionnaire-based cross-sectional study. The selection of study participants was by the convenience sampling method. The questionnaire contained thirty closed multiple-choice questions to assess their knowledge of MEs. Microsoft Office Excel software was used for compiling the answers. The descriptive analysis of the data is exhibited in graphs.

Results:

The majority of participants were mindful of the vital signs; only 55% of the participants know the importance of checking their respiration rate. The knowledge of identifying MEs such as anaphylaxis was 91%, and only 27%–37% of the respondents knew to identify angina, transient ischemia, and lidocaine toxicity. Approximately 15%–40% of the respondents only knew the management of angina, cardiac arrest, hyperventilation, respiratory obstruction, and seizure. Only 10% agreed that the best office emergency kit should be prepared by themselves. Roughly 78% of the respondents were conscious of the patient's referral whenever necessary and aware of state dental acts.

Conclusion:

This study reflects a significant need for training in executing ME among dental students who are to transmute into future dental professionals.

Medical emergencies in dental hygienists' practice

Dental hygienists in Poland work in various settings, including public health care institutions, private dental practices, dental clinics, kindergartens, and schools. They can often face medical emergencies, whose rate is increasing owing to comorbidities and aging of dental patients' populations. The aim of the study was to assess the prevalence of medical emergencies in dental hygienists' practice in Poland and the hygienists' preparedness and attitudes toward emergencies.A 10-question authors' own questionnaire was filled in by 613 dental hygienist. It referred to their cardiopulmonary resuscitation training, availability of emergency medical equipment in the workplace, the prevalence of medical emergencies including the need for an emergency medical service (EMS) call, and the management of cardiac arrest.Overall, 613 dental hygienists working in Poland participated in the study; 38.99% had taken part in basic life support (BLS) training within the previous 12 months and 35.89% within 2 to 5 years; 15.17% had experienced at least 1 emergency situation requiring an EMS call within the previous 12 months. Vasovagal syncope was the most common medical emergency (15.97%), followed by moderate anaphylactic reaction (13.87%), seizures (8.81%), hyperventilation crisis (7.50%), and hypoglycemia (7.34%).The most common medical emergency in dental hygienists' practice in Poland is syncope followed by mild anaphylactic reaction. Most of the dental hygienist had participated in a BLS course within the previous 5 years; however, 20% of them have never participated since graduation. Dental hygienists should participate in BLS courses every 2 years to keep the cardiopulmonary resuscitation skills and stay up-to-date with current guidelines. An important part of the study participants declare the lack of availability in their workplaces of life-saving equipment, including self-expanding bag resuscitator, oropharyngeal, and supraglottic airway device and oxygen source. Medical emergency equipment as recommended in the international guidelines should be available in every practice.

Preparedness and attitudes towards medical emergencies in the dental office among Polish dentists

BACKGROUND

Medical emergencies in dental offices are considered a problem in most countries owing to dentists' concerns about emergency preparedness, practical skills, lifesaving equipment and staff availability. The prevalence of medical emergencies in dental offices and dentists' preparedness have been analysed in several countries but have never been studied in Poland.

AIM

To assess the prevalence of medical emergencies in dental offices in Poland, as well as dentists' preparedness and attitudes towards medical emergencies.

METHODS

An 18-item questionnaire was completed by 419 dentists. It asked for information on their cardiopulmonary resuscitation training, availability of emergency medical equipment in the dental office, prevalence of medical emergencies and self-assessed competence in various dental office emergencies. Data were analysed using the Statistica 13.3 software package. Variability was measured with standard deviation. Pearson's linear correlation coefficient was used to determine correlation strength.

RESULTS

The most common medical emergencies in Polish dental offices were vasovagal syncope (46.30% of study participants experienced at least one case in the preceding 12 months), orthostatic hypotension (18.85%), hyperventilation crisis (18.61%), mild allergic reactions (16.23%), hypoglycaemia (15.99%) and seizures (11.81%). The prevalence of medical emergency situations requiring an emergency medical service call or medical assistance within the preceding 12 months was 0 for 80.66% of dentists, one for 12.65%, two for 4.53%, three for 1.20%, four for 0.48%, 5-10 for 0.48% and more than 10 for 0%. As many as 41.29% of the participants did not feel competent in managing sudden cardiac arrest, 74.47% in managing hypertensive crisis, 55.61% in managing asthma, 55.13% in managing anaphylactic shock and 52.99% in managing seizures.

CONCLUSION

The prevalence of medical emergencies in dental offices in Poland is comparable with that in other countries. A large number of dentists do not feel competent enough to manage medical emergencies. Better undergraduate and postgraduate training in medical emergencies is recommended, as well as broader availability of emergency medical equipment in the dental office.

Dental students' ability to locate emergency equipment-lessons learned from aviation

PURPOSE

The purpose of this study was to evaluate the dental student's ability to locate medical emergency equipment/items at the University of Michigan School of Dentistry clinic.

METHODS

A total of 138 second-year dental students (traditional group) participated in this study as part of a simulation-based medical emergencies rotation course held during the winter term of 2014 and 2015. Without prior training, students were tested on their ability to locate nine predetermined items on the clinic floor using a self-reported checklist. Six months later, a convenience sample of 18 students (novel group) from the same cohort were later trained on their location and retested individually.

RESULTS

Of the 138 students tested, only 10.14% students could locate seven of the nine items when compared to 100% in the novel group. Only 5.07% of students in the traditional group could locate all items initially, compared with 72.22% students in the novel group.

CONCLUSION

Whilst our students have lecture-based knowledge about medical emergencies, the results of our study identified a gap of knowledge of emergency equipment/item location amongst students. Therefore, an intervention performed with a similar group of second-year dental students supported that proper training may be used to achieve retention of knowledge. Based on our "novel group" results, we have incorporated targeted training in the dental curriculum that leads to students being better prepared in locating emergency equipment/items. This study suggests that other populations, such as faculty or staff, may also benefit from hands-on training.

Evaluation of knowledge, experience and perceptions about medical emergencies amongst dental graduates (Interns) of Belgaum City, India

Introduction: Medical emergencies can occur frequently in dental setting. Effective management of an emergency situation in the dental office is ultimately the dentist’s responsibility. The lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal action. For this reason, all health professionals including dentists must be well prepared to attend to medical emergencies. Providing basic life support [BLS] is dentist’s most important contribution until definitive treatment for a medical emergency can be given. Hence the study is aimed to assess the dental graduates (Interns) knowledge, skills and competency regarding dentistry-medical emergency interface. Method: Data were collected from 105 Interns of two dental colleges of Belgaum City using a structured questionnaire consisting of 7 item questionnaire (6 closed and 1 open ended). Results: Overall in all the years, syncope / faint was seen by 40.9% of the respondents, 37.1% with hypoglycemic attacks, allergic reactions by 17.1%, epileptic attacks by 7.6%, asthmatic attacks by 4.5% and angina 0.9%. The frequencies of the emergencies encountered were once or even more. Knowledge of the presence of drugs and equipments in the emergency drug kit and the confidence in regard to use them was low. Medical emergencies training were undertaken by 42% respondents, but in varying degrees. There was a desire for further medical emergencies training by majority of respondents. Conclusion: The study showed that syncope is the commonest medical emergency event. Dental graduates had a superficial knowledge of medical emergencies, drugs and equipments. Emphasis is placed on the need for more medical emergencies training to be offered, to increase knowledge and confidence of dental graduates (Interns) in the management of medical emergencies.

Key words:Medical emergencies, dental graduates, basic life support, emergency drugs.

Emergência médica na prática odontológica no Estado de Santa Catarina: ocorrência, equipamentos e drogas, conhecimento e treinamento dos cirurgiões-dentistas

Esta pesquisa teve por objetivo verificar a ocorrência de emergências médicas na prática odontológica, a adequação de equipamentos e drogas, e o nível de conhecimento e treinamento dos profissionais da odontologia no enfrentamento dos eventos emergenciais, tanto no serviço público quanto na clínica privada. Os questionários foram enviados via postal, aos 6.000 cirurgiões-dentistas (CDs) inscritos até abril de 2004 no Conselho Regional de Odontologia do Estado de Santa Catarina. Houve um retorno de 506 questionários (8,43%). A partir da análise dos dados, constatou-se que os CDs respondentes estão conscientes da importância do tema e sentem-se despreparados para solucionar uma emergência médica. As emergências relatadas com maior freqüência foram: lipotimia, taquicardia, hipertensão, reação ao anestésico local e hipoglicemia. O serviço público encontra-se com uma quantidade maior de equipamentos e drogas para emergência médica. Foi enviado, também, ofício às sete instituições de ensino superior com cursos de odontologia no Estado, consulta esta que acusou a inexistência de disciplinas específicas que tratem das emergências médicas. O tema normalmente é abordado em outras disciplinas com pequena carga horária, e nos semestres iniciais do curso.

Emergency drugs

There is universal agreement that dentists require emergency drugs to be readily available. Opinions differ as to the specific drugs that should comprise an emergency kit. This article has provided one opinion. Oxygen, epinephrine, nitroglycerin, injectable diphenhydramine or chlorpheniramine, albuterol, and aspirin should be readily available in a dental office. Other drugs such as glucagon, atropine, ephedrine, hydrocortisone, morphine or nitrous oxide, naloxone, midazolam or lorazepam, and flumazenil should also be considered. There are differences in the level of training of dentists in the management of medical emergencies [25]. Therefore the final decision should be made by the individual dentist who is in the best position to determine the appropriateness of these agents for the particular practice. Despite the best efforts at prevention, emergencies may still arise. Plans to manage these events are needed and there is the possibility that the drugs discussed above may be required. Their presence may save a life.