adult ce

Course Information

  • Course Author(s): Palma A. Freydinger, DDS; Fady F. Faddoul, DDS, MSD

  • CE Credits: 4 hours

  • Intended Audience: Dentists, Dental Hygienists, Dental Assistants, Office Managers, Dental Students, Dental Hygiene Students, Dental Assistant Students

  • Date Course Online: 09/16/2016

  • Last Revision Date: 06/29/2023

  • Course Expiration Date: 06/28/2026

  • Cost: Free

  • Method: Self-instructional

  • AGD Subject Code(s): 142

  • Online Course Link: www.dentalcare.com/en-us/ce-courses/ce516

  • Disclaimers:

    • P&G provides these resource materials to dental professionals; they do not own this content or bear responsibility for its accuracy.

    • Participants must be aware of the risks of integrating limited knowledge into practice. Only evidence-based dentistry should be used in patient therapy.

Conflict of Interest Disclosure Statement

  • The authors report no conflicts of interest related to this course.

Introduction to Medical Emergencies

  • Course Overview:

    • Participants will learn to diagnose and respond to adult medical emergencies in dental office settings.

    • Emphasizes risk assessment, recognizing immediately life-threatening medical emergencies (e.g., cardiac arrest) and problems that require timely stabilization (e.g., hypoglycemia).

Course Contents

  • Overview

  • Learning Objectives

  • Glossary

  • Introduction

  • Procedure-specific Risk Factors

  • Patient-specific Risk Factors

  • Hippocratic Oath Principle: “First, Do No Harm”

  • Primary Survey

  • Airway Obstruction and Handling

  • Secondary Survey

  • Medical Emergencies: Syncope, Postural Hypotension, Hypoglycemia, Angina Pectoris, Myocardial Infarction, Hypertensive Emergency, Hyperventilation, Ventilation Failure, Allergic Reactions (Pruritus, Urticaria, Angioedema, Anaphylaxis, Delayed Hypersensitivity Reactions), Seizures, and Cerebrovascular Accident

  • Local Anesthetics Toxicity

  • Summary

  • Course Test

  • References / Additional Resources

  • About the Authors

Learning Objectives

  • Upon completing this course, participants should be able to:

    • Identify common orofacial myofunctional disorders.

    • Discuss factors to consider in patient risk stratification with systemic diseases.

    • Explain essential elements needed to be prepared for medical emergencies in oral healthcare settings.

    • Recognize signs and symptoms, formulating diagnoses for emerging perioperative problems.

    • Initiate timely actions to stabilize the patient prior to the arrival of emergency medical services (EMS).

Introduction

  • Primary Obligation of Oral Healthcare Personnel (OHCP): Ensuring timely delivery of preventive, diagnostic, and therapeutic services based on patient circumstances.

  • Incidence of medical emergencies in dental settings is low but increasing due to more patients with medical issues seeking dental care.

  • OHCP must have knowledge and skills to assess patients' physical and emotional ability to handle dental treatment.

    • Diagnosis activities establish a medical database for at-risk patients.

    • Being ill-prepared for emergencies can lead to public condemnation or allegations of negligence.

    • OHCP should follow the acronym P-R-A-Y:

    1. Prepare for roles as first responders.

    2. Recognize factors and symptoms of emergencies.

    3. Act to stabilize.

    4. Yell for help, notifying EMS.

  • Basic life support (BLS) capabilities are essential to stabilize patients until EMS arrives, while advanced life support (ALS) activities require extensive training.

Procedure-specific Risk Factors

  • Every dental procedure elicits a stress-response called “surgical stress.”

  • Characterized by physiological and psychological changes, with magnitude proportional to:

    • Severity of tissue trauma

    • Duration of procedure

    • Volume of blood loss

    • Fluid shifts

    • Core body temperature changes

  • Stress-level classifications and associated major medical event rates:

    • High stressed: >5%

    • Intermediate stressed: 1-5%

    • Low stressed: <1%

  • For low-stress procedures, risk remains negligible unless significant patient-specific risk factors exist.

Patient-specific Risk Factors

  • Fundamental principle: “Never treat a stranger.”

  • Patient-specific risk assessment relies on detailed history from physical evaluation:

    • Current/past illnesses

    • Hospitalizations

    • Organ systems review

    • Family and social history

    • Drug allergies and adverse effects

    • Medication, vitamins, supplements taken, and diets

  • Importance of assessing a patient's Functional Capacity (FC):

    • Reflects functional reserve and correlates with maximum oxygen uptake.

    • Expressed in metabolic equivalents (METs); 1 MET = 3.5 ml O2/kg/min.

    • FC classifications:

    • Excellent: >10 METs

    • Good: 7-10 METs

    • Moderate: 4-6 METs

    • Poor: <4 METs

    • A low FC indicates heightened risk for emergencies.

      • Example: Asymptomatic patient with sedentary lifestyle reflecting poor FC may warrant preoperative evaluation.

      • Conversely, high-function capacity patients with history of CAD may not need preoperative testing.

Hippocratic Oath Principle

  • Emphasizes forming an emergency team and knowing what to monitor during treatment.

  • Monitor the patient’s physical and emotional status, especially when administering drugs.

  • Regular training under simulated conditions and routine checks of emergency drugs and equipment are essential.

Primary Survey Methodology

  • Hierarchical Steps in Emergency Situations:

    • Assess responsiveness

    • Check airway

    • Check breathing and pulse

  • All steps combine into the primary survey, focusing on life-threatening dangers necessitating immediate action such as obstructed airways, respiratory arrest, or cardiac arrest.

  • Initial assessment should include a physical examination, including baseline vital signs.

American Society of Anesthesiology (ASA) Classification System

  • Practical tool categorizing perioperative risk factors based on physical assessments.

  • Complication rates correlate with ASA classifications:

    • ASA PS I: 0.4/1000 risk

    • ASA PS IV: 9.6/1000 risk

Emergency Preparedness

  • Establish Emergency Team Roles:

    • Team Supervisor (Dentist): Assess patient, perform physical exams, obtain vital signs, determine treatment course, initiate CPR/AED.

    • Second Member: Notifies staff, gathers emergency supplies, prepares therapeutic agents, administers oxygen, assists with CPR/AED.

    • Third Member: Monitors vital signs, records pertinent information, activates EMS, assists with CPR/AED.

Emergency Drug Supplies

  • Essential drugs to have available:

    • Epinephrine: 1:1,000 autoinjectors (adult 0.3 mg; child 0.15 mg)

    • Bronchodilator: Albuterol inhaler

    • Diphenhydramine hydrochloride: 25 mg tabs

    • Nitroglycerin: 0.4 mg sublingual/tab/spray

    • Oxygen: Portable E cylinder with regulator, nasal cannula, nonrebreather masks, bag-valve-mask device

    • Aromatic ammonia, Glucose tablets, Aspirin (ASA): 325 mg, and various airway adjuncts

Primary Survey Steps

  • Responsiveness Assessment:

    • For responsive patients: Tap shoulder and ask, “Are you OK?”

    • Sign of consciousness includes being alert, responding to stimuli, or moving when prompted.

    • For unresponsive patients: Expect silence; place in supine position and gather the emergency team and notify EMS.

Airway Checking

  • Responsive individuals likely have a partially open airway; if unresponsive, check for obstruction and apply the head-tilt/chin-lift maneuver if needed.

Breathing and Pulse Checks

  • Check for breathing for 5-10 seconds and confirm pulse from carotid artery:

    • For responsive individuals, monitor until EMS arrives.

    • For unresponsive individuals, deliver rescue breathing and initiate CPR if no pulse is detected.

Syncope

  • Defined as a sudden loss of consciousness due to cerebral ischemia.

    • More likely to occur in younger individuals due to anxiety, pain, heat, etc.

    • Can lead to cardiovascular disorders in individuals over 50.

Airway Obstruction (Foreign Object)

  • The universal sign of choking is a patient clutching their throat. If they can't cough effectively, provide quick upward abdominal thrusts. For unresponsive patients, initiate CPR while maintaining availability of an AED.

Secondary Survey Protocol

  • If the patient is conscious, conduct a secondary assessment including blood pressure check, correlating presenting symptoms with specific organ systems.

Medical Emergency Categories Based on Symptoms

  • Emergencies analyzed via symptoms can be categorized into altered consciousness, chest pain, and aspects of ventilation failure, etc.

Tables Summary for Emergency Responses

  • Each medical emergency (e.g. Syncope, Hypoglycemia, Myocardial Infarction, etc.) includes prevention techniques, identification of signs/symptoms, emergency response steps and revisions detailing both recovery and deterioration signs.

Systematic Understanding of Various Medical Emergencies

  • With specific attention paid to conditions such as Hypertension, Hyperventilation, and Anaphylaxis, treatment protocols, drug dosages, and emergency action plans are outlined systematically for clarity.

Course Test Preview

  • Selection of questions with multiple-choice format covering the learning outcomes and comprehension of emergency protocols.

References

  • Comprehensive bibliographical citations supporting the principles and practices outlined in this study guide.

About the Authors

  • Brief biographies of authors Palma A. Freydinger, DDS and Fady F. Faddoul, DDS, MSD, emphasizing their professional credentials and contributions to dental education.