Table Of Content

Basic Guide to Medical Emergencies in the Dental Practice BASIC GUIDE TO MEDICAL EMERGENCIES IN THE DENTAL PRACTICE 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 This edition fi rst published 2014 © 2010 by Phil Jevon © 2014 by John Wiley & Sons, Ltd Registered offi ce: J ohn Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial offi ces: 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 offi ces, 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 identifi ed as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988. 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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: 1. Dental Care—methods. 2. Emergency Treatment—methods. 3. 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 1 2014 Contents Foreword ix Acknowledgements x About the companion website xi 1 An overview of the management of medical emergencies and resuscitation in the dental practice 1 Introduction 1 Concept of the chain of survival 2 Incidence of medical emergencies in dental practice 3 General dental council guidelines on medical emergencies 4 Resuscitation Council (UK) quality standards 5 ABCDE assessment of the sick patient 6 Medical risk assessment in general dental practice 7 Principles of safer handling during cardiopulmonary resuscitation 8 Procedure for calling 999 for an ambulance 10 Importance of human factors and teamwork 11 Conclusion 13 References 13 2 Resuscitation equipment in the dental practice 15 Introduction 15 Recommended minimum resuscitation equipment in the dental practice 16 Checking resuscitation equipment and drugs 20 Checking resuscitation equipment following use 22 Care, handling and storage of oxygen cylinders 23 Conclusion 25 References 25 3 ABCDE: Recognition and treatment of the acutely ill patient 26 Introduction 26 Clinical signs of acute illness and deterioration 27 The ABCDE approach 27 General principles of the ABCDE approach 28 The ABCDE approach to the sick patient 28 Principles of pulse oximetry 34 Procedure for administering oxygen to the acutely ill patient 38 Procedure for recording blood pressure 41 vi Contents Medical emergencies in the dental practice poster 44 Conclusion 46 References 46 4 Respiratory disorders 48 Introduction 48 Management of acute asthma attack 49 Management of hyperventilation 55 Management of exacerbation of chronic obstructive pulmonary disease 56 Procedure for using an inhaler 57 Procedure for using a spacer device 61 Conclusion 64 References 64 5 Cardiovascular disorders 66 Introduction 66 Management of angina 67 Management of myocardial infarction 69 Management of palpitations 73 Management of syncope 74 Conclusion 76 References 77 6 Endocrine disorders 78 Introduction 78 Management of hypoglycaemia 78 Procedure for blood glucose measurement using a glucometer 83 Management of adrenal insuffi ciency 85 Conclusion 86 References 86 7 Neurological disorders 88 Introduction 88 Management of a generalised tonic–clonic seizure 88 Management of stroke 93 Management of altered level of consciousness 96 Procedure for placing a patient in the recovery position 97 Spinal injury 101 Conclusion 102 References 102 8 Anaphylaxis 104 Introduction 104 Defi nition 105 Incidence 105 Pathophysiology 105 Causes 106 Contents vii Clinical features and diagnosis 107 Treatment 109 Risk assessment 113 Conclusion 114 References 115 9 Cardiopulmonary resuscitation in the dental practice 117 Introduction 117 Resuscitation Council (UK) automated external defi brillation algorithm 118 Procedure for cardiopulmonary resuscitation in the dental chair 118 Procedure for performing chest compressions 126 Conclusion 129 References 130 10 Airway management and ventilation 131 Introduction 131 Causes of airway obstruction 132 Recognition of airway obstruction 132 Simple techniques to open and clear the airway 133 Use of oropharyngeal airway 135 Principles of ventilation 138 Treatment of foreign body airway obstruction 147 Conclusion 150 References 150 11 Automated external defi brillation 152 Introduction 152 Ventricular fi brillation 153 Physiology of defi brillation 153 Factors affecting successful defi brillation 154 Safety issues and defi brillation 155 Procedure for automated external defi brillation 155 Conclusion 158 References 158 12 Paediatric emergencies 160 Introduction 160 ABCDE assessment of a sick child 161 Principles of paediatric resuscitation 162 Placing a child into the recovery position 170 Management of foreign body airway obstruction 170 Conclusion 173 References 173 13 An overview of emergency drugs in the dental practice 175 Introduction 175 Adrenaline 176 viii Contents Aspirin 179 Glucagon 180 Glyceryl trinitrate spray 181 Midazolam 182 Oral glucose solution/tablets/gel/powder 185 Salbutamol inhaler 185 Conclusion 187 References 187 14 Principles of fi rst aid in the dental practice 189 Introduction 189 Priorities of fi rst aid 190 Responsibilities when providing fi rst aid 190 Assessment of the casualty 190 Wounds and bleeding 195 Minor burns and scalds 200 Poisoning, stings and bites 200 Importance of record keeping 202 Summary 203 References 203 15 Professional, ethical and legal issues 204 Introduction 204 The scope of a dental professional’s accountability 205 The fi fth sphere of accountability 217 Legal requirements for consent and acting in a patient’s best interests 218 Duty of confi dence owed to patients by dental professionals 226 Conclusion 231 References 232 Index 235