Medical Emergencies in the Dental Office, 7e

561 Pages·2014·154.28 MB·English

by  Stanley F. Malamed DDS

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MEDICAL
EMERGENCIES
in the DENTAL OFFICE
MEDICAL
EMERGENCIES
in the DENTAL OFFICE
SEVENTH EDITION
STANLEY F. MALAMED, DDS
Dentist Anesthesiologist
Emeritus Professor of Anesthesia and Medicine
Ostrow School of Dentistry
University of Southern California
Los Angeles, California
Chapter 4, Legal Considerations, contributed by
DANIEL L. ORR II, DDS, MS (ANES), PHD, JD, MD
Clinical Professor of Surgery and Anesthesiology for Dentistry
University of Nevada School of Medicine
School of Dental Medicine
Las Vegas, Nevada
Clinical Assistant Professor of Anesthesia and Medicine
University of Southern California School of Dentistry
Los Angeles, California
3251 Riverport Lane
St. Louis, Missouri 63043
MEDICAL EMERGENCIES IN THE DENTAL OFFICE,
SEVENTH EDITION ISBN: 978-0-323-17122-9
Copyright © 2015 by Mosby, an imprint of Elsevier Inc.
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Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices, or
medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein.
In using such information or methods they should be mindful of their own safety and the
safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer of
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duration of administration, and contraindications. It is the responsibility of practitioners, relying
on their own experience and knowledge of their patients, to make diagnoses, to determine dosages
and the best treatment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
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Library of Congress Cataloging-in-Publication Data
Malamed, Stanley F., 1944- , author.
Medical emergencies in the dental office/Stanley F. Malamed; chapter 4, Legal considerations
contributed by Daniel L. Orr II. – Seventh edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-17122-9 (paperback : alk. paper)
I. Orr, Daniel L., II, author. II. Title.
[DNLM: 1. Dentistry–methods. 2. Emergencies. 3. Dental Offices–standards.
4. Emergency Treatment–methods. WU 105]
RC86.8
616.02′50246176–dc23
2014032360
Executive Content Strategist: Kathy Falk
Senior Content Development Specialist: Brian Loehr
Publishing Services Manager: Hemamalini Rajendrababu
Project Manager: Maria Bernard
Design Direction: Amy Buxton
Printed in Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To my mother and father,
who made it all possible,
to my wife, Beverly, and children,
Heather, Jennifer, and Jeremy,
and to my grandchildren,
Matthew, Rachel, Gabriella, Ashley, Rebecca, Elijah, and Ethan,
who make it all so worthwhile,
I dedicate this seventh edition.
FOREWORD TO THE SIXTH EDITION
I am very pleased to be invited to offer a foreword to I have always believed that the dental undergraduate
the new sixth edition of Medical Emergencies in the curriculum should include a better grounding in
Dental Office. In recalling the original publication of pathophysiology to provide a basis for practice. The
1978, one is impressed with the creative talent and dental profession has moved forward to use blood
knowledge of the “titans of teaching”—Dr. Frank pressure recording almost routinely, especially in
(“Cap”) McCarthy and Dr. Stanley Malamed. They assessing new patients, and has moved to require basic
foresaw the need and developed basic logical ways of life support (BLS) and advanced cardiac life support
assessing a patient’s physical status when presenting (ACLS) education for licensure. Further, monitoring
for dental treatment. devices are now mandated in most states for those
Undergraduate dental education often pays limited dentists who use sedative and anesthetic agents.
lip service to our basic concern for the well-being of the It is impressive to see how these teachings have changed
total patient as it struggles to teach the many manual over time; important algorithms that were believed to be
and technique-oriented procedures. But we know like gospel have been discarded as more experience has
that the “mouth is really part of the body,” and our been gained. The sixth edition of this book reflects these
concerns involve the whole individual, especially one improvements. These changes mandate that we keep
compromised by underlying systemic pathology. current in our new knowledge and practices.
Although a bridge or implant may fail, these are Some tragedies are inevitable when dealing with
repairable. When a patient sustains a stroke secondary patients, but knowing how and when to anticipate and
to an unsuspected hypertensive crisis or aspirates a manage medical emergencies reduces the likelihood
chunk of impression material that blocks breathing, that a tragedy will occur. The expense of training the
we are faced with a potential tragedy. Learning how to professional and lay public in the recognition and
assess the physical and emotional status of each patient management of emergencies is enormous, but a successful
provides a hedge against disaster. resuscitation, saving the life of a loved one, is worth it.
Norman Trieger, DMD, MD*
Chairman Emeritus and Professor
Department of Dentistry
Albert Einstein College of Medicine/Montefiore
Medical Center
Bronx, New York
*Deceased
vi
PREFACE TO THE SEVENTH EDITION
In December of 1975 I started writing Medical Progress has been made, yet much remains to be done.
Emergencies in the Dental Office. That first edition The awareness of our profession has been elevated, and
was published in April of 1978. As I wrote in the laudable achievements continue. The American Dental
preface to that first edition, my primary aim in writing Association has inaugurated an airway management
the book was, as it is today, to stimulate members of program, “Managing Sedation Complications.” Fourteen
my profession—dentists, doctors, dental hygienists, states mandate the presence of an AED (automated
dental assistants, and all other office personnel—to external defibrillator) in dental offices.
improve and to maintain their skills preventing medical Yet because of the very nature of the problem, what
emergencies and in recognizing and managing those few we in dentistry require is continued maintenance of a
medical emergencies that will inevitably occur. This aim high level of skill in the prevention, recognition, and
is even more focused in my mind as this, the seventh management of medical emergencies. To do so we must
edition of Emergencies, is written in 2014. participate in ongoing programs designed by individual
Approximately 75% of medical emergencies seen doctors to meet the specific needs of their offices.
in the dental environment may be preventable through These programs should include annual attendance at
implementation of a system of patient evaluation, continuing dental education seminars in emergency
treatment modification, and management. medicine; access to up-to-date information on this
Though most medical emergencies may be prevented, subject (through the Internet, journals, and textbooks);
potentially life-threatening situations will still occur. semiannual or annual “recertification” in basic life
I continually receive e-mails and telephone calls about support, PALS, or ACLS; and mandatory in-office
such situations. I have met with many doctors and other practice sessions in emergency procedures attended by
dental personnel who have had real-life encounters the entire office staff. Such a program is discussed more
with life-threatening medical problems. Virtually all of completely in Chapter 3.
these have occurred within the dental office. However, The ultimate goal in the preparation of a dental
a considerable number happened outside: on family office for emergencies should be for you, the reader, to
outings, while traveling, in restaurants, or at home. be able to put yourself into the position of a victim of a
There is a significant need for increased awareness by serious medical complication in your dental office, and
dental professionals in the area of emergency medicine. for you to be confident that your office staff would be
Although most states and provinces in North America able to react promptly and effectively in recognizing and
mandate current “certification” in basic life support* managing the situation.
(cardiopulmonary resuscitation [CPR]) for a doctor to Emergency medicine is a rapidly evolving medical
maintain a dental license, not all states and provinces specialty, and because of this, many changes have
have as yet addressed this important issue. Why they occurred since publication of the first edition of this
have not is incomprehensible to me. text. My goal now, as it was then, is to enable you to
As someone with a long-term commitment in the manage a given emergency situation in an effective
teaching of basic life support (BLS), pediatric advanced yet uncomplicated manner. Alternative treatments
life support (PALS), and advanced cardiovascular life and alternative drugs that are also effective may be
support (ACLS), I see an immense value in training all advocated by some authors. My goal, as well as theirs, is
adults in the simple procedures collectively known as simply to enable you to keep the victim alive until they
basic life support. Local and state dental societies, as either recovers or until emergency assistance becomes
well as specialty groups, should continue to present available to take over management . . . as long as they
courses in BLS or initiate them as soon as possible. are better able to manage the situation than are you.
Continued revision and updating of essential material
is found throughout this seventh edition.
*“The American Heart Association does not ‘certify’ competency In October 2010 the American Heart Association and
in any level of ‘life support.’ Cards given upon completion of a
the International Liaison Committee on Resuscitation
BLS, ACLS, or PALS course state that “the above individual has
(ILCOR) published revised guidelines for BLS, ACLS,
successfully completed the national cognitive and skills evaluations
in accordance with the curriculum of the American Heart and PALS. Significant changes in both philosophy and
Association for the BLS (or ACLS, or PALS) program.” technique of resuscitation (life-saving) were recommended
vii
viii Preface to the Seventh edition
and have been included in appropriate sections of Emphasis is placed on the newly revised management
this seventh edition: Chapter  5 (Unconsciousness: algorithm for all medical emergencies: P . . . position,
General Considerations), Chapter  11 (Foreign Body C . . . circulation, A . . . airway, B . . . breathing, and
Airway Obstruction), Chapter 26 (Chest Pain: General D . . . definitive care.
Considerations), Chapter  30 (Cardiac Arrest), and
Chapter 31 (Pediatric Considerations). Management of medical emergencies need not, and
The basic format of the text––recognition and should not, be complicated. Emphasizing this concept
management based on clinical signs and symptoms throughout this textbook should make it somewhat
rather than on a systems-oriented approach––has been easier for the entire office staff to grasp the importance
quite well received and continues in this seventh edition. of certain basic steps in life saving (P, C, A, B, D).
Stanley F. Malamed, DDS
Los Angeles, California
August 2014
EVOLVE INSTRUCTOR RESOURCES
Revised for the seventh edition is an online component • An electronic image collection contains most figures
available to instructors who wish to further the from the text in downloadable formats. The figures
understanding of this content in their classrooms, or can be implemented for study or additional lecture
practitioners who wish to utilize electronic resources material.
in the training of their office staff. The Evolve • More than 300 chapter-specific multiple choice
Instructor Resources for Medical Emergencies in the questions form a test bank that can be used to
Dental Office, available at http://evolve.elsevier.com/ create quizzes or exams for student assessment as
Malamed/emergencies, features three main elements: a course progresses. These questions are also useful
• Outlines of major headings in the text aid in teaching as a training tool to gauge office staff’s readiness to
plans and lecture preparation. Appendices from the respond in emergency situations.
book also are available.
ix
ACKNOWLEDGMENTS
As with earlier editions of this text, I have been fortunate Special “Thanks” are directed to my editor from
to have been associated with a number of persons who Elsevier, Mr. Brian Loehr, with whom I have interacted
helped to make the job of revision—in all seriousness— almost daily in preparation of this edition. I have worked
quite enjoyable. As I have discovered with each previous with many editors over the years on the various editions
edition, it is impossible to mention everyone involved of my three textbooks and have found Brian to be the
in the production of a book. However, I must mention most pleasant of “taskmasters.”
a number of persons without whom this volume would Reader input concerning previous editions of this text
not have been completed: Drs. Amanda Okundaye and and suggestions for new items for inclusion in future
Kenneth Reed who participated as photographic models editions have proved to be of inestimable value. I greatly
and tolerated all sorts of injustices and indignities, all in appreciate, and indeed wish to solicit, future comments
the name of science and education, as well as Mr. Illo from my readers.
Apelby and Matthew Boyd.
Mr. Derek Delahunt, Mr. Ken Rosenblood, and Stanley F. Malamed, DDS
Ms.  Rose Dodson also provided assistance with
photographs and information necessary to upgrade this
volume.
x