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Medical Emergencies in the Dental Office, 7e PDF

561 Pages·2014·154.28 MB·English
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YOU’VE JUST PURCHASED MORE THAN A TEXTBOOK! Evolve Instructor Resources for Malamed: Medical Emergencies in the Dental Office, 7th Edition Activate the complete learning experience that comes with each textbook purchase by registering at http://evolve.elsevier.com/Malamed/emergencies REGISTER TODAY! You can now purchase Elsevier products on Evolve! Go to evolve.elsevier.com/html/shop-promo.html to search and browse for products. 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. Copyright © 2007, 2000, 1993, 1987, 1982, 1978 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). 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 each product to be administered, to verify the recommended dose or formula, the method and 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 editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. 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

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