Low first aid knowledge among dentistry – what should we know and do?

first aid trainingFirst aid is immediate medical assistance given to a person who suffers from any kind of medical emergency. A wide range of medical emergencies can happen at the dental office and may be unexpected. But are we ready, as dentists and dental students, to manage any kind of emergency?

From a dental student perspective

All dental students, throughout their learning, attend courses focusing on diagnosis, management and prevention.

Despite the importance of medical emergencies-related classes in the dental industry, many dental schools fail to exhibit the importance of these prevention classes and focus on other subjects. Therefore, if any dental student faces any kind of emergency at their clinics, they would unconsciously panic and might commit errors that make the situation worse.

Furthermore, during the pandemic, many dental schools around the world taught these courses as virtual learning or e-learning without hands-on training or workshops. Imagine what would happen if these students face any kind of emergency in the future.

This will put the patient at risk and the dentist may face legal issues because they didn’t know what to do.

I remember my friend, who recently graduated from dental school, shared a real-life experience. The patient came into his private practice with acute anxiety. While he was working, she started to hyperventilate. A few minutes before the ambulance arrived, she fainted.

This is easily preventable by undertaking first aid training sessions.

What should we do?

Approximately 75% of medical emergencies are preventable if the dental team properly assess the patient before starting the treatment.

The mnemonic SAMPLE is a tip to help you remember and organise what to ask the patient.

SAMPLE mnemonic can help you identify the original cause of any medical condition, anaphylaxis for example as secondary to an allergen. So, what is SAMPLE?

S: signs and symptoms

Signs: all that you can measure. Like the vital signs that every team should measure before any treatment. Especially for medically compromised patients. Or all the sounds you can hear from auscultating the patient (wheezing, crackles).

Symptoms: you can directly know by asking the patient: ‘What is your chief complaint?’

A: Allergy

Do not ask the patient if he’s allergic to any medication. It limits the patient’s response to only medication.

Make your question broader by asking: ‘Do you have any allergies?’ Or ‘Are you allergic to any type of food, medication, or others?’

M: Medication

Ask simple questions like: ‘What medications do you take? And do you take them regularly?’

Don’t hesitate to ask more like: ‘Do you take any over-the-counter medications? Or supplements?’

P: Pertinent medical history

Besides the detective work you have done in the previous allergy and medical questions, ask the patient if he/she has any medical condition or history that you should know about.

Use follow-up questions to gather more information.

L: Last oral intake

Ask your patient what and at what time was the last time he/she ate.

This simple question might prevent a medical emergency at your clinic. Imagine, if the patient took his/her insulin shot (acquired information from previous questions) and came directly to your clinic on an empty stomach.

This question just saved your patient from an insulin shock.

E: Events

Let the patient describe to you the sequence that leads to his/her problem. This question makes you better understand the mechanism of the injury or even an underlying habit or injury that causes this problem.

Get ready for the worst

Despite the utmost preparedness you can have, there is always a risk of something unexpected happening. You need the knowledge and training in every medical emergency that can happen at the dental office by:

  • Enrol in basic and advanced first aid workshops
  • Revise what you learn frequently
  • Teach everything you learn to your dental team
  • Make fake scenarios at the dental office from time to time. Include different types of medical emergencies (eg anaphylaxis shock, vaso vagal attack, cardiac arrest). This will help you and your staff be more comfortable and confident when a real emergency occurs
  • Keep up to date with every first new protocol (AHA CPR guidelines change every five years)
  • Always check the first aid kit for any missing or expired equipment
  • When a medical emergency happens, stay calm. Call emergency services and start your assessment by doing a primary and secondary survey.

Surveying the patient

The primary survey includes: danger, response, circulation, airway breathing.

  1. Danger: remove any potential danger around the patient (anesthesia needle, sharp instrument)
  2. Response: check the patient’s response by providing a painful stimulus to determine the level of consciousness
  3. Circulation: check for a pulse by putting two fingers in the patient’s carotid artery or by putting an oximeter on his/her finger
  4. Airway: check if the  patient has an open airway and also ensure if there’s no danger of potential airway obstruction (stridor). Consider using head tilt/chin lift, suction
  5. Breathing: check if the patient is breathing by observing the chest elevation and has adequate oxygen in his/her blood by using an oximeter. Consider using an oxygen tank if the patient has hypoxia.

The secondary survey includes: a comprehensive history, vital signs, physical examination:

  1. Comprehensive history: use SAMPLE mnemonic to gather information. Once gathered, prepare the patient’s file to give it to the paramedic when they arrive and take the patient to the hospital
  2. Vital signs: take the vital signs of the patient and monitor him/her. Vital signs include heart rate, respiration, blood pressure, temperature, oxygen saturation, blood glucose
  3. Physical examination: make a full physical examination including inspection and palpation.

Conclusion

In the end, the keys to be successful to manage any emergency medical emergency are to stay calm, be confident in yourself and your team, organise what is a priority in assessment, and lots of training.

I hope this article acts as a wake about the importance of first aid in dentistry.


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