I recently visited a dental client for a CPR/AED training session. She had just taken over the practice and asked me to review the emergency equipment that was in the office. Although she meant well, she was totally unprepared. Every drug in the kit was totally expired—some by a few years, her AED was obsolete, and her oxygen tank was potentially dangerous. The dentist she bought the practice from left her with no useable emergency equipment and a wide-open window to litigation, should an emergency have occurred. Fortunately, this story ends well, but the consequences could have been catastrophic.

Preparing for an emergency can be done with a three-pronged attack: prevention, equipment, and training. We should also take a moment to remind ourselves that the most common emergencies in a dentist office include syncope, allergic reactions (possibly anaphylactoid in nature), chest pain, bronchospasm and hypoglycemia.

The best emergency to have is the one that you prevented. It is important to take the time to review the medical history and medications of your patients before they sit in your chair. Medications often clue us into the medical conditions people forgot to tell you or really don’t know they have. This information might tell you what to expect when they “open wide” for you as much as what medical emergencies you might have to be prepared to deal with. Asking follow-up questions to medical conditions might be beneficial as well. Getting a feel for just how well the insulin-diabetic has control over his/ her own blood sugar or what allergies a patient, about to receive a lidocaine injection, has will help you prevent potential problems while preparing for the worst case scenario. Don’t be afraid to think ahead and ask yourself, “What kind of medical emergency can I expect to see with this patient? What will I do when that happens”?

With respect to medications, it is important to remember that literally hundreds of new drugs come onto the market every year. It is nearly impossible to know what every medication is used for, what class of medications they belong to and which ones are now approved for use outside of their original intent. To help me in a pinch, I like to use the ePocrates app for my smartphone. I give you permission to cheat a little bit too.

When emergencies do arise, there are three pieces of equipment that you want at the patient’s side: oxygen, an emergency drug kit and an AED. I encourage you not to just take matters into your own hands. Certainly call 911 and let the paramedics and medical doctors do their jobs. Of course you probably do not have an ambulance crew at the ready in your waiting room, so there will be some things that you have to do until help arrives. Your equipment can help you provide emergency interventions and supportive care while you wait.

Oxygen can prove to be a wonder drug and should be used for patients in respiratory distress, in cases of anaphylactoid allergic reactions, for people experiencing chest pain, victims of cardiac arrest, and during the most common emergency: syncope. There are no contraindications for the short-term use of oxygen, and you can never over-do it. To deliver the oxygen to patients, every office should be stocked with a nonrebreather mask and a nasal cannula (some patients feel claustrophobic with a mask on their face) for adults. Have the same on hand in pediatric sizes, if you see children at your practice. Set your regulator to flow at 15 liters per minute (LPM) for a nonrebreather mask and 4-6 LPM for a nasal cannula. Also, think about the portability of your oxygen tank. If a patient needs oxygen in your waiting room, how will you get it there?

Your drug kit should be stocked with medications to help care for the most common emergencies. In addition to oxygen, the ADA suggests six: Aspirin, Nitroglycerine, Albuterol, Diphenhydramine, Epinephrine, and sugar. Dentists who perform conscious sedation will want to add antidotes to opiates (naloxone) and benzodizapines (flumazenil). It is most important that the dental practitioner is familiar with the medications in his/her kit, when to administer them, what route (sublingually, subcutaneously, inter-muscularly or intravenously), and what reactions or side-effects to expect. Before I give any patient a drug, I like to remember that they have four “rights”: Is the “right” patient getting the “right” drug, at the “right” dosage, by the “right” route?

It is also important that you make sure each drug is up to date and in good condition. While others might suggest assigning a staff member to this task once per month, I suggest that you do this yourself. You will be the most familiar with the medications in the kit and their administration. My suggestion is not to trust anyone else but yourself to perform these checks, as you are ultimately responsible for all medical care given in your office. To help you, many companies will provide an automatic refill program.

Most victims of sudden cardiac arrest go into ventricular fibrillation or ventricular tachycardia. Both of these disrhythmias may be corrected by quick defibrillation. For this reason, the New York State Dental Society pushed for it to be law that every dental office have an AED. Keeping your AED centrally located in the office will ensure rapid deployment to patients in your exam rooms as well as the waiting area. Make sure your AED pads are always within their expiration and that the battery is still good. Check your AED unit at least once per month. If the company you bought the AED from has a maintenance / reminder program, let them help you decide when it is best to replace batteries and pads. Place a numbered plastic seal on the zippers of the bag so that you are sure who checked the AED last.

All the equipment and prevention in the world is meaningless without training. EpiPens don’t administer themselves, and patients in cardiac arrest need CPR until the AED arrives. Having an emergency in your office may be one of the scariest moments of your career. How you handle that moment will be determined by how much you have prepared. EVERYONE in the office should have CPR and AED training and dentists and nurses should have periodic refreshers on the emergency drugs and oxygen they may have to administer. Dentists and their staffs who perform conscious sedation should also be trained in Advanced Cardiac Life Support (ACLS). Hold frequent drills in your office so that everyone knows what their role will be during the emergency. Seek help from a rescue professional to help you think of different scenarios and how to handle them.

Dental offices are not immune to a variety of medical emergencies. It is imperative to take steps that may help prevent potential medical distresses, have equipment and medications ready to administer in case of extremis, and prepare yourself and your staff for the most common medical emergencies. Procedures should be in place to handle this crisis as well as you handle fillings.

Your first aid kit should be stocked with materials to help care for the most common emergencies. If there is a potential for serious injury such as severe bleeding, make sure you have sufficient body substance isolation, gauze, roller bandages and blankets. It is most important that everyone who works at your facility is familiar with the kit and everything inside.

It is also important that you make sure each item in your first aid kit is up-to-date and in good condition. I suggest that you do regular checks yourself. If anyone else makes a mistake, you are still the person responsible for the condition of that first aid kit and the availability of first aid supplies.

Most victims of sudden cardiac arrest can often be revived by quick defibrillation (within 3 minutes) with an AED. CPR can help extend this window for a few minutes. If you have an AED, keep it centrally located to ensure rapid deployment to all parts of your facility. Consider multiple units if it will take more than three minutes to retrieve and setup anywhere in your location. Make sure your AED pads are always within their expiration date and that the battery is still good.

Having an emergency in your business may be one of the scariest moments of your career. How you handle that moment will be determined by how much you have prepared. EVERYONE in your workplace should have training in CPR/AED, basic first aid, and blood and air borne pathogens. Hold frequent drills so that everyone knows what their role will be during the emergency. Seek help from a rescue professional to help you think of different scenarios and how to handle them. No one should die at work.

Originally practiced in Europe, therapeutic hypothermia in victims of sudden cardiac arrest involves the purposeful reduction of body temperature to slow the organs’ need for oxygen during. Once cooled, doctors can perform surgical measures to correct the initial cause of the cardiac arrest. The body will then be slowly re-warmed in hopes of returning spontaneous circulation and long term survival.
The reintroduction of oxygen into the brain and other vital organs during Cardiopulmonary Resuscitation (CPR) causes microscopic damage to the cells, known as reperfusion injury. The cell membranes become more permeable, causing the cells to leak fluid into interstitial spaces. This is manifested as swelling. Since the brain is effectively contained within a “box” of finite size, swelling leads to brain herniation and ultimately death. The goal of therapeutic hypothermia is to reduce the amount of brain swelling that occurs during cardiac arrest.
Although therapeutic hypothermia is relatively new to cardiac arrest applications, it has been used successfully for many years in psychiatry, neurology and cardiothoracic surgery. The effectiveness of therapeutic hypothermia continues to be observed in sudden cardiac arrest patients that receive this treatment within an hour of onset. The Virginia Commonwealth University Medical Center reported that the death rate for cardiac arrest patients was cut in half after cooling patients receiving CPR. 1
The American Heart Association changed its guidelines for cardiopulmonary resuscitation and emergency cardiovascular care in 2005 to include the recommendation of therapeutic hypothermia as treatment for cardiac arrest.2 In 2009, the New York City Fire Department (FDNY) announced that cardiac arrest patients treated by any of their ambulances would receive ice saline to begin the cooling process while enroute to the hospital. Additionally, cardiac arrest patients are now only taken to hospitals where therapeutic hypothermia is administered. 3
On Long Island, Stonybrook University Medical Center is begining to practice therapeutic hypothermia for cardiac arrest patients in their ICU with very promising results.4
As resuscitation science continues to advance, we should underscore that good bystander CPR, including the administration of fast, hard and deep chest compressions, along with early defibrillation are important links in the long chain of survival for sudden out-of-hospital cardiac arrest victims. Optimal survival rates are enjoyed by those who receive early intervention and continued care in the hospital.
1Ong, M. Et al. “Controlled therapeutic hypothermia post-cardiac arrest compared to standard intensive care unit therapy”. Presentation to the 2006 Society for Academic Emergency Medicine.
2 “2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care”. Circulation 112, no. 24 (DEcember 2005).
3 Gupta, S. (2009). Cheating Death: The doctors and medical miracles that are saving lives against all odds. New York: Wellness Central
4 Personal conversation with Dr. Sam Parnia, June 2011.

 Have Dummy Will Travel, Inc. can help you fulfill your with annual training requirements in as little as 2 hours or less.  We will come to your workplace and provide bloodborne and airborne pathogen training that is endorsed by the National Safety Council or the American Heart Association.  In addition, we can help you develop and manage a written health and safety plan for your company, assist you in properly reporting work-related injuries and illness, provide a mock “walk-through” inspection of your facility to determine if there are any hazards to your employees and assist you in remediating any issues we might find. 

Have Dummy Will Travel, Inc. is a health and safety training company, specializing in CPR/AED training, first aid and workplace safety.  Click here to contact us today and to see how we can help make your workplace safer. 

 Another study found that although AEDs are prolific in public areas such as airports, sport stadiums and office buildings, less than half of the people populating these areas would be willing to use them and more than half of the people don’t even recognize them.  The take home message from these studies is clear: If you own an AED make sure it is maintained, make sure as many people as possible with access to the device are properly trained and make sure the unit is clearly visible to the general public.

 Have Dummy Will Travel, Inc. provides a turn-key maintenance program for any AED.  We can inspect your AED to make sure the battery and pads are up to date, we can provide CPR and AED training for your staff, family and friends and we can supply signage, wall mounts and accessories to make sure your life-saving device is within easy access.  Click here to go to our AED maintenance page.

 Sudden cardiac arrest is a leading cause of death in North America and Europe.  The chances of a person surviving decline by 7 to 10 percent every minute they are without defibrillation.  Contact us today to speak to a health and safety professional that can guide you through AED training, maintenance and visibility.

Source:  http://www.acep.org/Content.aspx?id=81440

Cardiac arrest happens because the victim’s heart rhythm has changed. The most common cause of cardiac arrest is Ventricular Fibrillation (VF) or Pulseless Ventricular Tachycardia (VT). Both of these potentially lethal heart rhythms are REVERSIBLE IF quickly treated with defibrillation.

Uncorrected, these cardiac conditions rapidly lead to irreversible brain damage and death. After approximately three to five minutes,[1] irreversible brain/tissue damage may begin to occur. For every minute that a person in cardiac arrest goes without being successfully defibrillated, the chance of survival decreases by 7 percent per minute in the first few minutes, and decreases by 10 percent per minute as time advances beyond the 3 minute mark.[2]

Early CPR is so important in increasing the chances of survival because it provides for a manual means of pumping oxygenated blood to the brain when the heart cannot. However, CPR alone will not be effective in returning spontaneous circulation to a cardiac arrest victim.

An Automated External Defibrillator, or AED, is a portable, electronic medical device that automatically diagnoses VF or VT in a patient,[3] and is able to treat them through defibrillation, allowing the heart to reestablish an effective rhythm. For this reason, AEDs are gaining in popularity. Public access defibrillators are mandated by law to be located in public schools, fitness centers, health clubs, public swimming pools, other places of public assembly and most recently, in dentist offices. Other popular places to find a public access defibrillator, although not required by law, include corporate and government offices, shopping centers, airports, restaurants, casinos, hotels, sports stadiums, universities, community centers, workplaces and any other location where people may congregate.

Dentists are amongst the latest group required to have an AED. Legislation passed into law June 2011 requires every dentist office in New York State to have an AED by January 1, 2012. The bill, in its final form, was endorsed by the New York State Dental Association, the American Red Cross of New York and the American Heart Association. As an incentive to purchase AEDs, New York State is offering a $500 tax credit per unit purchased.

Have Dummy Will Travel, Inc. is proud to offer the Philips OnSite AED.  Click here to learn more about why we recommend the Philips OnSite.

References:

[1] “Cardiopulmonary Resuscitation (CPR) Statistics”. American Red Cross. http://www.americanheart.org/presenter.jhtml?identifier=4483.

[2] American Red Cross. CPR/AED for the Professional Rescuer (participant’s manual). Yardley, PA: StayWell, 2006. (page 63).

[3] Kerber, Richard E; Becker, Lance B; Bourland, Joseph D; Cummins, Richard O; Hallstrom, Alfred P; Michos, Mary B; Nichol, Graham; Ornato, Joseph P; Thies, William H; White, Roger D; Zuckerman, Bram D (March 18, 1997). “Automatic External Defibrillators for Public Access Defibrillation”. Circulation (American Heart Association) 95 (1677-1682): 1677.

Who in your company is trained to give first aid? Is their certification current? What should you have in your first aid kit? Is your first aid kit missing anything? When was the last time someone checked to see if it was up to date, or if the packaging had yellowed?

Whether you are a small business owner or managing a large production plant, the possibility of an employee getting hurt on the job is very real. Being unprepared to handle such emergencies in today’s litigious world is risky, at the very least.

Click here to see the OSHA medical standard for industry.