Dental students' ability to locate emergency equipment-lessons learned from aviation.

PURPOSE: The purpose of this study was to evaluate the dental student's ability to locate medical emergency equipment/items at the University of Michigan School of Dentistry clinic. METHODS: A total of 138 second-year dental students (traditional group) participated in this study as part of a simulation-based medical emergencies rotation course held during the winter term of 2014 and 2015. Without prior training, students were tested on their ability to locate nine predetermined items on the clinic floor using a self-reported checklist. Six months later, a convenience sample of 18 students (novel group) from the same cohort were later trained on their location and retested individually. RESULTS: Of the 138 students tested, only 10.14% students could locate seven of the nine items when compared to 100% in the novel group. Only 5.07% of students in the traditional group could locate all items initially, compared with 72.22% students in the novel group. CONCLUSION: Whilst our students have lecture-based knowledge about medical emergencies, the results of our study identified a gap of knowledge of emergency equipment/item location amongst students. Therefore, an intervention performed with a similar group of second-year dental students supported that proper training may be used to achieve retention of knowledge. Based on our "novel group" results, we have incorporated targeted training in the dental curriculum that leads to students being better prepared in locating emergency equipment/items. This study suggests that other populations, such as faculty or staff, may also benefit from hands-on training.

Emergency drug kits: pharmacological and technical considerations.

The risk for complications while providing dental procedures is greatest when caring for patients having significant medical compromise. It is comforting that significant adverse events can generally be prevented by careful preoperative assessment, along with attentive intraoperative monitoring and support. Nevertheless, the office team must be prepared to manage untoward events should they arise. This continuing education article will address basic emergency drugs that should be available in all dental practices and additional agents that become essential for those practices providing various levels of procedural sedation or general anesthesia.

The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care.

Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.

A method for the removal of tungsten carbide rings.

BACKGROUND: The removal of metal rings from fingers is a well-described process that often employs a toothed cutting wheel or bolt cutters to sever the ring and allow it to be pried open. However, tungsten carbide (TC) rings are impervious to these traditional ring-cutting devices. STUDY OBJECTIVES: We sought to describe a method for removal of TC rings from cadaveric fingers and characterize potential complications of the technique. METHODS: On cadaveric fingers, we placed TC rings and created a snug fit by injecting a fluorescein and saline solution. The rings were removed by a controlled crushing technique using a pair of locking pliers. Fingers were inspected under magnification and using an LED (light-emitting diode) black light, and X-ray studies of each finger were obtained. Injuries were characterized. RESULTS: Six rings were applied and successfully removed from six cadaveric fingers through controlled ring shatter. After ring removal, two fingers demonstrated superficial (<1 mm deep) lacerations, one of which had residual debris within the wound. No phalangeal fractures were identified. CONCLUSION: Removal of a TC ring can be performed through controlled crushing using locking pliers. Superficial lacerations and retained debris are potential complications.

Medical emergencies: are you prepared?

Billy Tyne sailed ill-equipped directly into a "perfect storm" at the cost of his boat, his crew, and his life. As a profession, we must not allow our own hubris to ignore the challenges that we are now facing: increasingly complex medical histories, more patients desiring sedation treatment, and more dentists expanding their scope of clinical services. Sadly, a nationally recognized set of guidelines has yet to be adopted. In the meantime, each member of the profession must be prepared to properly respond to any medical crisis that may occur in the dental office. The 6 links of survival provides a solid basis to meet that need.

Medical emergencies in dental practice: 1. The drug box, equipment and general approach.

UNLABELLED: Every dental practitioner needs a knowledge of the diagnosis and management of medical emergencies. This first paper, in a series of two, deals with the general aspects of emergency treatment, including basic principles applicable to all emergencies and a consideration of the management of cardiac arrest. The second paper deals with more specific aspects of medical emergency management. CLINICAL RELEVANCE: All dental practitioners require a knowledge of medical emergency management.

Sports dentistry--what's it all about?

UNLABELLED: This paper provides an overview of dental conditions that commonly affect individuals competing in all levels of sport. Athletes represent a group of individuals who possess specific risk factors for various dental diseases and related injuries. These patients are at greater risk of dental caries, dental erosion and traumatic dental injuries. Therefore, a clear understanding of these conditions is vital for those practitioners who are involved in the dental care of these patients. CLINICAL RELEVANCE: The early diagnosis and management of dental conditions that affect athletes will ensure sound dental health is preserved for these high risk patients. The clinician needs to be aware of a variety of dental conditions that can prevent significant dental trauma and acute manifestations at the time of competition.

Preparing the dental office for medical emergencies.

Modern dental offices must be equipped to initiate prompt emergency care should the sudden need arise. With the elderly population in dental practices increasing, these emergencies will undoubtedly occur. This article discusses the basic emergency equipment the average dental office should possess to allow for an adequate initial response. It also discusses the policies and personnel needed for dealing with emergencies. Among the basic emergency equipment, an office should have syringes, an Ambu bag, a portable oxygen system, a sphygmomanometer (child and adult sizes), and an EKG/defibrillator. Emergency drugs that should be stocked include aromatic ammonia, aspirin, and nitroglycerine. The dentist should also develop a protocol and policy for his/her staff to follow when a medical emergency arise.

Locking plastic tie--a simple technique for securing a chest tube.

A quick and simple technique for securing a chest tube in the prehospital setting is described. The technique makes use of a plastic tie with a self-locking mechanism that is wrapped around the tube and sutured to the skin. The use of a plastic tie is recommended as a valuable component to chest tube kits for use in the prehospital setting.

"Cannot ventilate, cannot intubate" situation after penetration of the tongue root through to the epipharynx by a surfboard: a case report.

BACKGROUND: Surfing is an increasingly popular activity and surfing-related injuries have increased accordingly. However, to the best of our knowledge, there are no reports of penetrating upper airway injuries in surfers. We present a "cannot ventilate, cannot intubate" situation following penetrating neck injury by a surfboard fin. CASE PRESENTATION: A previously healthy 29-year-old Japanese man was swept off his board by a large wave and his left mandible, tongue root, and right epipharynx were penetrated by the surfboard fin. He presented with severe hypovolemic shock because of copious bleeding from his mouth. Direct laryngoscopy failed, as did manual ventilation, because of the exacerbated upper airway bleeding and distorted upper airway anatomy. Open cricothyrotomy was immediately performed, followed by surgical exploration, which revealed extensive ablation of his tongue root and laceration of his lingual artery. After definitive hemostasis and intensive care, he returned home with no sequelae. CONCLUSIONS: The long, semi-sharp surfboard fin created both extensive crushing upper airway lesions and a sharp vascular injury, resulting in a difficult airway. This case illustrates that surfing injuries can prompt a life-threatening airway emergency and serves as a caution for both surfers and health care professionals.

New use of a tracheal tube for rescue breathing in laryngectomees in the community.

The currently recommended method for rescue breathing in people who have had a laryngectomy is mouth-to-stoma. Even if they know what to do, by-standers are likely to find this technique unhygienic and therefore unacceptable. There is no equivalent of the pocket face mask for laryngectomees. This paper describes the practical differences that affect rescue breathing in patients with laryngectomy stomas and proposes a new use of a tracheal tube for rescue breathing in laryngectomees. Ten patients with permanent tracheal stomas scheduled for ENT surgery were ventilated successfully through a tracheal tube with the cuff applied to the outside of their tracheal stomas, following induction of anaesthesia and before the start of surgery. Observations of oxygen saturation, end-tidal carbon dioxide, expired tidal volume and chest movements were within acceptable limits. This device was simple to use and is hygienic and inexpensive. Laryngectomees' relatives, friends or carers with minimal training could use the tube in a mouth-to-tube-to-stoma technique should the need for rescue breathing arise. It could also be used by paramedic and medical staff in a mouth or bag-to-tube-to-stoma technique until a definitive airway can be inserted.

Dor e fatores associados em pacientes atendidos em um serviço de urgência odontológica no sul do Brasil / Pain and associated factors in patients attending an emergency dental service in southern Brazil

O objetivo deste estudo transversal foi avaliaro desfecho dor e fatores associados em pacientes atendidos em um serviço de urgência odontológica no sul do Brasil. Foram avaliados 137 prontuários provenientes de um projeto de extensão para capacitação em atendimento odontológico de urgência da Universidade Federal de Santa Maria (Santa Maria/RS), referentes ao período de abril de 2017 a dezembro de 2018. Os dados contidos na ficha clínica, autorrelatados pelos pacientes, foram coletados e variáveis relacionadas às características socioeconômicas, médicas e odontológicas foram submetidas à análise estatística descritiva e regressão de Poisson multivariada. A prevalência de dor nestes pacientes foi de 65,2%e a hipótese diagnósticamais prevalente foi de pulpite aguda irreversível (46,2% dos casos). A procura por atendimento foi maiorna faixa etária entre 40-59 anos (48,6%), no sexo feminino (64%), em pacientes sem nível superior (85,3%) e os dentes mais frequentemente tratados foram os posteriores (82,7%). Houve associação entre a presença de dor e variáveis médicas, sendo queos pacientes com mais de duas doençassistêmicas apresentaram maior prevalência de dor. O preenchimento inadequado dos prontuários odontológicos foi um achado comum, o que pode prejudicar o estabelecimento do perfil epidemiológico destes pacientes e o planejamento dos atendimentos futuros de forma eficiente, além de poder acarretar problemas jurídicos (AU).

This cross-sectional study aimed to evaluate the pain outcome and associated factorsin patients attending an emergency dental service in southern Brazil. One hundred and thirty-seven (137) patient records from an extension project for emergency dental care training at the Universidade Federal de Santa Maria (Santa Maria, RS, Brazil), relative to the period from April 2017 to December 2018, were evaluated. The data in the records, self-reported by the patients, were collected, and variables related to socioeconomic, medical and dental characteristics were subjected to descriptive statistical analysis and multivariate Poisson regression. The prevalence of pain in these patients was 65.2%, and the most prevalent diagnostic hypothesis was irreversible acute pulpitis (46.2% of the cases). The demand for care was greater in the age group between40-59 years (48.6%), in women (64%), in patients without university education (85.3%), and posterior teeth were the most frequently treated (82.7%). There was an association between the presence of pain and medical variables, being that patients with morethan two systemic diseases had a higher prevalence of pain. The inadequate completion of dental records was a common finding, which can impair the establishment of the epidemiological profile of these patients and the efficient planning of future dental care services, as well as cause legal problems (AU).

Office emergencies and emergency kits.

Preparedness to recognize and appropriately manage medical emergencies in the dental environment includes the following: current BLS certification for all office staff; didactic and clinical courses in emergency medicine; periodic office emergency drills; telephone numbers of EMS or other appropriately trained health care providers; emergency drug kit and equipment, and the knowledge to properly use all items. This update on office emergencies and emergency kits replaces the previous Association report, prepared in 1980 by the Council on Dental Therapeutics.

The automated external cardiac defibrillator: lifesaving device for medical emergencies.

BACKGROUND: More than 350,000 adult Americans die each year of sudden cardiac arrest, or SCA. The event is unpredictable and can occur in patients with no history of cardiac disease or cardiac symptoms. Drugs and cardiopulmonary resuscitation, or CPR, save only a small percentage of victims. The necessary response is rapid application of electrical shock, and the chances of success are reduced 10 percent for every minute of delay. TYPES OF STUDIES REVIEWED: The author reviewed the literature on resuscitation of people who have undergone SCA, and examined the emerging technology of automated external defibrillators, or AEDs, for correcting cardiac ventricular fibrillation. Included is a review of the controversies surrounding AED waveforms and energy levels. RESULTS: Automated cardiac defibrillators are becoming readily available because of improved technology and decreasing prices. AEDs are now commonly found in commercial aircraft, gambling casinos, sports arenas and public buildings, and will soon become as readily available as fire extinguishers. The use of AEDs is being taught in standard CPR courses. CLINICAL IMPLICATIONS: AEDs are being installed in more public locations, including some dental offices. As costs decrease and availability increases, there is significant potential use for AEDs in managing SCAs in dental offices.

Evaluation of techniques for intravenous catheter and tubing fixation.

OBJECTIVE: The aim of this study was to examine two techniques intended to prevent accidental displacement of intravenous catheters after proper establishment of infusion line access. METHODS: After catheter insertion and taping in position, fixation with gauze roll sequentially wrapped around the limb across which the tubing has been extended was compared with the use of a polyethylene roll manipulated by an attached "handle." The experimentation was performed on medical personnel serving as live models. RESULTS: Thirty-eight trials were conducted with 19 of each fixation technique. The variables measured were: time consumption, convenience, general satisfaction, and success score of the fixation. All of the measurements showed that the polyethylene roll was significantly the superior of the two methods. Despite forceful tugging of the tubing, polyethylene fixation virtually prevented any displacement whatsoever and was more than twice as rapid. CONCLUSIONS: We demonstrate a novel device allowing faster and more efficacious fixation of the infusion drip tubing and catheter suggested as the technique of choice in emergency medical field care.

An overview of drugs and ancillary equipment for the dentist's emergency kit.

The concept of a basic (i.e., essential) medical emergency kit suitable for a general dental practitioner varies somewhat between different authorities. A practitioner's choice is also dependant on the proximity of medical aid and the nature of the dental practice. Over recent years the trend has been to restrict the items to a minimum, in the interest of both common sense and safety, for example, just oxygen, adrenaline 1:1000, an oral carbohydrate source, glyceryl trinitrate and aspirin as first options. Ancillary equipment should include an oxygen therapy facemask, a pocket mask and a set of oral (Guedel) airways. Two further medication options for consideration are an aerosol bronchodilator and, in certain circumstances, an injectable antihypoglycaemic agent. This paper provides a selective overview of the subject. An absolute necessity is for dentists to be competent in Basic Life Support skills, and to maintain a complete and current medical history for all patients.