Medical emergencies in the dental office (Case study): Dental assisting
Annabelle is a dental assistant working in a general dental practice with dentist Gwen and is caring for Weston, a 62 year old patient who arrives for a tooth extraction.
As part of the dental team, Annabelle promotes patient safety and quality care by observing and identifying information, preparing for and recognizing the needs of the patient, safely assisting the dentist, monitoring and responding to the patient, and documenting care.
Annabelle knows that while medical emergencies are not common, they can occur during routine dental procedures. Patients often experience apprehension when going to the dentist, or they may have had a negative experience in a dental setting.
This can cause stress and anxiety, which are common triggers for medical emergencies. These emergencies can include syncope or fainting, rapid or deep breathing called hyperventilation, and postural hypotension, also known as orthostatic hypotension, which is a drop in BP and decreased blood flow to the brain that can occur when a patient stands up too quickly after being in a sitting or lying position, causing dizziness, syncope, or even a loss of consciousness.
Other common emergencies include allergic reactions to certain dental materials like latex gloves or topical anesthetics that can cause a rash or even a life-threatening reaction called anaphylaxis, asthma attacks that cause breathing difficulties, hyperglycemia and hypoglycemia, or high and low blood sugar.
Myocardial infarction or heart attack, angina or severe chest pain that's a warning sign for a heart attack, cerebrovascular accident or stroke when blood flow to the brain is interrupted, and seizure or convulsion.
Next, Annabel calls Weston from the waiting room. As they walk to the operatory, she sees that Weston appears to be walking slowly.
He's breathing heavily and is pale and sweating. She recognizes these as possible signs of stress and anxiety, but that they also could be a sign of a serious medical condition.
Weston, how are you feeling today? I'm a little tired and short of breath, but I just finished a walk outside, so I probably need to rest.
The pain in my teeth is getting worse though, so I hope Doctor Gwen can do something. OK, let's get you seated in the chair and get your vital signs.
Annabelle takes Weston's vital signs, which are P 112 BPM, respirations 26 breaths per minute, BP 154/94 millimeters of mercury, and oxygen saturation of 93% on room air.
His pain rating is 6 on a 0 to 10 scale, which he says he feels in his teeth and left shoulder. Annabelle documents this information in the dental record.
Annabelle understands that it's important to prepare for and recognize medical emergencies. She routinely participates in the team's preparations for medical emergencies by reviewing normal vital signs, common signs and symptoms of medical emergencies, and their established emergency protocols.
She also participates in mock emergencies with the rest of the dental team, and she recalls that the dentist will lead the team and remain with the patient to determine care, and the receptionist will call 911 and communicate with the paramedics.
Annabelle knows her role isn't to diagnose or determine treatment plans, but to support the dentist in these emergency situations.
So her responsibility is to obtain supplies and equipment, monitor vital signs, and assist the dentist with needed tasks.
Annabelle recognizes that Weston's abnormal vital signs, pallor, sweating, slow gait, shortness of breath, fatigue, and pain could indicate that he's experiencing an acute myocardial infarction.
So she immediately communicates Weston's signs and symptoms to dentist Gwen. Annabelle is now ready to safely assist dentist Gwen as they respond to the emergency.
After dentist Gwen comes into the operatory with Weston, Annabelle retrieves the automated external defibrillator, or AED, oxygen tank, and emergency medications, including aspirin and nitroglycerin, and brings them to the operatory.
Dentist Gwen asks Annabelle to have the receptionist call 911. Annabelle relays the request to James, the receptionist, clearly communicating Weston's name, age, and signs and symptoms.
While awaiting the arrival of emergency services, Annabelle continues to monitor and respond as the team continues to follow the established emergency protocol.
She assists dentist Gwen in placing AED pads on Weston. At dentist Gwen's request, Annabelle administers oxygen to Weston and takes another set of vital signs, which are P 118 BPM, respirations 28 breaths per minute, BP 162/102 millimeters of mercury, and oxygen saturation of 98% on 2 L of oxygen.
Annabelle reports these clearly and documents the updated vital signs in the dental record. When the ambulance arrives at the clinic, Annabelle stays with dentist Gwen in case additional tasks are needed and listens while the dentist reports Weston's history and current condition to the paramedics.
Annabelle knows that her documentation of events is part of the dental record that demonstrates that the standard of care was provided.
She also knows that the dental record is a legal document and recalls the importance of documenting the time of events, all actions taken, and the patient's response.
After Weston is transported from the clinic by the paramedics, Annabelle reviews all documentation to make sure it's complete.
All right, as a quick recap, Annabelle observed and identified information that indicated her patient was experiencing early signs of a medical emergency.
Together with the dental team, she prepared for and recognized medical emergencies by reviewing emergency protocols, participating in mock emergency exercises, and reviewing team roles.
She immediately reported her findings, assisted dentist Gwen during the emergency, and continued to monitor and respond to Weston until the paramedics arrived.
Finally, she ensured all documentation was accurate to support provision of the standard of care.
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