Are you really ready?

After nearly three decades of lecturing and teaching dental professionals, I feel like I have seen it all when it comes to what can happen ...

Jan 1st, 2012

By Louis Malcmacher, DDS, MAGD

After nearly three decades of lecturing and teaching dental professionals, I feel like I have seen it all when it comes to what can happen during a seminar. Earlier this year, something happened that never has before — an attendee went into a full cardiac arrest right in the middle of my lecture. Hopefully this article will be a good kick in the pants to all of us to update our emergency training and medical emergency kits in our office.

Here is what happened. I was at the front of the room just about to delve into a new hot topic in dentistry when, all of a sudden, I saw about 20 people in the room of a few hundred stand up and give their attention to someone in the audience. I walked over to see what was going on, and a few people were holding one of the attendees in a semi-reclined position. He looked like he had fainted, except that his eyes were open.

We immediately moved some chairs away and placed this man on the floor. We yelled out to call 911, and a couple of dentists ran into the hallway to look for an automated external defibrillator (AED). Two other dentists and I monitored the doctor’s pulse, which was weak and going fast. He was totally unresponsive, not sweaty, and we found out from the person sitting next to him that he had experienced no pain and had not complained of anything wrong.

Another dentist, Dr. Frank Martello, and I immediately began chest compressions on this patient at a rate of about 100 compressions per minute to a depth of two inches. For those who need a reminder about CPR, there are conflicting guidelines as to whether or not to include rescue breathing, but everyone agrees to begin chest compressions as soon as possible. Previously, the acronym for starting CPR was by checking the ABCs (airway, breathing, compressions).

The most significant changes in the 2010 AHA Guidelines involve changing ABC to CAB (compressions, airway, breathing). This change asks rescuers to begin chest compressions right away. For victims of sudden cardiac arrest, the critical elements of resuscitation are chest compressions and early defibrillation, which will begin earlier if there is no delay to open the airway and give breaths. If the patient is unconscious and unresponsive, take a quick look to see if he or she is breathing normally, and immediately begin compressions while someone calls 911. For those who have never actually done chest compressions, they should be done in a pretty hard and fast manner, a few fingers above the notch in the sternum. While you are doing chest compressions, you will hear and feel some popping noises and possibly ribs cracking.

I can tell you that when you’re in the middle of a situation like this, it seems like it takes forever for emergency services to arrive, when in reality it was probably only about seven to eight minutes. We found out later that there are no AEDs in the halls of the convention center because they have full-time EMTs on staff. But because it is such a big convention center, it still took about seven to eight minutes for them to get to our meeting hall.

The EMTs got straight to work by hooking up an AED. The AED diagnosed the patient as being in ventricular fibrillation (V-fib). As you may remember, V-fib is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly. While there is activity, it is undetectable by palpation (feeling) at major pulse points of the carotid and femoral arteries. This means that the heart muscles were just floundering around without pumping any blood. At this point, the AED did what it was supposed to do — shocked the patient three times until some heart rhythm was established.

As we all watched in amazement, the EMTs then drilled, and I do mean drilled, a central line into the long arm bone of the patient with an intraosseous syringe attached to a dremel drill. The long bones in the arms and legs are perfectly suited to infuse saline and medications, and they are easily accessible. The EMTs started the patient on saline, intubated him, and Dr. Martello and I kept up the chest compressions until they set up an automatic chest compression machine. This machine was a true wonder and kept up contractions on the dentist as the EMTs took him out on a gurney to the local university hospital.

The great news is that within 18 minutes of leaving the convention center, the patient was in an operating room and two stents were placed into his heart. I spoke to this dentist a week after the course, and he was home and had just done a little bit of gardening in his yard. Yes, he was quite sore and actually did have a couple of cracked ribs, but he was alive and very thankful, as we all were.

Training, training, training. This example is why you take CPR training repeatedly, so that in an actual emergency you know what to do almost automatically, and you don’t even have to think about it. I have been privileged to perform CPR now on five people, and thankfully they all lived. Some have suggested that maybe it’s me; maybe people just like to drop around me. I don’t know what it is, but it sure is a good thing to be prepared and trained.

Now it’s time for a kick in the pants. When was the last time you checked your emergency medical kit? Do you even know where it is? Have the medications expired? What’s in it and do you know how to use it? I have always been of the opinion that you don’t need a complex medical emergency kit unless you have had advanced training. A basic kit with some common, easy-to-use medications is the right fit for most dental offices.

Does your office have an AED? In some states it is now mandatory for dental offices to have one on site, and it is a good idea for every dental office to have one and for every team member to know how to use it. It has been said (only half-jokingly) that if the dentist in the office is a middle-aged male, an AED is essential because chances are good the dentist may be the primary beneficiary of this equipment. All joking aside, it is time to treat the dental office as a primary health care facility that is properly equipped for emergencies.

Because of this experience, I had our team find one of the best AEDs and medical emergency kit (STAT DDS Emergency Medical Kit) on the market at the best price available. Get an AED and a simple-to-use medical emergency kit for your office today! Every dental office needs to be prepared.

The same concept can be applied to our dental careers. The key to a happy and successful dental practice is training and education on new techniques, so that you can produce successful patient outcomes over and over again. Certainly a lecture atmosphere can be a wonderful learning experience, but nothing replaces hands-on training, whether it is on models or live patients. Can you imagine learning CPR training by lecture only? Hands-on training where you physically go through the movements, whether for CPR or other dental-related training such as restorative, implants, Botox and dermal fillers, removable prosthodontics, or exodontia, is essential to train your hands to perform the procedure so that when it comes to crunch time, you will be ready to go. Your brain will run through the procedure and guide your hands to properly carry it through.

I thoroughly enjoy all of my teaching activities, whether it is lecture or hands-on. Here is the way I look at it — if I can motivate attendees at a lecture to add new things to their office and improve their practices, then I have accomplished my goal as a teacher. When I teach one of my hottest topic hands-on courses, and attendees learn how to actually perform new techniques that they can instantly integrate into their office, then I have accomplished my goal as a teacher and a dental professional.

Hands-on training is what made you a dentist. Hands-on training in CPR is what prepares you and your entire dental team for emergencies, so make sure your training is up to date. That same lesson applies to your dental career — get some hands-on training and make sure you are up-to-date with the latest techniques, products, and technology in dentistry that will directly benefit your patients.

Dr. Louis Malcmacher is a practicing general dentist and internationally known lecturer, author, and dental consultant. An evaluator emeritus for CLINICIANS REPORT, Dr. Malcmacher is the president of the American Academy of Facial Esthetics at facialesthetics.org. Contact him at (440) 892-1810 or email drlouis@FacialEsthetics.org. His website is www.commonsensedentistry.com, where you can sign up for a free monthly e-newsletter.

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