CPR in the dental chair: Preparing the dental office to respond to cardiac arrest
Those who work in dental offices will rarely (if ever) have to deal with life-threatening emergencies. But sometimes, at-risk patients such as the elderly and those medically compromised will undergo procedures that will aggravate pre-existing conditions, or will have adverse reactions to anesthesia. Among the possible emergencies that a dental staff may encounter, sudden cardiac arrest (SCA) is the among the most likely to result in the death of a patient.
Treating sudden cardiac arrest will require a coordinated effort on the part of staff in order to effectively activate the “Chain of Survival” required to afford the victim the best chance of recovery. For the first responder, this will include rapid activation of EMS personnel, rapid defibrillation, and early application of effective CPR. These steps must be initiated as quickly as possible, and thus requires premium, frequent training for the entire office staff. This means keeping everyone up-to-date on their CPR certifications, and training the staff as a cohesive unit, rather than everyone learning separately. CPR Seattle has provided BLS/CPR for Healthcare Providers classes for many dental offices, and there a few things we suggest keeping in mind when working in such an environment.
Identify a team leader (generally, but not necessarily the dentist). Someone will need to coordinate the rescue effort. We recommend at least one person per shift be designated as such. Keep in mind that everyone, not just the team leader, needs to be trained in CPR. An important consideration is that there may be three different levels of CPR training present in the dental office:
- Heartsaver CPR (lay rescuer), essentially one-rescuer CPR and AED training
- BLS/CPR for Healthcare Providers, which also covers two-rescuer CPR and bag-mask use
- ACLS, where the use of IV/IO therapy and drug administration is learned and practiced.
Each office must devise a plan with the possibility that each staff member may have learned different guidelines for CPR (most college dental programs will require students to have BLS certification when entering the program).
- Make sure that at-risk patients are designated as such. Make sure a complete medical history is obtained and evaluated. Referral of high-risk patients to a hospital dental residency may be prudent.
- Most emergencies seem to develop out of fear and pain. Manage these before an emergency develops.
- Equipment such as a stethoscope, a blood pressure cuff, and a system for delivering oxygen should be kept at hand. An AED will be indispensable, and in some states (such as Washington), a legal requirement. Use of an advanced airway is recommended (endotracheal intubation or Laryngeal Mask Airway) for those practitioners trained in their use.
- CPR practice during training sessions should be performed in both the operatory and the office/waiting room – anywhere a victim may be. There are considerations to make for patients who suffer cardiac arrest while in a dental chair; some studies indicate that in some cases CPR may not be effective unless a victim is on the floor, others have demonstrated the opposite. If the patient can be quickly moved to the floor without delaying CPR, then this is generally recommended. If the patient cannot be moved, or cannot be moved without delay, consider placing a stool underneath the chair to provide support. Alternately, a cardiac board can be used when inserted underneath the prone patient. When you have onsite training take place, place mannequins in the dental chairs for at least part of the practice session so that everyone can experience the adjustments they may have to make.
There is an online resource at dentalcare.com that can help dental offices learn to function as an effective response team. The five-hour course, entitled “Management of Medical Emergencies in the Dental Office” is intended for Dentists, Dental Hygienists, Dental Assistants, Dental Students, Dental Hygiene Students, and Dental Assistant Students. It covers all aspects of managing emergencies and can be taken online or downloaded in a PDF (registration is required to take the test and record continuing education credits).
There are also several ADA online continuing education classes that may be of use in preparing for office emergencies:
- Recognition and Management of Complications during Minimal and Moderate Sedation
- Bare Bones Basic Emergency Drug Kit
- Impact of Advances in Diabetes Care on Dental Treatment of the Diabetic Patient
When an emergency develops, those offices that can best manage it successfully are those that know there is no substitute for thorough training, practice, and planning. Keep all staff trained and updated. CPR classes don’t have to wait until a certification card expires; the more often training takes place, the more effective the rescuer (contact CPR Seattle to schedule a “BLS scenario session” to give everyone a quick chance to review and practice their skills together in the workplace). Stay updated on the latest guidelines. Make sure everyone in the office is familiar with and can operate the AED.
Odds are you won’t have to perform CPR on any patient. In the event you do, you need the fastest and most comprehensive response possible. Practicing your CPR in the environment where you may have to perform it will go a long way towards ensuring your patient has the best chance of survival.
Hass, Daniel. Management of Medical Emergencies in the Dental Office: Conditions in Each Country, the Extent of Treatment by the Dentist. Anesth Prog. 2006 Spring; 53(1): 20–24.
Dying in your chair - Could you and your staff handle a patient medical emergency and avert the worst? Eileen White, dentalproductsreport.com
Laurent F, Segal N, Augustin P. Chest compression: Not as effective on dental chair as on the floor. Resuscitation. 2010;81(12):1729.
Fujino H, Yokoyama T, Yoshida K, and Suwa K. Using a stool for stabilization of a dental chair when CPR is required. Resuscitation. 2010;81 (12):1729.
Phero, James C. Basic Life Support is Critical to Successful Cardiopulmonary Resuscitation. Inside Dentistry, March 2011, Volume 7, Issue 3
Lepere AJ, Finn J, Jacobs I. Effiacy of cardiopulmonary resuscitation performed in a dental chair. Australian Dental Journal, 2003