Time to Review Procedures

Jeffrey Caso

13 years ago

Last Saturday morning, usually a busy but mellow day, I was tested by a patient, and while all turned out well, it got me thinking. A routine direct composite on tooth #7 turned into a medical emergency very quickly. I have been treating this 17-year-old patient since she was three years old. Other than hygiene, sealants and Invisalign she has never needed any other treatment. On this day she presented with an incipient Class 3 lesion on the mesial of # 7. We decided to treat it today as she has a very busy schedule and is hard to appoint. Her mother warned me that just recently she has been having difficulty accepting treatment at her physician's office, and last week fainted when having a throat culture.

I spent a few extra minutes explaining to her what we needed to do and talked her through the injection. She tolerated it well, and in a few minutes I began the procedure with the high-speed drill. In a flash she passed out. I stopped immediately and repositioned the chair to lower her head. I spoke to her and she came back quickly. I held a cold compress on her forehead. Her pulse was steady, and bam, out again. This time was longer and I started to become more concerned.

We train for these situations, and the staff was on it from the start. In a quiet and efficient way, the emergency kit was opened and placed by my side. The oxygen tank was placed at the ready. BP cuff, pulse ox and AED were kept out of sight but placed within reach. We all were concerned that if this skittish patient saw a lot of equipment she would only get worse. Fortunately, as soon as it began it was over.

She came to, started to talk, regained her color, normal pulse, BP ok. Just embarrassed. We slowly, finished the procedure, which is a weird thing to do in light of what just happened. It was necessary to close the tooth up and I felt that creating more anxiety with reappointing her and having to go through this again was just not worth it. The remainder of the procedure was relatively easy. I followed up with a phone call at the end of the day and all was fine. The mother praised the way the office handled the situation.

So, when Monday came and I had the full staff in, I rewarded them with lunch and took the opportunity to go through other emergency scenarios. We had a nice time and learned some new things and refreshed other things. Watching any patient go through this - especially a young patient - can be overwhelming. The facial color change and twitching can be frightening. Your staff needs to know what to do without thinking.

Use this blog post as an opportunity to review your emergency protocol, check your equipment, if you do not have an AED in the office, get one. Retrain your staff and run scenarios right down to what each person should be doing when you call 911.

Don't wait for the emergency to happen, prepare, rehearse and rest easy.