ly assesses its CPR methods and procedures making modifications when needed. As a result, previously taught ideas could
undergo minor to moderate variations that healthcare providers
may be unaware of if refresher courses were taken biannually.
Action #6: Know the Location and Proper
Utilization of Emergency Drugs and Equipment
Acquiring and maintaining emergency drugs and equipment
for the dental practice is an essential component of emergency
preparedness. Too often, dental teams make the mistake of
storing emergency kits in locations that are difficult to access.
Drugs and equipment should always be stored in a central
location for quick and easy retrieval during urgent situations
to minimize response time. In addition, it is plausible for an
emergency event to occur outside of the dental operatory; as
a result, storage cases or carts containing essential drugs and
equipment must be portable so that teams can respond to any
person in any room of the office.
Oxygen (O2) is used in almost all emergency situations with the
exception of hyperventilation.
5 If possible, O2 saturation levels
should be monitored with a pulse oximeter before, during and
following oxygen therapy. In addition, high flow oxygen ( 15
liters per minute) should be administered and titrated accordingly based on O2 saturation levels when managing a critically
Oxygen should always be available in a transportable unit,
preferably an “E”-size cylinder which holds over 600 liters, so
that it can be administered in any area of an office.
5, 15 Portable
oxygen tanks enable the dental team to deliver oxygen under
positive pressure to anyone who is unconscious or not ventilating properly. Bag-valve-mask devices (i.e., Ambu-Bag)
with an oxygen reservoir connected to an oxygen supply is the
most efficient technique of ventilating high concentrations of
inspired oxygen in patients when respiration has ceased.
Automated External Defibrillator
The automated external defibrillator (AED) is an indispensable piece of equipment that has become the standard of care
in oral health care settings. According to the American Heart
Association, more than 350,000 cardiac arrests occur outside
of the hospital setting in the United States each year.
life-threatening medical condition is typically caused by ventricular fibrillation (VF), an abnormal heart rhythm in which
the electrical impulses in the heart’s lower chambers become
rapid and erratic, often without warning.
16 As the heart quivers
uselessly, it loses its ability to pump blood to the body’s vital
organs. Failure to immediately respond to cardiac arrest will
result in loss of consciousness and respiratory activity followed
The dental team’s basic action plan for a Sudden Cardiac
Event (SCA) must be designed so that an AED is deployed in
a quick and efficient manner as the survival probability is near
zero after eight to ten minutes. Successfully managing a SCA
entails immediately recognizing the emergency, rapidly initiat-
ing a 911 call, and deploying an AED within 4-5 minutes.
AED’s are voice-prompted, computer-driven, devices
that work by analyzing the heart’s rhythm releasing an elec-
trical shock to the heart via pads placed on the victim’s chest
if needed. This shock, called defibrillation, is the only effec-
tive treatment to reestablish a normal sinus rhythm when a
person is experiencing cardiac arrest.
15 It is worth noting that
excessive chest hair can interfere with the AED’s pad to skin
contact. While some AED devices include razors, chest hair
can be more quickly removed with a piece of duct tape to al-
low for better adherence of the pad to the victim’s chest. Other
important AED considerations include placing pads at least
one inch from pacemakers and not deploying the device when
metal objects (i.e., jewelry, piercings, the metal underwire of a
bra) are in close contact with the adhesive pads.
AED’S are extremely effective in restoring a normal
heart rhythm when it is deployed immediately and operated
properly. Statistics indicate that each minute without defibril-
lation results in a decrease in survival rate by approximately
17 The AHA now includes defibrillation in its “chain of
survival,” and since 1998, hands-on AED training is included
in all AHA Healthcare Provider and Heartsaver® courses.
Furthermore, some states, including Florida, Washington, and
Illinois, mandate that dentists keep an AED on premises.
Emergency preparedness is particularly central in saving
the life of a SCA victim because it impossible to predict when
an event will occur. Most victims of SCA have never been la-
beled as “high risk”, roughly 20 percent have no prior history
of heart disease, and 10 percent of SCA events occur in persons
under the age of 40. What’s more, the overwhelming majority
of SCA events do not occur in a hospital type setting.
Emergency Drug Kit
The contents of the emergency kit should be packed in an
appropriately labeled designated storage unit. Furthermore,
contents should be checked periodically to ensure that no drugs
in the kit have expired. According to Rosenberg (2010),
the following drugs should be included in the basic drug kit
for dental practice: epinephrine (for treating cardiovascular
and respiratory manifestations of acute allergic reactions),
diphenhydramine (for management of mild allergic reactions),
nitroglycerin (for treatment of acute chest pain caused by
angina pectoris), bronchodilators (to treat bronchospasm
caused by an asthmatic attack or anaphylaxis), glucose (to treat
hypoglycemia), and aspirin (to prevent further clot formation
during an evolving myocardial infarction). Box 3 lists the
basic emergency drugs and equipment for the general dental
practice. Note that the kit would be more extensive for the
dental provider who administers oral sedation or intravenous