COVID-19 and Medical Emergencies in the Dental Practice
Considering the surge of COVID-19 cases globally and the nature of the virus, the likelihood that dental professionals may have a COVID-19 positive patient in their chair is high. Guidance for emergencies that may occur in dental practices involving COVID-19 positive patients is important. In an article published in July 2020 in the journal British Dental Journal aimed to “provide an overview of the current guidelines relating to the management of medical emergencies in COVID-19 patients in the dental practice.”1
It is advised that all relevant dental staff should prepare for the possibility of a medical emergency in a COVID-19 patient. Though it is unlikely to have a COVID-19 positive patient, during the pandemic dental professionals should assume every patient is COVID-19 positive. If dental professionals become flippant and do not follow appropriate guidelines; the consequences could be disastrous. Resuscitating COID-19 positive patients is particularly dangerous. Performing chest compressions is considered an aerosol-generating procedure by many public health agencies.
Guidance is as follows:
Call for help
Confirm cardiac arrest
Call 911 (999 in England)
Attach AED
Start chest compressions: minimum PPE before starting chest compressions should include gloves, apron, fluid-resistant surgical mask, and eye/face protection.
Start ventilation: minimum PPE that should be donned before starting ventilation procedures include, single-use disposable glove, single-use disposable fluid-resistant overall/gown, single-use filtering facepiece respirator, and eye/face protection
Allocate gatekeeper: this individual should limit the number of people in the room. If an emergency occurs in the waiting room, ask all patients to leave the room.
Infection prevention & control: following the event hand hygiene, environmental decontamination, etc. should be completed.
Debrief
Additionally, the guidance recommends covering the patient’s mouth and nose during chest compressions to reduce the production of aerosols. It is important to run drills to ensure every member of the dental team knows their responsibilities and roles they will play in the event of an emergency. These drills should include safe donning and doffing of PPE to prevent self-contamination.
Ideally preventing a medical emergency would be the best scenario. COVID-19 patients’ respiratory function can quickly decline, if this occurs ensure the patient is sitting upright to help with breathing, administer oxygen, and call EMT. This may prevent the emergency from escalating into a cardiac event.
The authors conclude by stating, “The COVID-19 outbreak presents dental staff with unprecedented challenges and difficulties. They must ensure that they remain up-to-date with national guidelines and that they are prepared to respond effectively should a COVID-19 patient suffer a medical emergency in the dental practice.”
Has your office discussed changes in emergency response since the onset of the pandemic? Does each team member know their role? Have you considered the changes necessary to safely perform CPR on a potential COVID-19 positive patient?
Jevon P, Shamsi S. COVID-19 and medical emergencies in the dental practice. Br Dent J. 2020 Jul;229(1):19-24. doi: 10.1038/s41415-020-1782-5. PMID: 32651513; PMCID: PMC7348561.
