|Year : 2021 | Volume
| Issue : 5 | Page : 741-747
The knowledge and awareness of medical emergencies and management among dental students
Khadijah Mohideen1, Balakrishnan Thayumanavan1, C Krithika2, Rafique Nazia3, Balasubramaniam Murali1, C Pravda4, Maimoon Arshadha5
1 Department of Oral Pathology and Microbiology, Sathyabama Institute of Science and Technology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
2 Department of Oral Medicine and Radiology, Dr. M.G.R. Educational and Research Institute, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India
3 General Dentist, Andaman and Nicobar Islands, India
4 Department of Oral Medicine and Radiology, Sathyabama Institute of Science and Technology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
5 General Dentist, Dubai, United Arab Emirates
|Date of Submission||23-Sep-2020|
|Date of Decision||30-Oct-2020|
|Date of Acceptance||18-Nov-2020|
|Date of Web Publication||05-Jun-2021|
Department of Oral Pathology and Microbiology, Sathyabama Dental College and Hospital, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Every dentist should anticipate being confronted with a medical emergency (ME), and one should always be ready to treat the most catastrophic ones. Aim: This study aimed to assess the knowledge of dental clinical students of Tamil Nadu in the ME understanding and management to create awareness toward patient care. Methodology: A total of 768 dental students, including final-year students and residents from different colleges, took part in the questionnaire-based cross-sectional study. The selection of study participants was by the convenience sampling method. The questionnaire contained thirty closed multiple-choice questions to assess their knowledge of MEs. Microsoft Office Excel software was used for compiling the answers. The descriptive analysis of the data is exhibited in graphs. Results: The majority of participants were mindful of the vital signs; only 55% of the participants know the importance of checking their respiration rate. The knowledge of identifying MEs such as anaphylaxis was 91%, and only 27%–37% of the respondents knew to identify angina, transient ischemia, and lidocaine toxicity. Approximately 15%–40% of the respondents only knew the management of angina, cardiac arrest, hyperventilation, respiratory obstruction, and seizure. Only 10% agreed that the best office emergency kit should be prepared by themselves. Roughly 78% of the respondents were conscious of the patient's referral whenever necessary and aware of state dental acts. Conclusion: This study reflects a significant need for training in executing ME among dental students who are to transmute into future dental professionals.
Keywords: Awareness, dental students, emergency kit, management, medical emergency
|How to cite this article:|
Mohideen K, Thayumanavan B, Krithika C, Nazia R, Murali B, Pravda C, Arshadha M. The knowledge and awareness of medical emergencies and management among dental students. J Pharm Bioall Sci 2021;13, Suppl S1:741-7
|How to cite this URL:|
Mohideen K, Thayumanavan B, Krithika C, Nazia R, Murali B, Pravda C, Arshadha M. The knowledge and awareness of medical emergencies and management among dental students. J Pharm Bioall Sci [serial online] 2021 [cited 2022 May 28];13, Suppl S1:741-7. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/741/317530
| Introduction|| |
Medical emergencies (MEs) may occur at any time, can be immediately triggered by long-standing dental procedures. The MEs can also be succored by just being benevolent to grasp the beings' fear and edginess. The incidence of MEs had reported at least two crises in a year. Another study had pointed out the frequency of 164 events per million dental visits. A previous study also stated that dentists who practice for four decades would have exposed between 9 and 11 emergencies. About three-fourth of dentists in the UK have witnessed nonlife-threatening crises in their practice.
| Methodology|| |
The current cross-sectional study used a model of the self-administered and structured questionnaire comprising thirty closed-ended multiple-choice questions and complemented by 800 final-year students and interns, given the assurance of confidentiality of their responses. The questionnaire form's reliability established using a pilot test and validity assessed by expertise check. This type of convenience sampling was used to select the study participants. Out of overall forms, filled were 768 forms. The remaining 32 questionnaires were incomplete or filled by either an obligation/uninterested in revealing information, and few had not returned it. Hence, we did not include the study's incomplete forms, and the response rate was 96%. The survey encompassed part A and part B. The “part A” section comprised demographic variables included gender and year of the student. The part B section consists of five segments, with a total of thirty questions. The answers were compiled with Microsoft Office Excel software. The descriptive analysis of the data was exhibited in graphs.
| Results|| |
The questionnaire comprises five segments – (a) knowledge of vital signs and measurement, (b) knowledge of diagnosing the ME, (c) the pathophysiology of MEs, (d) managing MEs, and (e) preparedness to avoid MEs [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e.
|Figure 1: Questionnaire: (a) Section a, (b) Section b, (c) Section c, (d) Section d, (e) Section e|
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Knowledge of vital signs and measurement
Although most 96% of participants check the patient's vital signs before proceeding any treatment, only 70% of them acknowledged the occurrence and identification of a ME, eased by the patient's vital signs. They had sufficient knowledge, nearly 78%–83%, about the measurement of the vital signs. Among 768 participants, 70% of respondents preferred to check the carotid artery's pulse during an emergency. Approximately 83% of students knew to diagnose tachycardia. Among them, only 55% of the participants would choose to check and record the patient's respiratory rate when they were not attentive [Graph 1].
Knowledge of diagnosing medical emergencies
Nearly 80% of the participants stated that syncope to be the most frequently occurring medical crisis, and they knew to identify the signs and symptoms of the same. Still, only 37% of students could pick up signs of transient ischemic attack. The identification of MEs such as allergy, anaphylaxis, asthma, and hypoglycemia was appreciable. It was around 75%–90% in the present study. Still, only 30% of the respondents were able to identify symptoms of angina [Graph 2].
Knowledge of pathophysiology of medical emergencies
More than half of the participants, nearly 72%, agree that most emergencies happen during or immediately after the administration of local anesthesia (LA). The majority of about 86% of respondents were aware of the consequences of over drug dosage or hypersensitivity reactions. Only 27% of the participants were mindful of psycho-behavioral patterns while on LA administration, knew to identify lidocaine toxicity and the root causes. Nearly 65% of the participants knew the causation of hyperventilation. However, only 41% of the participants only knew the etiology of syncope [Graph 3].
Management of medical emergencies
Nearly 83% of participants knew to manage syncope. Around 39% are only aware of respiratory obstruction and breathing difficulty management during a dental procedure. Most of the participants, 75%, knew to immediately ease the patient with asthma signs using an Albuterol aerosol inhaler. Only 15% of participants would choose to call emergency service and proceed to cardiopulmonary resuscitation (CPR) if the patient suffer from cardiac arrest. Firmly 77% of the respondents replied that diabetic patients might encounter hypoglycemia, and they should get immediately treated with oral sugar substitutes. Few participants, 25%, only knew about coaching techniques for managing hyperventilation. Very few nearly 38% of the participants were aware of the management of epilepsy during dental treatment. Approximately 72% of the participants knew the need for nitroglycerin availability in the emergency kit and the administration. However, only 30% of participants were very confident to handle MEs such as myocardial infarction in the dental office efficiently. About 80% of the respondents answered correctly about anaphylaxis and administration of epinephrine. Still, they were not aware of hydrocortisone indication for the prevention of recurrent anaphylaxis [Graph 4].
Preparedness to avoid medical emergencies
Only 10% agreed that the best office emergency kit should be prepared by themselves. A maximum of 73% of respondents accepted that knowing the patient's problems will improve the emergency plan, avoid future crises, and provide appropriate patient care. Nearly 70% of the participants agreed on updating medical history for frequently visiting patients, knowing patients' medications, and measuring vital signs could prevent most MEs. Roughly 78% of the respondents were conscious about referring the patient for medical consultation whenever necessary, and they were also aware of state dental acts [Graph 5].
| Discussion|| |
A survey included 4309 dentists from 50 US states and seven Canadian provinces established that 30,608 MEs had happened over 10 years., None of these crises are dentally concerned with but are possibly life-threatening medical problems that occurred, while the patients were on dental therapy. The literature had recognized about 3% of Brazilian dental professionals had experienced cardiopulmonary arrest. Five percent of dentists from Ohio had implemented CPR to manage crises in their clinical carrier. The rise in the number of deaths during dental therapy increases medicolegal case records. These studies had stressed that MEs seem to be growing in the future. The dentist's experience and expertise will speak by analyzing the patient's bodily etiquette and listening. If the brain is tuned, the emergency will not frighten them and let them manage the patient confidently and efficiently.
Hence, dental practitioners must be familiar with relevant medical problems and have proper knowledge of oral health-care complications, treatment, and possible medical circumstances. Lack of wisdom associated with the patient's vulnerability lead to a medical/dental emergency. A medical crisis is distinct as a circumstance arising due to disease, anxiety, and resultant complications during the therapeutic procedure, putting the patient at risk. While urgency is a state with no substantial risk to the patient. However, an instantaneous standard of care is of ultimate significance in both cases. The standard care is depicted as “what a person with the same level of experience would have done in similar circumstances.” The dentists who had adequate training in essential life support measures do not feel proficiency in delivery., Furthermore, basic and advanced life support skills deteriorate after a few months., The lack of confidence in handling MEs can lead to potential concerns, resulting in legal action.
A life-threatening crisis can happen to anyone at any time. Most of the MEs occurring in the dental office are due to the patient's increased stress apprehension. Hence, it is indeed very crucial for the patient to stay calm before any treatment establishes. The patient should not be petrified before undergoing or during the therapeutic procedures but instead letting them express their sensitivities. The adequate air availability, the right amount of free space around, and trying best for the patient not to face anxiety may avoid a ME. Diazepam is a beneficial premedication for relieving stress and pressure in patients who are to undertake dental surgical procedures.
The measurement of vital signs is valuable in detecting a ME. One should record the temperature, blood pressure, pulse rate, and respiratory rate before any dental therapy., Sometimes, recording the weight of the patient is unnoticed. The due importance should be given to obese patients since most of them may be prone to cardiac issues.
We recognized that the maximum occurring medical crisis is syncope. Usually, the children are not likely to be syncope victims since they do not hide their fear and are communicative. The majority of the dental students in this study were aware of syncope management and the Trendelenburg position but were not aware of the stimulating factors and syncope prevention. The diagnosis of the cause of an emergency is a vital key to lessen it. For example, factors like fear and anxiety may predispose MEs such as hyperventilation and syncope. A crucial aspect of managing a ME is to avert or correct the heart and brain tissues' inadequate oxygenation. Unfortunately, most dentists were not trained in understanding the etiology, signs, and symptoms of angina and transient ischemia. Successful emergency management depends on the recognition of pathophysiology, along with an immediate response., According to a dental negligent act, if the patient develops anaphylaxis and dies after LA without an initial test dose, the dentist will be held liable. Very few of the respondents were confident to deal with patients who act strangely being on lidocaine toxicity. Most of the respondents could not find out the toxicity. Inadequate awareness about the emergency conditions' etiology makes the dentists unable to handle the circumstances when an emergency occurs.
The confidence in estimating signs of anaphylaxis/allergy/hypersensitivity, asthma, and hypoglycemia was awe-inspiring. Simultaneously, the dentist needs to get skilled proficiently to manage alarming emergency circumstances and related problems promptly to save the patient, making the dental surgeons more capable and self-assured in their clinical practice. Very few possessed the knowledge of breathing coaching to ease hyperventilation and the management of angina patients. The seizure occurring in the dental chair must be managed by the sequential steps such as discontinuing the procedure instantly and placing the patient on his/her lateral side to reduce foreign material aspiration probabilities. Only the least number of respondents were aware of midazolam buccal or intranasal route in managing seizures. A delayed or nonresponsive reaction to a ME as if cardiac arrest may significantly worsen the prognosis. The immediate implementation of CPR can increase the chances of survival after a cardiac arrest. Adequate training is essential to perform immediate CPR in the case of MEs. A previous study had found that the availability of the pocket oxygen mask in the clinics was only about 18.3%. The present research recognized that approximately 15%–40% of the respondents were only aware of mandatory oxygen administration in cardiac arrest and severe respiratory obstruction. Mild-to-moderate respiratory obstruction or choking relief depends on the patient's consciousness and responsiveness to repeatedly performed abdominal thrusts (Heimlich maneuver). The present study suggests that students need substantial training in controlling hyperventilation, seizures, respiratory obstruction, angina, and cardiac arrest. The basic life support training provides proficiency in managing MEs, which includes an assessment of the position of the patient (P), assessing circulation (C), maintaining the airway (A), and supporting breathing (B) (CABs). After considering CABs, the dentist should initiate definitive care (D) for the emergency.,
Many dentists were aware that recording vital signs before dental treatment, updating the patient's medical history in their subsequent visits aid in recognizing their underlying disease and medication and thus beneficial to prevent future complications. They were also conscious about referring the patient for medical consultation whenever in need. The present study supports the previous research, which states that the assurance in using emergency drugs and required equipment was insufficient compared to the awareness about the same. Many dentists did not have it in their notice that they should prepare the appropriate emergency kit according to their self-requirement. More than 50% of the dental professionals were heedless of the adjacent hospital's emergency number for immediate contact with a ME. Minimal knowledge and experience in managing emergencies lead to hesitancy, malaise, and limited appreciation of practitioners' responsibility. Our study results suggest and support the previous report that the emergency training courses are mandatory in the dental teaching curriculum, and it is as significant as other subjects of the dental study for the successful practice and management of dentistry.
| Conclusion|| |
As healers, we are intended to be fully conscious of patients and their overall health before we begin any dental treatments. The optimal way to handle a ME is to be organized in advance. Dental students lack the knowledge to manage MEs and are unaware of equipment and kits to hold on to in their practice. The acquisition of budding dentists' training in emergency medical circumstances management will formulate them for their competent future practice. Therefore, dental colleges should implement the courses to cultivate their students to handle MEs with associated acquaintance and alertness.
Our sincere thanks to Mr. Syed Imran Maktoum, Director, Kalbani Group, for supporting us in the present work.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Müller MP, Hänsel M, Stehr SN, Weber S, Koch T. A state-wide survey of medical emergency management in dental practices: Incidence of emergencies and training experience. Emerg Med J 2008;25:296-300.
Anders PL, Comeau RL, Hatton M, Neiders ME. The nature and frequency of medical emergencies among patients in a dental school setting. J Dent Educ 2010;74:392-6.
Atherton GJ, McCaul JA, Williams SA. Medical emergencies in general dental practice in Great Britain. Part 2: Drugs and equipment possessed by GDPs and used in the management of emergencies. Br Dent J 1999;186:125-30.
Malamed SF. Medical Emergencies in the Dental Office. 7th
ed.. St. Louis: Mosby; 2015.
Bryan RB, Sullivan SM. Management of dental patients with seizure disorders. Dent Clin North Am 2006;50:607-23.
Gonzaga HF, Buso L, Jorge MA, Gonzaga LH, Chaves MD, Almeida OP. Evaluation of knowledge and experience of dentists of São Paulo state, Brazil, about cardiopulmonary resuscitation. Braz Dent J 2003;14:220-2.
Kandray DP, Pieren JA, Benner RW. Attitudes of Ohio dentists and dental hygienists on the use of automated external defibrillators. J Dent Educ 2007;71:480-6.
Kumar K, Mukhi CS. Basic resuscitation in dental office: A review. IJSS Case Rep Rev 2014;1:22-5.
Haas DA. Management of medical emergencies in the dental office: Conditions in each country, the extent of treatment by the dentist. Anesth Prog 2006;53:20-4.
Broadbent JM, Thomson WM. The readiness of New Zealand general dental practitioners for medical emergencies. N Z Dent J 2001;97:82-6.
Stafuzza TC, Carrara CF, Oliveira FV, Santos CF, Oliveira TM. Evaluation of the dentists' knowledge on medical urgency and emergency. Braz Oral Res 2014;28:1-5.
Verma K, Jasiowski S, Jones K. Revitalising the medical emergency team call. Crit Care 2015;19 Suppl 1:409.
Cooper S, Johnston E, Priscott D. Immediate life support (ILS) training Impact in a primary care setting? Resuscitation 2007;72:92-9.
Yang Y, Zhang W, Peng M, Tong L, Lin S. Acute fatal chest pain: Optimized procedure in emergency department. BMC Emerg Med 2013;13 Suppl 1:S4.
Wood I. Medical emergencies and complications in the practice. Prim Dent J 2014;3:6.
Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale. J Am Dent Assoc 1978;97:816-9.
Kalladka M, Greenberg BL, Padmashree SM, Venkateshaiah NT, Yalsangi S, Raghunandan BN, et al
. Screening for coronary heart disease and diabetes risk in a dental setting. Int J Public Health 2014;59:485-92.
Amirchaghmaghi M, Sarabadani J, Delavarian Z. Preparedness of specialist dentists about medical emergencies in dental office-Iran. Aust J Basic Appl Sci 2010;4:5483-6.
Kumarswami S, Tiwari A, Parmar M, Shukla M, Bhatt A, Patel M. Evaluation of preparedness for medical emergencies at dental offices: A survey. J Int Soc Prev Community Dent 2015;5:47-51.
Chapman PJ. Medical emergencies in dental practice and choice of emergency drugs and equipment: A survey of Australian dentists. Aust Dent J 1997;42:103-8.
Mohideen K, Thayumanavan B, Balaji S, Balasubramaniam AM, Vidya KM, Rajkumari S. Management of medical emergencies in dental office – A review. Int J Med Health Sci 2017;6:170-5.
Mehmet Y, Senem Ö, Sülün T, Hümeyra K. Management of epileptic patients in dentistry. Surg Sci 2012;3:47.
Lloyd G. Resuscitation Council (UK) basic and advanced life support guidelines 2015. Br J Hosp Med (Lond) 2015;76:678, 680.
Handley AJ. Basic life support. Br J Anaesth 1997;79:151-8.
Gupta T, Aradhya MR, Nagaraj A. Preparedness for management of medical emergencies among dentists in Udupi and Mangalore, India. J Contemp Dent Pract 2008;9:92-9.
Jodalli PS, Ankola AV. Evaluation of knowledge, experience and perceptions about medical emergencies amongst dental graduates (Interns) of Belgaum City, India. J Clin Exp Dent 2012;4:e14-8.
Albelaihi HF, Alweneen AI, Ettish A, Alshahrani FA. Knowledge, attitude, and perceived confidence in the management of medical emergencies in the dental office: A survey among the dental students and interns. J Int Soc Prev Community Dent 2017;7:364-9.