Management of anaphylaxis in the dental practice: an update.

Anaphylaxis is a severe and potentially life-threatening allergic reaction that can occur in the dental practice. There are a number of dental-related causes including mouthwashes, local anaesthetics, latex and antibiotics. The dental team must be able to respond effectively and manage the life-threatening situation appropriately following Resuscitation Council UK guidelines. The timely administration of adrenaline is life-saving; any delays can lead to a poor outcome. With the current national supply issues with adrenaline auto-injector devices, there is an expectation that GDPs should be competent at drawing up adrenaline from an ampoule and administrating it intramuscularly. The aim of this article is to provide an update on the management of anaphylaxis in the dental practice with particular reference to the procedure for intramuscular injection of adrenaline.

Devising a protocol for calling 999 from a dental practice and using SBAR to ensure effective communication and handover.

If a medical emergency occurs in a dental practice and it is necessary to call 999 for an ambulance, it is important to ensure that it is done safely and proficiently. It is particularly important to ensure effective communication with the ambulance service, ideally using the SBAR communication tool both when calling 999 and also during handover to the paramedics once they arrive. These arrangements still need to be followed even during the pandemic crisis in which we we are all. This article outlines the procedure for calling 999 from a dental practice and discusses the use of SBAR to ensure effective communication with the ambulance service.

Using National Early Warning Score (NEWS) 2 to help manage medical emergencies in the dental practice.

If a medical emergency occurs in the dental practice, members of the dental team must be able to respond promptly, effectively and safely. Fundamental to this response is knowing when it is necessary to call 999 for an ambulance and communicating effectively with the ambulance service to ensure the timely arrival of the emergency services and timely transfer to hospital. This can be helped by using the Royal College of Physicians' (RCP's) National Early Warning Score (NEWS) 2, widely used by the ambulance service and in hospitals - it reliably detects deterioration in adults, triggering review, treatment and escalation of care. Although NEWS2 hasn't yet been validated for use in primary care, NHS England is encouraging its widespread use in this sector. Using NEWS2 in the dental practice will help the dental team to effectively, confidently and safely manage medical emergencies, including sepsis, should they arise. This will facilitate effective teamwork and help to ensure enhanced patient outcomes. This article provides an overview of NEWS2, including benefits for using it in the dental practice and guidance on how to implement it.

Management of odontogenic infections and sepsis: an update.

The management of odontogenic infections has improved over recent decades, but further improvements are still required. The ongoing education of GDPs and their dental teams on this issue continues to be important, especially during the current COVID-19 pandemic, where remote triage poses additional difficulties and challenges.Odontogenic infections can lead to sepsis, a potentially life-threatening condition caused by the body's immune system responding in an abnormal way. This can lead to tissue damage, organ failure and death. A patient with non-odontogenic-related infection could also present with sepsis at a dental practice. Early recognition and prompt management of sepsis improves outcomes. GDPs and their dental teams should be trained in the recognition and management of sepsis. Age-specific sepsis decision support tools have been developed by the UK Sepsis Trust to help dental staff recognise and manage patients with suspected sepsis.The aim of this article is to provide an update on the management of odontogenic infections and sepsis.

COVID-19 and medical emergencies in the dental practice.

As the government's coronavirus (COVID-19) lockdown starts to be eased and the NHS starts entering phase two of its response to the COVID-19 pandemic, dental practices are expecting a sharp increase in the need for dental treatment. Dental care professionals will have legitimate concerns regarding the risk of transmission of COVID-19, particularly if required to respond to a medical emergency, such as a cardiac arrest. This article provides an overview on being prepared for, and responding to, such an emergency, with particular reference to recently published Resuscitation Council (UK) guidance. A suggested aide-memoire for managing a COVID-19 resuscitation situation is also included, which the authors hope will help dental practices to devise guidelines to meet their local needs, as well as promoting the team response to such a difficult and challenging event.

Medical emergencies in the dental practice poster: revised and updated.

Medical emergencies can occur in the dental practice. The posters 'Medical Emergencies in the Dental Practice' and 'Emergency Drugs in the Dental Practice' have been designed to help dental care professionals to respond effectively and safely to a medical emergency. They have been updated and completely revised in line with current national guidelines and recommendations. The 'Medical Emergencies in the Dental Practice' poster is available as an insert in this issue of the British Dental Journal. Both posters are available to download from https://www.bda.org/advice/Pages/Patient-care.aspx .

Management of oxygen therapy in the dental practice.

Dental practices should have immediate access to oxygen, oxygen tubing and non-rebreathe oxygen masks in the event of an emergency situation. Although oxygen can save lives, if it isn't administered and managed appropriately, there is a potential for serious harm and even death. Dental professionals must, therefore, ensure that they and their team understand the principles of oxygen therapy. The aim of this article is to provide an overview of the management of oxygen therapy in the dental practice.

Cardiac arrest equipment to support circulation.

Cardiac arrest trolleys must be equipped with all the instruments and medication needed to deal with an acute adult cardiac arrest. Nurses must not only be familiar with these contents but also know how to use, check and maintain them. This first part of this two-part series looked at equipment to aid airway and breathing; this second part focuses on circulation. Note that drug doses mentioned here relate to the adult patient and will be different for children.

Cardiac arrest equipment to support airway.

Each hospital should have standardised cardiac arrest trolleys equipped with all the instruments and medication needed to deal with an acute adult cardiac arrest. Nurses must know the contents of these trolleys and how to use them to fulfil their common role as first responder. This first article in a two-part series looks at equipment to aid airway management and breathing; part two will focus on circulation.

Using OSCE for mandatory training.

Mandatory training for nursing staff is vital to ensure the safety of patients, staff and visitors. This article discusses using objective structured clinical examination to structure this training.

Defibrillation 2: Using defibrillators in hospital.

Patients who have a cardiac arrest in hospital should, if it is indicated, be defibrillated as quickly as possible--ideally within three minutes. Most hospital wards and other clinical areas have access to defibrillators with both advisory (semi-automated) and manual modes. The former enables first responders, including nurses without ECG interpretation skills, to defibrillate the patient while awaiting the arrival of the cardiac arrest team who can then select and use the manual mode. Most hospital nurses will be trained in advisory defibrillation, while a few will be trained in manual defibrillation. This article provides an overview of defibrillation in hospital, and looks at both advisory and manual defibrillation.

Can adapted EWS improve response to deterioration?

All nurses must ensure deteriorating patients are identified early, and a timely and effective response is implemented. This article discusses a new early warning system and training programme, which are intended to prevent avoidable cardiac arrests.

Recognition and treatment of anaphylaxis in hospital.

Anaphylaxis is a life-threatening, generalized or systemic hypersensitivity reaction characterized by rapidly developing airway, and/or breathing, and/or circulation compromise, usually associated with skin and mucosal changes. Summoning expert help, positioning the patient appropriately, administering high-flow oxygen, and administering adrenaline by intramuscular injection are the key initial treatment and management options. This article draws on the literature, including published guidelines, to discuss the recognition and treatment of anaphylaxis in hospital.

Recognition and treatment of anaphylaxis in the community.

Anaphylaxis is a severe, life-threatening, generalized or systemic hypersensitivity reaction characterized by rapidly developing airway and/or breathing and/or circulation compromise usually associated with skin and mucosal changes. Calling 999 for an ambulance, positioning the patient appropriately and administering adrenaline intramuscularly are the key initial treatment and management options. The aim of this article is to discuss the recognition and treatment of anaphylaxis in the community.

Procedure for recording a standard 12-lead electrocardiogram.

The 12-lead electrocardiogram (ECG) is an essential diagnostic tool, particularly in the management of coronary heart disease. It records the electrical activity of the heart from 12 different viewpoints or 'leads' by attaching ten cables to the patient's limbs and chest. The procedure for recording a standard 12-lead ECG is described, including preparation of the patient and of the equipment. It is important that the nurse is familiar with the manufacturer's recommendations regarding the use of the electrocardiograph before commencement of the ECG. Guidance is given on how to accurately locate the intercostal spaces to ensure correct positioning of the chest leads (V1-V6); alternative placements are also given. It is essential that connection or placement of the ECG electrodes/leads is accurate to prevent misdiagnosis. The ECG trace needs to be clear to enable accurate and reliable interpretation. Standardization of the procedure is important to achieve comparable results.

Nurse-led pharmacological stress testing: an overview.

Myocardial perfusion imaging (MPI) is a noninvasive diagnostic tool that can provide valuable information on coronary blood flow at rest and during stress. Dynamic exercise is the stress technique of choice with patients who can achieve an acceptable workload; for those unable to do so, pharmacological stress testing with adenosine or dobutamine can be used. Nurses trained in ECG interpretation and advanced resuscitation skills are increasingly involved in supervising pharmacological stress tests. This article provides an overview of nurse-led pharmacological stress testing.

How to ensure patient observations lead to effective management of bradycardia.

Bradycardia can be a normal physiological sign in fit young adults. However, in acute illness it may indicate life threatening heart block or precede asystole. This article outlines the assessment and management of patients with this condition.

How to ensure patient observations lead to prompt identification of tachypnoea.

Tachypnoea is one of the first signs of patient deterioration and accurate measurement of respiratory rate is a fundamental part of assessment. This article aims to describe the assessment and management of tachypnoea.