What’s in Your Dental Sedation Emergency Kit?

By Genni Burkhart

This online course qualifies for 1 hour of CE credit automatically issued with a digital certificate upon completion.

Although dental emergencies are rare, having the necessary equipment and training is critical during a life-threatening event. The "What's In Your Emergency Sedation Kit?" course reviews the essential components of an emergency kit (focusing on cardiac events). This course is presented by DOCS Education and Jim Bovia, EMT-P, who also leads the DOCS Education ACLS certification training.

During this presentation, Jim Bovia discusses the lifesaving tools every dental office must have available and ready to use in an emergency. You and your team will learn the necessary steps, including 911 calls, chest compressions, airway management, and fluid resuscitation. The course also includes:

• A review of the essential components of an office emergency kit.
• How to size and insert the oropharyngeal and nasopharyngeal airways.
• The use of an AED during a cardiac emergency in the dental office.
• Understanding the differences in providing IV and IO vascular access.
• Identify what the dentist and team should do in an emergency.

The recommendations in this course do not replace your state's requirements; they are a list of recommendations for your emergency kit in addition to your state's requirements.

Crash Carts

If your office has multiple floors, you'll need one cart for your emergency supplies on each floor. Lightweight backpacks are recommended for multiple floors or emergencies outside, such as in a parking lot.

DOCS Education follows the American Heart Association (AHA) guidelines to obtain certification. Additionally, (PALS and ACLS) cards need to be in your emergency kit, and everyone on your team should be familiar with them.

What's In Your Emergency Kit?

Some of the items recommended to include in your emergency sedation kit are, but not limited to:

1. Automated External Defibrillator (AED)

DOCS recommends using a hybrid AED that makes all decisions for you and has a screen so the doctor can bypass the machine and make lifesaving decisions on your own. DOCS recommends the ZOLL AED Pro®.

This device is flexible for basic and advanced rescuers who experience Real CPR Help® and provides real-time feedback on the rate and depth of chest compressions to enhance CPR resuscitation quality.

2. King LTS-D Airway

It is recommended to have three adult and one pediatric size to secure the airway.

Remember: “If you don’t have an airway, you don’t have a patient.”

The King LT-D is a versatile, disposable airway management tool and an excellent alternative to tracheal intubation or mask ventilation. It’s easy to insert and strategically designed to minimize airway trauma.

It takes around six seconds to place this device on average, and there's no certification for use. However, it's advised that the doctor place this tube. These tubes can save lives. Therefore, it's highly recommended to keep them in your emergency kit and know how to place them quickly when needed.

3. An Ambu SPUR II Valve Mask

This is the only resuscitator made from SEBS material instead of PVC. The Ambu SPUR II valve mask classifies the SPUR II as environmentally safe and fully disposable, thus eliminating all cross-contamination risks.

The team must be proficient and experienced enough to use a valve bag mask properly during an emergency, as they are somewhat tricky. Practice is the only way. In the hospital, a specialized team responds to emergencies to perform this specific procedure, and that's a reminder that you should never try to use this on a patient alone. Two people are best. During the video course, Jim Bovia reviews the proper placement and use of the valve bag mask.

4. IV Fluids

These should be of normal saline, including IV tubing, and a way to place it, such as 14 and 18-gauge needles.

5. Countering Agents For Allergic Reactions

State regulations require EpiPens or liquids, Zantac H2 inhibitors, epinephrine, aspirin, adult 325 mg and low doses 81 mg, and an inhaler. Check with your state to see what your specific requirements are.

Teamwork Saves Lives

In emergencies, it's the doctor's responsibility to make sure someone on the team calls 911. The doctor is not responsible for compressing; they are responsible for ensuring a team member is doing so. As someone on the team calls 911, another compresses the chest; another applies the AED, and the doctor places the king tube.

In cardiac arrest, doctors place the advanced airway by determining the tube size based on the patient's height.

Using The AED During Cardiac Emergencies

A hybrid, high-quality AED might be the most critical equipment you can buy for your emergency kit. Advantages include:

• A visual real-time bar graph and metronome to guide you in achieving optimal compression levels.
• See-Thru CPR filters CPR artifacts to display a patient’s underlying ECG rhythm to reduce interruptions in compressions, allowing the professional rescuer to see underlying organized rhythms during resuscitation.
• Data storage that is immediate and customizable for maximum productivity while reducing costs.
• It is the only AED to use USB storage and wireless connection for transfer capability without removing it from the field.
• Compatible with ZOLL’s RescueNet® field data collection options.

With the pro model, you can see the display screen to help you determine the readout. This is essential because all AED Machines can misinterpret data 10% of the time. You can override the machine with a hybrid AED model when the readout isn't incorrect.

The general process for use is to:

1. Turn the AED machine on. (Only place on patients receiving CPR.)
2. Follow prompts and expose their chest.
3. Place the pads. One goes on the right collarbone and the other under the left arm on the side.
4. If there's excessive body hair, look for the area with the least body hair, such as high axillary.
5. Remove the medicated patch.
6. Compressions continue until the machine says, "STAND CLEAR."

It's crucial to position the defibrillator pads correctly to ensure effectiveness. Place one pad directly over the heart and the other just to the left of the spinal column on the back unless you see a device such as a pacemaker. In that situation, don't place the defibrillator pad there.

Instead, anterior-posterior placement needs both pads, one over the heart and one just to the left of the spinal column on the back. (This ensures that the defibrillator delivers a safe and effective shock.) Additionally, team members must continue performing continuous chest compressions, providing asynchronous breaths, and seeing their chest rise.

Continuous compressions are done at a rate of 110 with one asynchronous breath every 6 seconds. You must also see a good chest rise while another team member applies the defibrillator.

IV and IO Vascular Access

During cardiac arrest, it’s essential to have vascular access.

Ideally, you should prepare to provide emergency care for a patient for at least 20 minutes before the ambulance arrives, emphasizing high-quality chest compressions, running fluids, and repressurizing the vascular system, which allows oxygenated blood to flow throughout the body.

Repressurizing the vascular system refers to administering fluid through the blood vessels to increase blood pressure and maintain adequate blood flow.

As Jim Bovia explains in detail during the course, easy-to-use IOs are worth the investment, and they can save a patient's life during a cardiac emergency.

You can download this course and watch it anywhere using the DOCS APP. Get it on Google Play or the Apple Store. Watch the video and complete the quiz to earn 1 CE credit. Scientific support and additional resources are available here.

Purchase of this course grants access for one year. It requires an internet connection, a computer with video and audio capabilities, and, in some cases, Adobe Reader to view handouts and articles.

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Author: With over 14 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the Editor in Chief of the Incisor at DOCS Education.