A member of DOCS Education writes:

Our office has been doing oral conscious sedation for several years now and, thankfully, we have never faced an emergency situation with a patient. There are two questions that arise from my patients and my staff that we would appreciate input on.

  1. What is the stopping point for the dental team in an emergency situation with a sedation patient once the EMT personnel arrive?
  2. If a drug reversal is necessary and is successful; does EMS still need to be contacted?

Thank you in advance for your time.

Dr. Anthony Feck, Dean of DOCS Education Faculty, responds:

A fully comprehensive plan for emergency treatment is outlined in both DOCS Education’s DALS and PALS courses. Above all else I recommend taking these courses to be best prepared in an emergency situation. DALS and PALS are taught by John Bovia, and give you essential skills to respond to respirator failure, airway obstruction and cardiac problems. The course uses patient simulators to instruct you on how to deal with real-life emergency situations. It’s an invaluable part of your sedation training, and I suggest you enroll in our next offering.

All that being said, here are some answers for you in the meantime:

If EMTs have been summoned, you are responsible for providing emergency care (appropriate BLS, or ACLS) to the patient until the EMTs arrive and assume said responsibilities. At that point they become primary emergency caregivers and you are there to give them information and provide assistance as needed.

Flumazenil is administered for two reasons only:

  1. The patient is not responding appropriately to verbal stimulation.

    If their oxygen saturation number is above 90%, then reversal to a point where the patient is now responding appropriately, and all vital signs are stable, does not warrant calling 911 (as long as the patient remains conscious and vital signs are WNL). However, if the patient was unresponsive and 1.0 mg of reversal does not result in the patient responding appropriately, or if O2 stats become sustained below 90%, then summoning EMTs is advised.

  2. The patient is responding to verbal stimulation but is in respiratory depression.

    In the DOCS educational curriculum we use an acronym to define the need for using reversal agent for respiratory depression - CAEBOR. In a conscious patient with an appropriately positioned airway, and properly functioning monitoring equipment, who has taken a few deep breaths of room air, then is placed on 100% supplemental O2, and still does not resaturate, then the patient should be reversed. If the reversal procedure results in a conscious patient with normal vitals, including oxygen saturation, then calling 911 is not necessary, although careful monitoring for at least an hour is. If however, reversal of respiratory depression does not result in consciousness and stable resaturation, then emergency help must be summoned.

While the questions as to whether help should be sought can seem complicated, and during the stress of a crisis makes the choice even more difficult, follow this very simple admonition: When in doubt, call for help.

The information contained in this, or any case study post in Incisor, should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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