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PREFACE TO THE SEVENTH EDITIONIn December of 1975 I started writing Medical Emergencies in the Dental Office. That first edition was published in April of 1978. As I wrote in the preface to that first edition, my primary aim in writing the book was, as it is today, to stimulate members of my profession—dentists, doctors, dental hygienists, dental assistants, and all other office personnel—to improve and to maintain their skills preventing medical emergencies and in recognizing and managing those few medical emergencies that will inevitably occur. This aim is even more focused in my mind as this, the seventh edition of Emergencies, is written in 2014.

Approximately 75% of medical emergencies seen in the dental environment may be preventable through implementation of a system of patient evaluation, treatment modification, and management.

Though most medical emergencies may be prevented, potentially life-threatening situations will still occur.

I continually receive e-mails and telephone calls about such situations. I have met with many doctors and other dental personnel who have had real-life encounters with life-threatening medical problems. Virtually all of these have occurred within the dental office. However, a considerable number happened outside: on family outings, while traveling, in restaurants, or at home.

There is a significant need for increased awareness by dental professionals in the area of emergency medicine. Although most states and provinces in North America mandate current “certification” in basic life support* (cardiopulmonary resuscitation [CPR]) for a doctor to maintain a dental license, not all states and provinces have as yet addressed this important issue. Why they have not is incomprehensible to me.

As someone with a long-term commitment in the teaching of basic life support (BLS), pediatric advanced life support (PALS), and advanced cardiovascular life support (ACLS), I see an immense value in training all adults in the simple procedures collectively known as basic life support. Local and state dental societies, as well as specialty groups, should continue to present courses in BLS or initiate them as soon as possible.

Progress has been made, yet much remains to be done. The awareness of our profession has been elevated, and laudable achievements continue. The American Dental Association has inaugurated an airway management program, “Managing Sedation Complications.” Fourteen states mandate the presence of an AED (automated external defibrillator) in dental offices.

Yet because of the very nature of the problem, what we in dentistry require is continued maintenance of a high level of skill in the prevention, recognition, and management of medical emergencies. To do so we must participate in ongoing programs designed by individual doctors to meet the specific needs of their offices. These programs should include annual attendance at continuing dental education seminars in emergency medicine; access to up-to-date information on this subject (through the Internet, journals, and textbooks); semiannual or annual “recertification” in basic life support, PALS, or ACLS; and mandatory in-office practice sessions in emergency procedures attended by the entire office staff. Such a program is discussed more completely in Chapter 3.

The ultimate goal in the preparation of a dental office for emergencies should be for you, the reader, to be able to put yourself into the position of a victim of a serious medical complication in your dental office, and for you to be confident that your office staff would be able to react promptly and effectively in recognizing and managing the situation.

Emergency medicine is a rapidly evolving medical specialty, and because of this, many changes have occurred since publication of the first edition of this text. My goal now, as it was then, is to enable you to manage a given emergency situation in an effective yet uncomplicated manner. Alternative treatments and alternative drugs that are also effective may be advocated by some authors. My goal, as well as theirs, is simply to enable you to keep the victim alive until they either recovers or until emergency assistance becomes available to take over management . . . as long as they are better able to manage the situation than are you.

Continued revision and updating of essential material is found throughout this seventh edition.

In October 2010 the American Heart Association and the International Liaison Committee on Resuscitation (ILCOR) published revised guidelines for BLS, ACLS, and PALS. Significant changes in both philosophy and technique of resuscitation (life-saving) were recommended

*“The American Heart Association does not ‘certify’ competency in any level of ‘life support.’ Cards given upon completion of a BLS, ACLS, or PALS course state that “the above individual has successfully completed the national cognitive and skills evaluations in accordance with the curriculum of the American Heart Association for the BLS (or ACLS, or PALS) program.”

viii Preface to the Seventh edition

and have been included in appropriate sections of this seventh edition: Chapter  5 (Unconsciousness: General Considerations), Chapter  11 (Foreign Body Airway Obstruction), Chapter  26 (Chest Pain: General Considerations), Chapter  30 (Cardiac Arrest), and Chapter 31 (Pediatric Considerations).

The basic format of the text––recognition and management based on clinical signs and symptoms rather than on a systems-oriented approach––has been quite well received and continues in this seventh edition.

Emphasis is placed on the newly revised management algorithm for all medical emergencies: P . . . position, C . . . circulation, A . . . airway, B . . . breathing, and D . . . definitive care.

Management of medical emergencies need not, and should not, be complicated. Emphasizing this concept throughout this textbook should make it somewhat easier for the entire office staff to grasp the importance of certain basic steps in life saving (P, C, A, B, D).

Stanley F. Malamed, DDSLos Angeles, CaliforniaAugust 2014