Heart Health Banner Fo
Heart Health Banner Fo
Heart Health Banner Fo
Heart Health Banner Fo
Heart Health Banner Fo

Heart attacks: Are you ready?

Feb. 15, 2013
Are you prepared if a patient or staff member has a heart attack at your office? FOCUS Editorial Director Maria Perno Goldie, RDH, MS, provides information about the symptoms for heart attacks and advises that hygienists be familiar with emergency equipment and emergency medical services in the dental or dental hygiene office.
Cardiac arrest is a leading cause of death in North America, resulting in more than 330,000 deaths per year.(1) As health care providers, dental hygienists and dentists are required to have CPR training to obtain or renew a state license. If resuscitation efforts fail to restore cerebral blood flow within minutes of cardiac arrest, brain damage may be irreversible. Even after blood flow is restored, secondary brain injury can occur if cerebral edema results from direct tissue injury or blood–brain barrier disruption. Death from brain injury is common after cardiac arrest, but the patient is more likely to survive and to have a better neurologic outcome when cooled.(2) Mild hypothermia is where the patient is cooled to a core temperature between 89.6°F (32°C) and 93.2°F (34°C).(3) Despite its demonstrated benefit, many patients fail to receive this brain-saving treatment. Chances for both survival and a good neurologic outcome are improved when mild hypothermia is induced shortly after reperfusion. Unfortunately, this treatment is often omitted from advanced cardiac life support protocols.(4) In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality.(3) What can we do to prevent cardiovascular and heart disease? Physical fitness is one of the strongest predictors of individual future health status.(5) Together with cardiorespiratory fitness, muscular or musculoskeletal fitness has been increasingly recognized in the pathogenesis and prevention of chronic disease.(6) To download a printable version of a guide, Exercises for a Healthy Heart, go to the website.(7) Try to keep the person calm, and have them sit or lie down. If the person is not allergic to aspirin, have them chew and swallow a baby aspirin (It works faster when chewed and not swallowed whole). • Know the heart attack symptoms in men and women and what to do when they occur • If you or someone you are with experiences chest discomfort or other heart attack symptoms, call 911 right away. Do not wait more than 5 minutes to make the call. • Try to keep the person calm, and have them sit or lie down • If the person is not allergic to aspirin, have them chew and swallow a baby aspirin (It works faster when chewed and not swallowed whole) • If the person stops breathing, you or someone else who is qualified should perform CPR immediately. If you don't know CPR, the 911 operator can assist you until the EMS personnel arrive • Emergency medical services (EMS) personnel can begin treatment on the way to the hospital and are trained to revive a person if his heart stops • If you witness heart attack symptoms in someone and are unable to reach EMS, drive the person to the hospital. If you are experiencing heart attack symptoms, do not drive yourself to the hospital unless you have no other choice.(8)
Be familiar with the emergency equipment in the dental or dental hygiene office. Be sure to know where your emergency kit is stored, and that all the medications contained therein are up-to-date. Researchers at the University of Texas Health Science Center have developed a computer program to simulate medical emergencies in the dental office. The simulator displays an office environment on a computer screen with a "patient," dentist and available equipment. The programs can take a user through a variety of medical emergencies most commonly seen in the dental office (like a heart attack, syncope or asthma attack). The user can look up the patient's medical history, check vital signs or provide medications. A scenario must be completed within a realistic time frame or the patient "dies." The dental emergency simulator is still a work in progress and is currently being tested at the University of Texas Health Science Center. Eventually, researchers would like to incorporate its use into the dental school curriculum for use in training dentists nationwide. The equipment may also be used in continuing education programs to enable working dentists to practice their skills or enhance their preparedness for a medical emergency. Currently, investigators say the best way to ensure proper care for a medical emergency is for patients to inform their dentists about underlying medical problems and ask what kinds of steps a dental office has taken to deal with an emergency.

University of Buffalo’s Behling Simulation Center is the nation’s first simulation center that focuses on inter-professional collaboration and education for health care providers.(9)

For more information on medical emergencies in the dental office, visit the referenced websites.(10,11)

Last, but not least, March 20 is World Oral Health Day! See the section of this newsletter for ideas and materials to help you better serve your community!

References
1. Roger VL, Lloyd-Jones DM, Benjamin EJ et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation 2012; 125 (1):e2-e220.
2. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, Smith K. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346(8):557-63.
3. Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346(8):549-56.
4. Erb JL, Hravnak M, Rittenberger JC. Therapeutic Hypothermia After Cardiac Arrest. AJN, July 2012, Vol. 112, No. 7, 38-44.
5. Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009; 301:2024-2035.
6. Stump CS, Henriksen EJ, Wei Y, Sowers JR. The metabolic syndrome: role of skeletal muscle metabolism. Ann Med. 2006; 38: 389-402.
7. http://nursing.advanceweb.com/SharedResources/Downloads/2013/021113/HeartHeath.pdf.
8. http://www.webmd.com/heart-disease/heart-attack-symptoms-emergency?page=2.
9. http://www.buffalo.edu/ubreporter/archive/2011_06_30/dental_simulation.html.
10. New Zealand Code of Practice Medical Emergencies in Dental Practice. http://www.dentalcouncil.org.nz/.
11. ADA Medical Emergencies. http://www.ada.org/4737.aspx?currentTab=2.

Sincerely,

Maria Perno Goldie, RDH, MS

To read previous RDH eVillage FOCUS introductions by Maria Perno Goldie, go to introductions.

To read more about heart health facts, click here.