Medical Emergencies Matter

In a residual theme of “going deep”, Dr. Kuba and Bethany dig into a weighty and important topic today – medical emergencies. Together they reflect on several REAL scenarios that recently occurred in the dental field. They discuss the appropriate steps to take during an emergency in order to protect your patients, your practice, and yourself. In addition, they discuss preventive steps that can be taken to ensure that your team responds well before, during, and after an emergency. Do yourself a favor and take notes today!  

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Transcript

Hey lady, question for you. Yeah. So, you talked about leadership um seminar. Yes.

0:08
What why should a doctor come to that and bring their team? What are we talking about at the leadership seminar?

0:13
Oh my gosh, so many content things that are important like team morale, um accountability, how to manage without

0:20
micromanaging things like how to do performance reviews and compensation reviews.

0:26
Okay. So, I am going to challenge you on that a minute cuz if I was seeing this come through like my email or whatever,

0:32
I'd be like, "What? How is this any different that I could find on any number of sources or a webinar on why should I come to Dallas?"

0:40
Yeah.

0:41
Why? Handson practice. So, we're going to be talking about all of those subject matters, but we're also going to be practicing some of the content, which

0:50
is, I think, going to make it very exciting, but also practical. And that's the game changer right there because I think I go to a lot of webinars, listen to a lot of things, and I'm still like,

0:59
what do I do with this information?

1:01
But at the leadership course, we're going to show you hands-on. Yes. How to do these things. So, everybody needs to be there.

1:08
September 18th is the day. Sign up.

1:18
What's up? Hey, lady.

1:20
You haven't eaten breakfast, have you? I have, but I'm prepared to vomit it all up because I know what we're talking about. You know what I was going to bring up?

1:29
Um, so I think it's uh So, anybody listening, if you're eating your breakfast sandwich, put it down. Put it down.

1:36
If you've eaten, turn this off and wait for an empty stomach, please.

1:41
Um, I don't think we're talking about anything that we all haven't had nightmares about or haven't experienced some or, you know, it's not it's not new

1:50
or uncharted territory, but I still think important to talk about because I've had a colleague

1:57
call me um gosh, it was a couple months ago and this happened in his office and then um I think two colleagues actually,

2:05
one happened in her office, one in his office. Uh and so it and I think the question that I

2:14
was being asked was what should I do here?

2:18
Um and so I kind of was like uh why Hang on. Let me ask Bethany. I don't. So um anyway, it's uh liability stuff,

2:31
which is why it always makes me queasy,

2:33
which is why I'm saying, "Did you eat something?" Because it always makes me want to barf. Um, so one was swallowed

2:40
burr, the other one was a swallowed stainless steel crown.

2:45
And so one, if we could talk about what do we do in those cases, but then also for me from a um

2:54
legal, what do I do legally and some of those nuances? So, can we

3:00
get into all of that? Let's do Okay.

3:03
Let's do Which one should I And then you've got one. Yeah. So, where do you want to start?

3:10
Which is the Let's start with the least throw upy and then we'll Okay. Well, let's start with the swollen

3:19
bird because you do hope the patient throws that up and when they don't then what do we do?

3:25
So yeah, the So obviously the I'm assuming hopefully the the client of

3:34
your or the the person that you're talking to was knew right away. I would assume that Burr was swallowed, right?

3:43
Yes.

3:44
Uh yes, I'm trying to remember. Yes, I think so.

3:47
Okay. Yes. Yes. He knew that it it he could tell it he knew the moment it flew out of the hand piece.

3:55
Okay.

3:56
And then the patient was like and then ended up swallowing it.

4:00
Okay. So in that case, and you can totally disagree with me on this, but I would always want to assume the worst

4:07
case scenario. So in this case, we we would want to assume that it was aspirated unless

4:15
they throw up and it comes back up and we see it. So can we go like as if this was real time? So we are about to finish

4:23
our prep or we're mid prep and the bird disappears.

4:28
So what am I doing? I'm stopping right away.

4:31
Mhm. And I am I think I probably would be stopping and kind of going you okay

4:38
buddy like did you whatever and then seeing what the patient's doing but then maybe making eye contact with my assistant and being like check the suction trap or whatever.

4:49
Yep.

4:50
So what am I doing if a parent is in the room?

4:53
That's what makes us a parent or any care I mean any loved one that I mean if this is an adult patient that doesn't always preclude that there's another

5:02
adult in the room. So I do think um first of all this is going to go back for a minute. We've got to make sure

5:09
that our team is prepared for emergency scenarios like this. I know you guys do regular emergency training. This is one

5:18
of I don't want to say the more common things that could happen, but oftent times we plan for in our emergency

5:25
training like, oh, somebody has a heart attack in the waiting room. We plan for things that are I I hate to even say unlikely to happen,

5:34
but it's like rare scenarios, but to me,

5:37
plan for this with your team, which I don't think I've ever planned for this with a team. like what would and I think I'm I'm getting nauseous now thinking

5:45
about going okay which of my assistants could be in the room with me are any of them savvy enough to know

5:52
that the burr was lost and I'm panicking and mom's sitting right there and if I say go check the traps what do you mean

5:59
go check the traps right now what am I checking the trap for like are we going to have that kind of dialogue is it going to be like what what am I so I'm

6:07
just trying to imagine that scenario in my head so it to me this is a part of the medical emergency training. Again, I

6:14
think sometimes we focus too much on the technical like who's calling 911 and who's doing, you know, which is still helpful. We got we've got to do that.

6:24
But to me, a part of medical emergency training is going how do we communicate in the moment

6:32
when there is an emergency? And I don't a lot of people will develop code language. I had a lot of offices that are like, "What is our code for this?"

6:40
or "What is, you know, for a" and we think of all the scenarios. What if an angry patient walks in at the front?

6:47
We're nervous they're going to go off the radar. How are we getting doctor's attention? Um what if something clinically is going wrong in another

6:55
room and we don't want to sound the alarm to the whole office? And so you go through how are we communicating? But then you have to repeat that information

7:04
over and over and over. This is why schools do fire drills and and active shooter drills and all of that. It's like the repetition of it is what's most

7:12
important so that hopefully that comes back in the moment. And the communication is to me a pivotal part of

7:19
medical emergency training. It's why when you have people come in and train medical emergency or you do it yourself,

7:27
you talk about not just the technical aspect of what you're doing, but what you're saying to one another. Like I think it's important to go especially

7:36
because I think a lot of times like in Texas for example you're required to yearly do emergency training but we all

7:42
know how turnover it can go and like okay you did it in January but now Suzie left and Mary started and Mary Mary may

7:50
not know where the AED is. I mean I know where the fire extinguisher is and you don't want to be caught off guard in those moments. So it's important to talk about stuff like that. But I think what

7:58
you're saying here too is not only do you literally need to know where the fire extinguisher is, but what are we saying in front of the patient and what

8:07
are we, you know, if if all you're doing is saying, "Okay guys, like remember these are the emergency exits and this is where we keep our oxygen." That's

8:14
just the very very very tip of the iceberg.

8:17
Yes, it is. So, I would hope that you've got some kind of code with your assistant where if I look at you in this way or if I look at you and blink,

8:30
you know, very strongly a few times, you know, we're in an emergency situation.

8:34
So, whatever I say next, don't question it. So, have some kind of visual way. If you haven't created that

8:42
yet and you find yourself in this situation, well, let me say, if you haven't created that yet and you're listening to this podcast, do not go

8:50
another day without creating these communication structures.

8:55
Can you create some stuff for the digest? Absolutely.

8:58
Like maybe a checklist of sorts or verbage or suggestions. not not the typical I think all of us can look

9:06
online and print off a emergency whatever like that's not what I'm talking about. I want something more like how can we train our teams to things maybe we need to think about.

9:17
Yes plan for um yes be on the lookout for that in the May uh digest. We'll make sure to have that. That's a great suggestion. So yes,

9:26
if you haven't done that yet, don't go a day further without at least having a conversation with your clinical team to figure out what would we do in these

9:35
scenarios. And a lot of times I'm surprised at how many times a clinical team member has fears of something that

9:42
could or might happen and they don't know what they would do in that scenario. So a lot of times you could even just have a clinical meeting where

9:49
you're like, "What are the scenarios y'all worry about and let's start with those."

9:58
Which is so funny you say that because I think my team is opposite.

10:00
They are so confident in, oh yeah, we've been to the Southwest Dental Conference and we sat on that hour lecture where they talked about and look, our

10:05
emergency drug kit, we've got aspirin and we've got nitroglycerin and we've got the cake icing for, you know, hypoglycemia. We're good.

10:14
Yeah.

10:15
It was very eye opening because I in Texas, we have to have pals every two years for our sedation permits. And so

10:23
myself and a colleague of mine were taking PALS together and we had our own little private trainer and um he mentioned how he does emergency

10:31
trainings in the office for your team and can go through your office to kind of show things whatever. And so I was like hey Jose can you come to my office

10:39
I'll pay you whatever. We had him come to the office and he made us do like hands-on type like let's go into the

10:46
operatory now pretend you need to put the AED on like let's practice putting the pads on like to that level. And he

10:55
said something and I was like you know what I need to go back and look at our crash cart. Bethany I looked at our

11:01
crash cart and I was I thought it was funny. I was pissed. I

11:08
was scared because I open the top drawer that's labeled whatever it was labeled and I'm seeing all this mish mash of

11:17
stuff and I'm like what is this in the top main section and then I like the drawer you would probably go to

11:26
the drawer you would go to first if you need I'm like what is this? So then I went to the next drawer that was labeled band-aids or whatever. Well, in the band-aid drawer is um which I'm like,

11:36
why are band-aids in the emergency cart? Because anyway,

11:40
but it was band-aids and like a uh nasal canula and a um what else was in there?

11:49
A diabetes the glucometer. Yeah.

11:52
Okay. Open the third one. There's literally trash in the third one.

11:55
There's like wrappers. So, somebody opens something and there's those. And I'm like, what is going on in this crash

12:02
cart? So, I was like, "Thank God we had that training that because otherwise I wouldn't have thought about it. I haven't looked at the crash card. Knock on wood, we haven't needed it." So,

12:12
we've got a team and a checklist in place that you go and you check the expiration dates on everything and we have our tink, our compliance guide that

12:19
sends us our checklist. Make sure you've got your, you know, LMAs and your oral airways and whatever else we need for our sedation checklist. Great. We have

12:27
all of that. So, the girls are sitting nice and pretty thinking that we are good to go. Bethany, I open that top

12:35
drawer. You know what was in that top drawer that I said was the mish mash? What? Expired stuff. Why?

12:42
I do not know, but for some reason, my team thought that that was a good place to put expired stuff in the crash car at the top.

12:53
Oh.

12:54
So I'm like, "Okay, so if I needed Narcan and I open that top because that's the first thing I would think to open and I see Narcan,

13:03
you're telling me basically I'm going to be giving expired Narcan because which I don't think I would have pulled anything from that top because it was so disorganized.

13:13
But I don't know what I would do in an emergency situation." And so if that was my first thing was like ah there's some Narcan or if I said to somebody else if

13:21
I knew Narcan is in drawer three or in the drawer marked whatever but my front desk who's not a clinical person is the one helping me in this emergency.

13:29
Yeah. And they're like does it look like this?

13:31
Yeah. And I don't know where they've pulled it from. Why are expired meds and expired equipment I I don't have an answer for that. I couldn't ask because

13:39
I think I my face would have crushed whoever gave that answer. So, I just ignored it and I pulled everything out and was like, "Where's the trash bag?

13:48
Let's go in the trash."

13:50
Um, and then like, "Yeah, let's clean the trash out. Let's" and so and then as we're going through I'm like, "What is this?" And they're like, "Oh, it's the syringe for blah blah." And I'm like,

14:02
"But Narcan is nasal now. We don't need a syringe for this anymore. Can we throw that away?"

14:10
We discovered some of the vials of meds from the pharmacy that have changed.

14:14
Like previously it was in this type of vial so you needed this type of syringe. Oh wow.

14:20
Well that doesn't match up. So I guess for me I've been thinking we do our emergency trainings.

14:27
This should be in order. Well, I wasn't physically doing it myself. And I'll say even if I was doing it, I don't know that I would

14:36
have thought about a syringe matching up. Um, but I hadn't done our emergency training for the team in a while. My

14:44
associate was doing all of that. So, I don't think he was paying attention to is the syringe adding up because he's not the one who orders the meds. So,

14:51
he's probably thinking, well, Kuba orders the meds. She's checking the syringes.

14:55
And I'm like, well, I didn't realize the vial changed. Wow.

14:58
So, right. So, all of this was like, oh my god. Like so we revamped the entire thing throughout a bunch of We had an

15:05
emergency suction that it turns out it doesn't work anymore. So glad we had a backup one.

15:14
Yeah.

15:15
But in the moment y'all check this. So basically they see that the power works.

15:20
They plug it in every month and they check that the power works. But does it suction? Right.

15:25
And the part that needs it. So I was like, "Well, have y'all put a suction on there?" So, we tried practicing then. It wouldn't suction.

15:32
So, I'm like, can somebody YouTube this to figure out why this is not working? Wow.

15:36
Well, one of the parts was broken. Turns out that part doesn't exist anymore. Can we just throw this unit away? So, I

15:44
can't fault the team. They were doing what they were tasked to do. On the checklist, it says once a month, check the AED. Once a month, check this. So,

15:51
they flip it on. The power works. They think they're done,

15:54
right? But they weren't taking it further.

15:57
But they weren't taking it further. And so anyway, all of that was making me want to vomit and go, "Thank God, I haven't needed any of these things in

16:05
this emergency kit cuz I wouldn't have had the right syringe I needed." Yeah.

16:08
So it made me and new associate has been on board now for at this point about 4 months. And I'm like, you know what?

16:14
What better timing to make sure that both of us are in sync and we really simplified our system a little bit good so that we could have up to date.

16:24
We had a um a uh what are those called?

16:27
those braslo tape things that come in the pal's book and my assistant had taped it to the wall and maybe I had told her to tape it to

16:34
the wall. I I'm I'm betting I did at some point.

16:37
But then I'm looking at this Brzlo tape and I'm like none of this stuff. We don't have atro pain in our office. We don't have adenosine in our office. We don't have XYZ in our office.

16:48
Why do I have this brzo tape up and in an emergency are we all going to be trying to read this thing and then discovering at that point that we don't even have these drugs? Right.

16:56
So anyway, get rid of that tape. Like it's a false sense of security right now cuz we're not Let's make this really like what can we use in an emergency cuz

17:05
that's what we're going to need. Not all these false hopes of we have some syringes in there. We've got some vials in there. So y'all I I just went through

17:14
it myself. And it was embarrassing for myself to go, how how did I let this happen?

17:20
Yeah. because I have prided myself every year. I make sure we go to a medical emergency training. I make sure I'm on top of my pals in CPR.

17:29
I thought we had all of this in line and it was very embarrassing and concerning that we did not have things the way we needed them.

17:39
We do now. But um so anyway, back to the swallowed burr.

17:43
Back to the Okay, let's assume parents not in the room. Let's assume you check your trap and you've determined that the patient did swallow it. then what am I doing?

17:51
So then we've got to get the patient to a treatment stable spot. Um so whatever what whatever procedure you're in,

18:00
you've got to at least get the patient to where once that um anesthetic wears off, they're not going to be in pain or at risk of further injuring that tooth.

18:10
So you've got to at least get them stable in some way. And then we do have

18:16
to inform the patient of the issue. So again, clinically, you could probably

18:23
speak to this more than I, but I would say get the patient stable before the communication of what has occurred. Um,

18:32
and then let's do Do you have any advice on the communication of it? I was going to I was going to ask you that like it should be the doctor.

18:40
Yes. Oh, a great question. Yeah,

18:42
because I would love to throw my manager in there and just be like, "Oh my god, I can't face this patient. Can you It's got to be the doctor."

18:48
Yeah. So, and and the reason being is the doctor is going the even though it's not the doctor's quote unquote fault.

18:59
Like a burr faulty, you know, popping out is like in most situations, the doctor couldn't have done anything about

19:06
it, you know. Um, but if there's anybody that's going to get blamed for said accident, it's going to be the doctor.

19:17
And I think it actually implies guilt if the doctor steps away from that situation and tags another team member

19:24
in. So, we don't want the patient to who might not have cast blame to then be like, why is the assistant telling me

19:33
this? He or she must have done something wrong. So, we want to just be straight out in front like this is this is what

19:41
happened. But the communication needs to be very clear. So, chances are the patient would know they swallowed something most likely.

19:50
Okay.

19:51
You would think that they've recognized in that moment. Um, but the as far as

19:59
clarity, we need to know exactly what the next steps are. We can't be like in our head, I don't know what I'm about

20:06
to tell this patient on the next steps cuz I myself don't know the next steps.

20:11
So, make sure that you've collected your thoughts enough to be like, okay,

20:16
you have swallowed a burr. Um, this happened at this point, you know, when we stepped away and I've been monitoring

20:24
you, but we do need you to take some next steps. I need you to do this. I need you to do, you know, and then so

20:31
have your plan in place and if there's options to that plan, like for example,

20:37
you mentioned uh swallowing a stainless steel crown, we do have options. I mean,

20:42
you don't have to go immediately to the doctor. You can evaluate watch poop for the next few days.

20:47
I'm going to I'm going to argue that I think standard would be you need to go to make sure it's not in the lung.

20:52
Exactly. But clinically, if you're just like, "Hey, I I think there's options here."

20:57
I'm with you. I feel like the cleaner you can make it where you're like, as your doctor in this scenario, I want you to do this, this, and this, and I'm

21:05
going to to coordinate with you on step two or whatever the case may be. But if as a clinician, you're like, well, if it were my kid, I would do this. Okay, then

21:14
present two very clear options to the parent or to the patient in this particular case. But all that to say,

21:20
have your plan plan for what you're going to say in place. And of course, communicate

21:27
with as much calmness and confidence as you can muster. We want to be clear about the potential consequences of the

21:36
situation, but we also don't want to cause panic in this like a typical emergency.

21:42
So, let's say let's go to crown crown scenario. And so now the kid swallowed a crown and uh you tell the parent and you're like, "Well, we were trying to

21:50
fit this and the crown slipped and he swallowed it. Um, we need to make sure

21:58
that it's not in the lungs, so I want you to go to urgent care or go to the ER and go get it." I would even do the homework of which ER,

22:07
which ER, not that you're making a recommendation,

22:10
but just say, I want you to go to either urgent care or ER. By the way, the two closest to us are this one and this one.

22:19
It you're not saying like I want you to go to this urgent care or I want you to go to this ER, but you're just communicating to the parent the two closest ones are these.

22:27
Um, so I think that the question that comes to mind for all of us is then who is paying for said ER visit?

22:35
So, this is where I'm going to say,

22:37
don't fork out a dime until you talk to your malpractice.

22:44
So, this came up recently with a client of mine who asked the same question like, "Oh, I'm sending them a swallow

22:53
crown. I'm sending them to ER, urgent care. I can't remember which it was. Do I need to go ahead and and pay for that?" And I was like, "Whoa, whoa,

23:01
whoa, whoa, whoa. No, no, no.

23:03
because malpractice needs to guide you on that in the safest way possible. In my mind,

23:11
if you pay for something, it's implied guilt and then you're on the hook for anything, any surgery that they might

23:19
need to remove this crown from the lungs or whatever. To me, if you paid that first ER bill, in my mind, you would be

23:27
paying then for all of it. So, I I can't even tell you what to do other than don't do anything. Talk to malpractice first and let them tell you.

23:36
And I think you had mentioned too to me at some point that um malpractice if you did pay without consulting them and without them guiding you. And you just were like,

23:46
"Oh, it's just the ER. It's just for the chest X-ray." Yeah. You know, I don't want to get into this issue with mom, I'll just pay for it. It'll be fine.

23:53
Um, might they say might malpractice say, "Well, you went rogue, so now we're not involved in this at all."

24:02
So, let's assume that a surgery was needed if they were going to cover it.

24:05
Now, they're like, "Nuhuh. You're on your own."

24:07
just not any to me I think this is just me personally which I get that there's

24:17
you know there's there should be some inherent the patient should know there are inherent risks it's in our consent

24:25
form that you know that you could move or that you coughed and it made me drop the crown and whatever but I still feel

24:32
like I would just feel bad for this patient now having to pay 300 bucks or 500 bucks or 10 bucks, whatever it is

24:38
for this chest X-ray, the inconvenience of it all and doing all of that and now they're getting a bill for it and potentially, you know, if it was a

24:47
permanent crown I was seating, like, do I pay for that? Do they pay for that?

24:52
Like, say they say we were seating a PFM on tooth number 30 and it fell and the patient swallowed it and it came out in

25:00
their poop. Well, they don't want to dig it out of the the poop and they don't want the poop crown in their mouth,

25:04
right? So, do I pay for the lab bill for that? Right. Do you pay for it? Like, what? And like,

25:12
so I think to me that's where I'm just like, I have no idea. And to me, because I tend to be a people pleaser and I don't want people upset. I'm already

25:20
going, are you blaming me? Are you blaming yourself? What are you doing?

25:23
Maybe I should just offer to pay for that.

25:25
But then, like, it could get me in trouble,

25:28
too. So, I just the whole thing I'm like, oh my god, my stomach hurts. I I don't know. I don't know what to do with that. And again, this is why we have one

25:36
of the many reasons why we have malpractice because we don't we can't make the best decision in the moment because our feelings are like, "Oh, if I

25:45
were in this case, this is what I would want." But you ha you have to come back to leaning on your resources and your malpractice is there to protect you from

25:54
situations like this. So, let them protect you and let them guide you and then you follow their lead. You're under their guidance at that point. Um I don't

26:03
know why I'm so suspicious of insurance in general. I think you know but even malpractice or then maybe even the incident that I've talked about you know

26:10
before where yeah like I had insurance and yeah they guided me and they settled the case and they paid the patient and whatever that was for that kid that fell

26:19
and um so it wasn't my malpractice it was my general liability to the building whatever but I just fundamentally disagree with that.

26:28
I don't think that that was fair. And I'm just suspicious like when you're saying they'll guide you and tell you what to do. I think I tend to go but

26:35
you're not my friend. And it's like yeah, they're not your friend. They're they're making a business decision because that's what insurance does. And

26:43
could what they do cause a board complaint because they're saying don't pay for it and now the patient's blasting me all over the place and

26:50
badmouthing me in the community? Like all of that goes through my mind, but I obviously you're right. Like that's

26:58
number one is contact your malpractice. Yeah.

27:01
And um and they are they're making a very non-emotional business decision. They they are making a decision that they

27:08
believe puts you at the least risky spot. Um a and I don't know if malpractice has

27:17
like a protocol that every malpractice follows. I don't know. I don't know how they work to determine what's the right

27:23
course of action. Um, but I know that ultimately it's going to it needs to be on them. If

27:32
we play out worst case scenario and this burr is in the lungs and we're talking a surgery and all of this, like

27:40
they have it needs to be on them. You've paid for them to ultimately financially protect you from a scenario like this.

27:46
And so they've got to be in the loop from the beginning. Um, so as far as paying, not paying, I don't I can't I I

27:54
can't advise I won't advise on that just because that's ultimately got to be something that you talk about with malpractice. So that too, like it would be like,

28:02
okay, well now we don't want poopy crown back in our mouth. Am I I mean, is that one fair enough to say, "Yeah, we'll just get your new crown made."

28:09
If it were me, I would say absolutely.

28:11
You pay for the lab bill to get a new crown paid.

28:15
Okay. being made and because that's within the confines of your office versus a medical facility that you are paying a bill for somebody

28:22
else. That's your own financial decision that you're getting to make. And yes, I would not make the patient pay for a new

28:30
crown on top after we don't want to do anything to inflame them further. So yeah, make the new crown

28:38
like just I I think I just start going through again like Miss Smith, you're the one who sneezed. You're the one who said you couldn't tolerate that rubber dam. Yeah.

28:47
You're the one who said proceed without and so I did and now I get to pay the for the new bridge. Like how fair is that? It's not. It's not.

28:56
It really isn't. But it's the the crap we have to put up with. So, and thankfully it's not an everyday thing,

29:03
but it's like when it does happen, you want to the main thing is set the feelings aside and mitigate risk. How can I reduce this patient getting upset?

29:13
How can I reduce the, you know, chance that I might be on the line for a surgery? That's where malpractice comes

29:20
in. Like, how do I uh mitigate the risk that they're going to panic and freak out while I have my plan for what I'm going to say to them before I say it?

29:28
I'm going to have real clear instructions. Uh, you know, just mitigate risk is the best thing that I can think of. every decision that you

29:37
make needs to be a chance of quelling the the potential negative outcome.

29:43
Well, it goes I the one I think about too is the guy that fell off a bench in our office and I was asking you and my

29:51
one um team member was like, "Oh, we should get him a gift card for massage cuz he fell and whatever." I'm like,

29:56
"Oh, that's a great idea." And then I stopped and I was like, "Whoa, whoa, whoa, whoa, whoa,

30:01
no. Like, you need to use your brain on this. And if we do that, then we're admitting that we broke the bench or we gave you a bad bench or whatever.

30:09
Um, and then I waited for you to kind of tell me how to manage that situation. I think we talked about that two or three years ago on a podcast, but

30:16
um, that that flashes back to my mind because you're right, in the moment I tend to be the feel and make sure they feel good and make sure they feel, but

30:26
people's feelings are all over the place. I could come back to bite you real quick. And it's sad that we have to think that way, but it is the reality of

30:32
the situation that just every every step you take can lead every step you take has a ripple effect, positive or

30:40
negative. And what you're trying to do is to eliminate the negative ripples that could happen. And something as simple as, oh, I'm just going to write

30:49
this person a real sweet note and, you know, apologize that he fell in the practice and send in this massage card.

30:55
Guilt, guilt, guilt. We did something wrong. You should be mad at us. you should, you know, which is so sad because it's like the human side of you wants to do something really sweet and

31:03
kind, but there's a potential negative to that that has to be considered and you don't know what those potential negatives are without talking to your resources ultimately.

31:14
Um, what what else? You had that one other example that's not uh that's not one of these swallowed crown things, but

31:21
it was more of a medical emergency in the office that a team member did not um do what they needed to do. Do you mind talking about that one?

31:32
Just ends up being a mishmash of things that can go wrong. Yeah. Emergencies that can happen. Yes. So,

31:39
you know, registered dental assistant had the uh licensing to be able to monitor uh nitrous. So, doc started the

31:48
nitrous um stepped in a few minutes later and notice that the patient sorry. So, so started nitrous stepped

31:55
out let's say to do a hygiene check. Who knows? Comes back in which assistant of course had been in the room the whole time. comes back into

32:02
the room and notices a physical twitching with the patient in the chair

32:09
and he immediately takes the steps that he needs to take to get the oxygen flowing and uh looks at the assistant

32:17
and was like, "How long has this been happening?" And the assistant was like,

32:21
"Well, pretty much the whole time." And so we think of a situation like that and

32:28
we're just like how how like you've been trained you you have the certification to be able to watch the patient and yet

32:35
you're clearly watching the patient and not doing anything to a physical manifestation or reaction to the nitrous.

32:44
So what do you do in a situation like that? You know same scenario. Now, he obviously jumped in and immediately addressed the the immediate physical

32:52
concern and patient is fine. It's all all fine.

32:59
But you, it begs the question like, how did this happen? How do we have an assistant that didn't respond to the signs or treat it with the appropriate

33:08
amount of um action? Action. That was quite She just sat there.

33:15
Yeah. Yeah. So even that it's like what do you do in that situation? And so um what I guess what would you do in that situation?

33:24
I think I would want to know what happened. Yeah.

33:26
Like what did you just freeze? Did you panic? Did you Yeah. What happened? Yeah. Do we know what happened?

33:35
No.

33:37
because basically she saw the signs and just didn't think it was a big deal which is I don't know I I I don't know.

33:47
So because there you're exactly right.

33:50
So he immediately was like what in the heck you know and he ended up uh sending her home right away cuz he's like I

33:58
you're obviously not in the right state of mind to be assisting even though there was nothing wrong. There was there was nothing wrong. I mean there was she wasn't going through a personal trauma.

34:07
She the assistant was fine but it was a an eye openener for him where he was like oh my gosh the practice is at risk. The patient is

34:16
at risk if you can't recognize that that was not normal.

34:20
Like that was the point of your certification. Yeah. Yeah. So what were you doing in class? Well, you're just checking a box, right?

34:27
Did you not realize that you were the one now in the room monitoring? Monitoring. Yeah.

34:33
Like you are a part of this. You're not just the checkbox person. Exactly.

34:36
You're a part of this the care for this patient. Yeah.

34:39
I think for me the only reason I have a little empathy for that is cuz I wonder for myself like I've always been like this is why medical emergency stuff scares me because yes I'm trained. Yes,

34:48
I've been through pal number of times uh pals but um will I be able to perform in that moment?

34:55
Like what will my emotional state be? And how will I process the situation? Um, so I wonder for her,

35:05
is that where she has never dealt with another emergency? Does she is she just not that bright of a person? Did she

35:12
just panic? Was she, you know, looking at her eyew watch and not even noticing?

35:17
Like who knows? It could have been Yeah,

35:19
a number of those. But I think it's You're exactly right. It's like every person's going to respond differently to

35:26
an emergency or even be able to recognize an emergency. So to me in this

35:33
case or any case where there's an emergency that happens in the practice,

35:38
there's got to be this like deal with it right then and there. get get the patient safe obviously, but then there's

35:47
got to be some debrief that happens like, okay, what can we learn from this scenario that we just walked through?

35:53
And not just with the one person or, you know, but it's got to cause this like what do we learn from this and how do we

36:02
protect ourselves from something like this happening again? Because we've got,

36:06
as awful as it sounds, we've got to take advantage of these scenarios when they hit us and not just to navigate successfully in that moment, but to go,

36:15
how do we prevent this from happening again? What training do we need? And how can we learn from this, which I think is

36:22
the best. We talked about silver linings in a recent ep episode. That's the silver lining to uh any type of

36:29
emergency is we've got to fight to actually learn something from it. Um,

36:33
and not that it's always preventable or but we can always go back and self-reflect and go, is there anything that we would have done better in this situation? If it ever happens again,

36:43
what how could we handle it better? So,

36:45
I guess takeaways from this mishmash episode, I guess number one is if you do have something happen,

36:52
uh, an adverse outcome with a patient like swallowing a burr or doing whatever, get them to where they are in a safe, stable, like to the ER to make

37:01
sure that they're the crown can pass and all of that.

37:04
Um, but as far as a what are we doing in the office, I guess that would be a documentation debrief, like making sure we've documented

37:12
Yes. that day so that it doesn't look like we're fudging notes later. I think sitting and talking with your clinical team to go, how did this happen?

37:20
Um, you know, was this a hand piece that we knew was on, you know, and and we we kept not sending it off? Is that me

37:29
being cheap doc? Is it you guys not reminding me of that? Um, is it, you know, airway where, you know, next time

37:38
no matter what the patient says, we have to use a rubber dam or is dry or whatever. I don't you know it's kind of going through those steps like

37:45
how do we prevent this from happening um how calling medical malpractice

37:53
to go okay what am I what are my next steps here what am I talking to the patient about what am I making sure even getting them to guide you on your documentation even

38:01
yes um I even actually the other day I had a uh a newer assistant and um we ended up

38:11
having to I can't remember extract a over retain something whatever and I went back and I looked at her notes and um she did not put that we did

38:20
the throat screen with the gauze and I was like remember when we had that there and she's like yeah I was like you have got to document that because if for

38:29
some reason the kid had swallowed whatever and we don't have in our notes that we had we tried to protect the

38:36
airway we're hosed it's over. So, um I was like, you've got to remember those details. Like that is that is not just uh what shade of composite did we use?

38:46
That's a vital note that we need in there. Anyway, so kind of talking through our what is going to be our

38:53
plan? How far are we pushing with this patient who's got claims to have this gag reflex? Are we referring them? Are we sedating them? Are we refusing to see

39:02
them? Because we don't want to be back in this situation again. But I think you have to kind of look back and reflect and go, how did this happen?

39:08
Yeah. Um, even though it may be no fault of your own, like she sneezed and the crown dropped, but still having to talk through it.

39:15
Yeah. To to to I think that's important to do.

39:19
That's another takeaway. Calling malpractice, documentation, all of that. Um, crash cart stuff.

39:25
I was going to say crash carts. The other takeaway on this when and or your systems. When was the last time you went through your own um binder of your medical emergency list? For me,

39:37
I'm like, we don't even have that drug anymore. Why is it that that's what we would grab?

39:42
Because if I if I were to pull this at the time of an emergency and go, what am I supposed to do again? If a patient is having a, you know, anaphylactic

39:50
reaction and I look and I'm like, we don't even have that form of Benadryl anymore. Yeah.

39:54
Or we have that vial, but the syringe doesn't work. Or I don't know how to use the syringe. I don't remember what I'm drawing up.

40:00
Was it 0.1 one? Does my syringe is it a 0.1 syringe? Is it a one syringe? Like I have no idea. that that's what we discovered when we were going through our crash card. We were like, "This is

40:08
not the syringe that even matches up with wow that dosage."

40:12
Um, so anyway, so have you have you done your due diligence to make sure that you are protecting yourself with all of that? And my guess is a lot of us don't because number one, it's yucky.

40:21
Yeah. Two, it's timeconuming. Yeah.

40:24
Three, it's kind of like h I don't want to jinx myself. Like if we're going to assume the crash card's fine and we're going to assume we never need it. Yeah. The minute I look at the crash card,

40:31
somebody's going to have an emergency. So let's not jinx ourselves. Never mind. I'm not going to look at it.

40:35
But you can't Yeah, it Yeah, it we can't avoid it. Like, we got to just dig in and and even if this episode prompts all

40:43
of these little like protect yourself type things, that's kind of the point that it is like don't don't listen to this episode and do nothing with it.

40:53
Like really make sure that you're protected on all sides.

40:59
re-evaluate your medical emergency training and go, hey, have we been thorough enough with that? Have we talked about the communication that

41:07
needs to occur? Do we have code words that we all need to be, you know, be remembering? Maybe we need to increase the frequency of our medical emergency

41:15
trainings because we don't feel, you know, super adequately prepared. Like,

41:19
well, I will tell you the one my takeaway from after our crash cart stuff where I was just like, oh my god, oh my god. And here my team is patting

41:27
themselves on the back. And frankly, me too, patting ourselves in the back that here we go. We are We've got our, you know, nothing's expired. It's all Well,

41:35
it was expired. It was just stuck in an expired drawer. But like in the in the kit itself, Yeah.

41:40
there was nothing. But anyway, um but when we had our uh guy Jose come in and do that training for us, and then we

41:50
subsequently went through the crash cart and cleaned it up, I was like, "You know what? I'm bringing somebody in twice a year and I'm going to bring Jose in every February and then we've got uh one

41:58
of our hygienists um husband's a paramedic firefighter and so he's always said oh if you ever need me to come whatever I reached out to him I was like

42:07
give me some dates and then we will come up with content for you to come in and show us how to rig up this show you know test us on how

42:15
we draw up that make sure we've got spa checks so I'm like you're going to come every September Jose's going to come every February like we're going to do this twice because I don't know what

42:23
staff differences there are. I don't know.

42:27
There's too many things that can slip through the cracks as I found. Yeah.

42:30
That things that I thought I was on top of that we were not.

42:33
Yeah. I I think that's a great takeaway from this too is just go over and above on the emergency training. You know,

42:41
bring in resources that you feel like would be helpful and really challenge your team to think about things differently, different perspectives from different trainers, I think is a great

42:50
takeaway, too. rather than having Jose twice, it's like you're having two different perspectives, which I think is important as well. So, yeah, do do

42:58
something with the content from this episode. Thanks for joining the conversation today. We hope that you are

43:06
comforted in knowing that you are not alone, but we also hope that you're walking away with some really great tips and tricks to try in your practice.

43:15
We value your feedback, so please take a few moments to rate and review the podcast. Finally, we want to make sure

43:24
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43:31
let us know what topics you want us to cover. As always, please know that we are rooting for you today as you manage your dental drama.