Dentists=Physicians?

[UNLV OMS GUNNABE]

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Well, I have always heard the arguments on this forum about how dentists are doctors too and how we are holding our pt's lives in our hands...

After the first day of my ACLS course I have to say that we don't know crap about emergency medicine. If I truly am holding my pt's life in my hands it would at least be nice to know a little more about an EKG. I have the feeling little johnny is going to die in my megacode tomorrow

P.S. Thanks toofache for mentioning rapid interpretation of EKG's in another post... it helped a ton.

P.P.S. don't jump on my case and get defensive about our profession... I'm too overwhelmed right now to take the time to make this more P.C.

 

[OMFSCardsFan]

After the first day of my ACLS course I have to say that we don't know crap about emergency medicine.

I totally agree, neither do we learn much about medicine in general. Ignorance is bliss...the more you learn, the more there is that you realize you don't know.

 

[GatorDMD]

I totally agree, neither do we learn much about medicine in general. Ignorance is bliss...the more you learn, the more there is that you realize you don't know.

I am studying for ACLS now... taking it this weekend! 😱 Wish me luck!

 

[scalpel2008]

a little clue about ACLS for the neophytes....just make sure you know the algorithms in the fold out card you get with the book and you should be fine for the megacode. And in the megacode, after you go through an algorithm and you finally get the patient to normal sinus rhythm, make sure you don't stop without checking pulse (they love to trick you with PEA)

 

[kato999]

I was ACLS certified last year and I can say that I have pretty much forgotten everything. If you are not in the ER or a paramedic you will not be using the info enough to retain it and really should not be attempting to give verapamil IV to somebody. I do have a ton more respect for all those that are saving lives everyday because me stressing about getting a PVS impression without voids is really nothing compared to what they do on a daily basis.

 

[GatorDMD]

Well, I have always heard the arguments on this forum about how dentists are doctors too and how we are holding our pt's lives in our hands...

After the first day of my ACLS course I have to say that we don't know crap about emergency medicine. If I truly am holding my pt's life in my hands it would at least be nice to know a little more about an EKG. I have the feeling little johnny is going to die in my megacode tomorrow

P.S. Thanks toofache for mentioning rapid interpretation of EKG's in another post... it helped a ton.

P.P.S. don't jump on my case and get defensive about our profession... I'm too overwhelmed right now to take the time to make this more P.C.

toof do you mind reposting the rapid interp of EKG's?? 😕

 

[UNLV OMS GUNNABE]

I am studying for ACLS now... taking it this weekend! 😱 Wish me luck!

Studying? What's that?

 

[Rezdawg]

Well, I have always heard the arguments on this forum about how dentists are doctors too and how we are holding our pt's lives in our hands...

After the first day of my ACLS course I have to say that we don't know crap about emergency medicine. If I truly am holding my pt's life in my hands it would at least be nice to know a little more about an EKG. I have the feeling little johnny is going to die in my megacode tomorrow

P.S. Thanks toofache for mentioning rapid interpretation of EKG's in another post... it helped a ton.

P.P.S. don't jump on my case and get defensive about our profession... I'm too overwhelmed right now to take the time to make this more P.C.

Who says all physicians know something about emergency medicine? Sure, they may have gone through some basic steps, but unless you are involved in emergency medicine on a regular basis, you wouldnt be ready to handle the situation, physician or not.

Dentists do not hold their patients lives in their hands, however, having the title "physician" doesnt automatically make you a God of health care. Every physician has their limits, which usually lies in the area of medicine that they pursued, and not much more outside of that.

 

[superchris147]

Well, I have always heard the arguments on this forum about how dentists are doctors too and how we are holding our pt's lives in our hands...

After the first day of my ACLS course I have to say that we don't know crap about emergency medicine. If I truly am holding my pt's life in my hands it would at least be nice to know a little more about an EKG. I have the feeling little johnny is going to die in my megacode tomorrow

P.S. Thanks toofache for mentioning rapid interpretation of EKG's in another post... it helped a ton.

P.P.S. don't jump on my case and get defensive about our profession... I'm too overwhelmed right now to take the time to make this more P.C.

what are you talking about?!?!?!

in our physio class we learned how to interpret ekg's, mother f'in p waves

oh wait, we've all already forgotten that material, such is dental school, memorize and forget

 

[UNLV OMS GUNNABE]

Who says all physicians know something about emergency medicine? Sure, they may have gone through some basic steps, but unless you are involved in emergency medicine on a regular basis, you wouldnt be ready to handle the situation, physician or not.

Dentists do not hold their patients lives in their hands, however, having the title "physician" doesnt automatically make you a God of health care. Every physician has their limits, which usually lies in the area of medicine that they pursued, and not much more outside of that.

This is a perfect example of the response I was hoping NOT to get. I am here to complain and not to have any type of debate whatsoever.

 

[UNLV OMS GUNNABE]

toof do you mind reposting the rapid interp of EKG's?? 😕

Just search for "rapid interpretation of EKG's." Man, could you be any lazier? 😍

 

[GQ1]

Well, I have always heard the arguments on this forum about how dentists are doctors too and how we are holding our pt's lives in our hands...

After the first day of my ACLS course I have to say that we don't know crap about emergency medicine. If I truly am holding my pt's life in my hands it would at least be nice to know a little more about an EKG. I have the feeling little johnny is going to die in my megacode tomorrow

P.S. Thanks toofache for mentioning rapid interpretation of EKG's in another post... it helped a ton.

P.P.S. don't jump on my case and get defensive about our profession... I'm too overwhelmed right now to take the time to make this more P.C.

dumb argument, who would want to be in a dermatologists, hematologist, pathologists hands in an emergency situation. dentistry is in all actuality tought as a field of medicine at many schools, therefore physician would be an appropriate title.

 

[S Files]

dumb argument, who would want to be in a dermatologists, hematologist, pathologists hands in an emergency situation. dentistry is in all actuality tought as a field of medicine at many schools, therefore physician would be an appropriate title.

The OP is being sarcastic. He has some mental health issues and is a little bored, hence the post.

 

[Ankylosed]

Dentists do not hold their patients lives in their hands, however, having the title "physician" doesnt automatically make you a God of health care. Every physician has their limits, which usually lies in the area of medicine that they pursued, and not much more outside of that.

I strongly disagree with your statement. Many dentists are holding their patient's lives in their hands. Any dentist that is practicing IV sedation with Fentanyl is doing this. The dosage is measured in MICROGRAMS and an overdose could easily result in respiratory arrest. You need to rethink your statement.

 

[GatorDMD]

Just search for "rapid interpretation of EKG's." Man, could you be any lazier? 😍

you know me bro! I just got done with day one of ACLS and i know I am so lost. It sucked because on the registration i had to tell them nurse, student, or resident for different fees and they kept calling me doctor in front of everyone!! I was the only "dr" in the room and I knew the least... man, if i could blush! They called em up for everything.... 1st intubation, EKG interps, etc... I even said I was a dental student!... and they still were like"dr." this and "dr" that! 😳

 

[Rezdawg]

I strongly disagree with your statement. Many dentists are holding their patient's lives in their hands. Any dentist that is practicing IV sedation with Fentanyl is doing this. The dosage is measured in MICROGRAMS and an overdose could easily result in respiratory arrest. You need to rethink your statement.

Okay, regardless, a physician still has far greater responsibility in this department. Its not even a comparison.

 

[Rezdawg]

This is a perfect example of the response I was hoping NOT to get. I am here to complain and not to have any type of debate whatsoever.

Maybe you should have had a different title and opening statement then...you open yourself up to that.

 

[aphistis]

Maybe you should have had a different title and opening statement then...you open yourself up to that.

Or alternately, maybe you should read people's entire posts before popping off at them.

P.P.S. don't jump on my case and get defensive about our profession... I'm too overwhelmed right now to take the time to make this more P.C.

Did you not read that part, or just decide to ignore it?

 

[esclavo]

Well, I have always heard the arguments on this forum about how dentists are doctors too and how we are holding our pt's lives in our hands...

After the first day of my ACLS course I have to say that we don't know crap about emergency medicine. If I truly am holding my pt's life in my hands it would at least be nice to know a little more about an EKG. I have the feeling little johnny is going to die in my megacode tomorrow

P.S. Thanks toofache for mentioning rapid interpretation of EKG's in another post... it helped a ton.

P.P.S. don't jump on my case and get defensive about our profession... I'm too overwhelmed right now to take the time to make this more P.C.

Do you know who else doesn't know crap about emergency medicine... dermatologists, ophthamologists, and a host of other doctors. Truth is if you don't stay sharp you lose your ability. I had a patient tank last week in the CT scanner in front of a veteran neurosurgeon (27 years of practicing-excellent surgeon) and an orthopedic surgeon (practicing 18 years) and guess who ran the code... you got it. I was shocked that they both told me to run it and that both of them hadn't ran a code in over a decade!!!! I asked the neurosurgeon to intubate and he told me to wait that RT was on their way! The orthopedic surgeon kept yelling give him some Ancef, give him some Ancef (I think he was meaning to say some other drug-I don't know what). Complete cardiothoracic arest in a trauma patient in the scanner. Those who stay sharp with their skills -critical care docs, ED docs, trauma docs and other intensivists, ED nurses (this group of people are actually incredible at ATLS) are the ones who stay sharp. If you go down in a family practice doctors office 3 miles from the hospital, your prognosis might not be tremendously different than going down in a dentists office or a podiatrists office or a dermatologists office or an opthamologists office. Depends who has the emergency equipment and who has stayed the most current and sharp in their practice of emergency medicine. If you think ACLS is tough wait till ATLS and PALS....then talk about a traumatic arrest or pediatric arrest then your list of who doesn't know crap gets even larger....

 

[scalpel2008]

Do you know who else doesn't know crap about emergency medicine... dermatologists, ophthamologists, and a host of other doctors. Truth is if you don't stay sharp you lose your ability. I had a patient tank last week in the CT scanner in front of a veteran neurosurgeon (27 years of practicing-excellent surgeon) and an orthopedic surgeon (practicing 18 years) and guess who ran the code... you got it. I was shocked that they both told me to run it and that both of them hadn't ran a code in over a decade!!!! I asked the neurosurgeon to intubate and he told me to wait that RT was on their way! The orthopedic surgeon kept yelling give him some Ancef, give him some Ancef (I think he was meaning to say some other drug-I don't know what). Complete cardiothoracic arest in a trauma patient in the scanner. Those who stay sharp with their skills -critical care docs, ED docs, trauma docs and other intensivists, ED nurses (this group of people are actually incredible at ATLS) are the ones who stay sharp. If you go down in a family practice doctors office 3 miles from the hospital, your prognosis might not be tremendously different than going down in a dentists office or a podiatrists office or a dermatologists office or an opthamologists office. Depends who has the emergency equipment and who has stayed the most current and sharp in their practice of emergency medicine. If you think ACLS is tough wait till ATLS and PALS....then talk about a traumatic arrest or pediatric arrest then your list of who doesn't know crap gets even larger....

well said...in our hospitals (as is probably true with most hospitals) the only people that ever intubate a significant # of patients are anesthesia, ER, OMS on their anesthesia rotation, and critical care. Other than this, the other services get minimal exposure to airway management (other than surgical airways). Even the general surgeons don't really get to intubate because they are busy sticking in the chest tubes and lines in the trauma activations while the ER resident is tubing them. I am not surprised one bit that the Neurosurgeon would rather have the RT dude intubate. And as far as the ortho guy yelling "Ancef"....thats is some funny ****...we just call them extermity OMS...while we are face ortho.

 

[Rezdawg]

Or alternately, maybe you should read people's entire posts before popping off at them.


Did you not read that part, or just decide to ignore it?

Oh no, I can read both parts Bill...but you cant make one statement and then ask later to ignore it...whats the point of that? If he doesnt want to deal with a certain issue, then leave it out of the post...its as simple as that. He "popped" off on me before I "popped" off on him.

 

[Rezdawg]

Just noticed esclavo echoed my thoughts (although, in a much more interesting way)...lets see if he gets any crap for it since he's an OS...or maybe I just get the grunt of it from guys like Bill since Im still only a first year.

 

[toofache32]

toof do you mind reposting the rapid interp of EKG's?? 😕

I'm still trying to remember what he's referring to. Maybe I was in another drunken stupor that night....

 

[toofache32]

...The orthopedic surgeon kept yelling give him some Ancef, give him some Ancef ....

OH **** that's the FUNNIEST thing I've read on this forum in YEARS!!!

My wife is staring at me like I'm some idiot laughing at the computer screen.

 

[toofache32]

Okay, regardless, a physician still has far greater responsibility in this department. Its not even a comparison.

These are 2 different issues we're talking about here. Physicians aren't dentists and dentists aren't physicians.

When I've got a full maxilla disimpacted and sitting on the patient's chin and I'm staring at the skull base....do I not have the patient's life in my hands more than a dermatologist lopping off a skin goober or a pathologist whose patients are already dead?

If you're interested in having more of the patients' lives in your hands (read: more morbidity) then there are dental and medical specialties to fit the description.

 

[toofache32]

well said...in our hospitals (as is probably true with most hospitals) the only people that ever intubate a significant # of patients are anesthesia, ER, OMS on their anesthesia rotation, and critical care. Other than this, the other services get minimal exposure to airway management (other than surgical airways). Even the general surgeons don't really get to intubate because they are busy sticking in the chest tubes and lines in the trauma activations while the ER resident is tubing them....

Besides anesthesia residents, OMFS residents intubate more than anyone else....including general surgery and ENT who each tend to assume that they are the last work in airways. I intubated over 200 tracheas (and a few esophagus's) during my anesthesia rotation. There's no way anyone else besides anesthesia has done this much.

 

[Rezdawg]

These are 2 different issues we're talking about here. Physicians aren't dentists and dentists aren't physicians.

When I've got a full maxilla disimpacted and sitting on the patient's chin and I'm staring at the skull base....do I not have the patient's life in my hands more than a dermatologist lopping off a skin goober or a pathologist whose patients are already dead?

If you're interested in having more of the patients' lives in your hands (read: more morbidity) then there are dental and medical specialties to fit the description.

True, dentistry can include more severe cases, but the vast majority of dentistry isnt life or death...at least not to the extent of medicine. Medicine has its specialties that arent life threatening (radiology, derm), but many more fields that are. The OMS field brings about many situations that have the lives of the patient in the hands of the doc, but thats also because those OMS procedures are closer to medicine than to typical dentistry...or at least 50/50.

80% of dentists are GP...GP's, typically, are not put in situations where they can kill their patients...or at least, with any common sense, do not put their patients in a life threatening situation. Medicine has its exceptions as well, but a much greater percentage of M.D.'s have the life of their patients in their hands...thats a reason why many choose dentistry over medicine. Thats all Im trying to say. Just cant speak properly sometimes.

 

[esclavo]

This thread brings up a great opportunity to talk philosophically (sp?-ahhh, I don't give a crap if it is spelled right or wrong).... this is why I think a person should practice widely and constantly keep their skills fresh. When you are a private practice guy you need to run mock codes every 6 months or so. You need to ask another OMFS or ED doc to come into your office and spent 2-4 hours and kick the !#$% out of your staff and yourself to keep your skills sharp. If you haven't intubated anyone in quite some time, go spend an afternoon in the hospital on anesthesia and do some intubation. If you don't use your skills, you lose them. I talked to an OMFS who had a 27 year old die in the office... it shell shocked him. He couldn't intubate her, didn't have the emergency equipment he wanted (laryngoscope light out, staff freaking out and completely unversed in any kind of emergency algorithm, no one could find half the things he was asking for because he wanted things he had never put in his office....sad crap) and it had been too long and he failed. 100% savable person but he was rusty and he admitted it... he said he couldn't hardly practice for the next 6 months for sheer lack of confidence. But it is his own fault. He'd rather go sit on a boat at the lake than stay after and train his staff. He'd rather go work out at the gym that assure his skills are what they used to be...he'd rather sit on his can in the doctors lounge BSing with the boys when anesthesia is intubating a patient of his than be in the room and ask anesthesia if he can intubate the patient...it takes investment in yourself and in your staff and in your facilities and equipment to be able to take care of emergencies. No one pays you for that investment. It doesn't make you money, but it does make a difference if things go "south" on you (no offense to those who live in the south-kinda funny though)

 

[OMFSCardsFan]

It doesn't make you money, but it does make a difference if things go "south" on you (no offense to those who live in the south-kinda funny though)

Then there are people like TX, who have to pay to have people go south on him...

 

[slackerjock99]

dentists>physicians

 

[drhobie7]

This thread brings up a great opportunity to talk philosophically (sp?-ahhh, I don't give a crap if it is spelled right or wrong).... this is why I think a person should practice widely and constantly keep their skills fresh. When you are a private practice guy you need to run mock codes every 6 months or so. You need to ask another OMFS or ED doc to come into your office and spent 2-4 hours and kick the !#$% out of your staff and yourself to keep your skills sharp. If you haven't intubated anyone in quite some time, go spend an afternoon in the hospital on anesthesia and do some intubation. If you don't use your skills, you lose them. I talked to an OMFS who had a 27 year old die in the office... it shell shocked him. He couldn't intubate her, didn't have the emergency equipment he wanted (laryngoscope light out, staff freaking out and completely unversed in any kind of emergency algorithm, no one could find half the things he was asking for because he wanted things he had never put in his office....sad crap) and it had been too long and he failed. 100% savable person but he was rusty and he admitted it... he said he couldn't hardly practice for the next 6 months for sheer lack of confidence. But it is his own fault. He'd rather go sit on a boat at the lake than stay after and train his staff. He'd rather go work out at the gym that assure his skills are what they used to be...he'd rather sit on his can in the doctors lounge BSing with the boys when anesthesia is intubating a patient of his than be in the room and ask anesthesia if he can intubate the patient...it takes investment in yourself and in your staff and in your facilities and equipment to be able to take care of emergencies. No one pays you for that investment. It doesn't make you money, but it does make a difference if things go "south" on you (no offense to those who live in the south-kinda funny though)

Very interesting post.

 

[TucsonDDS]

Did he even have an ambu bag in his office. There is no reason why he should have had to intubate someone in the office unless there was just copious amounts of blood and even then he would have been better off bagging the girl until the parametics got there. Proper bagging can be just as effective as intubation for the short term and proper bagging is 1000% better than messing around wasting time trying to intubate. I feel for the guy, it is something that he and his staff will never forget. I would guess they are all ACLS card holders today.

 

[Bitters]

Did he even have an ambu bag in his office. There is no reason why he should have had to intubate someone in the office unless there was just copious amounts of blood and even then he would have been better off bagging the girl until the parametics got there. Proper bagging can be just as effective as intubation for the short term and proper bagging is 1000% better than messing around wasting time trying to intubate. I feel for the guy, it is something that he and his staff will never forget. I would guess they are all ACLS card holders today.

Dont be fooled into thinking an ambu bag is the savior. It entirely possible that this patient was having laryngospasm in which case baging wont do much for you.

Remain calm. You can’t work if you panic.
The first priority is always bag-mask ventilation. Don’t rush to intubate.
Have an organized game plan. Know what to do next if what you’re doing works, and what to do next if it doesn’t.
If you can’t ventilate, intubate.
Keep track of time.
If your first attempt to intubate doesn’t work, think what to do differently the second time to succeed.
If you can’t intubate in two tries, go back to the bag mask and try to oxygenate.
If you can’t ventilate and can’t intubate, open the neck.
Most airway problems, even extreme, can be worked as an algorithmic sequence of steps.
Fall back to a simple method if it will at least temporize.
Even a modest plan may be successful if continued firmly.
PRACTICE whenever you can. These skills are perishable. Current trends recommend quarterly skills evaluation of airway and intubation skills.

 

[aphistis]

Dont be fooled into thinking an ambu bag is the savior. It entirely possible that this patient was having laryngospasm in which case baging wont do much for you.

Remain calm. You can’t work if you panic.
The first priority is always bag-mask ventilation. Don’t rush to intubate.
Have an organized game plan. Know what to do next if what you’re doing works, and what to do next if it doesn’t.
If you can’t ventilate, intubate.
Keep track of time.
If your first attempt to intubate doesn’t work, think what to do differently the second time to succeed.
If you can’t intubate in two tries, go back to the bag mask and try to oxygenate.
If you can’t ventilate and can’t intubate, open the neck.
Most airway problems, even extreme, can be worked as an algorithmic sequence of steps.
Fall back to a simple method if it will at least temporize.
Even a modest plan may be successful if continued firmly.
PRACTICE whenever you can. These skills are perishable. Current trends recommend quarterly skills evaluation of airway and intubation skills.

Nice post. 👍

 

[scalpel2008]

I disagree, positive pressure ventilation is the first step in treating a laryngospasm and is usually successful. In the instances it's not then succinylcholine is your friend.
I like your sequence of steps to manage the airway. I think it's critical everyone to realize that when all of this is going down and your sphincter tone is in full contraction, you are also treating the underlying cause ie have the rest of your team either administering the appropriate drugs (be it narcan, epi, amiodarone or whatever depending the reason for the code) or getting the paddles ready if indicated. Its definitely a team approach with the nurses. And if you are not staying upto date with current life support standards, you don't deserve to be sedating patients because the cliche that anesthesia is 99% boredom and 1% pure terror is very true.

 

[Bitters]

agreed with the ppv, the post just made it seem that if the bag was available then all is well. also if the reason is blood or secretions in the larynx ppv should be avoided

 

[TucsonDDS]

I agree as well, I didn't mean that PPV will fix everything but it will take care of 95% of problems for the 10 minutes until parametics arrive. Many times people are way to eager to intubate when a little support is all that a patient needs. I don't know what the circumstances were when that patient died but there aren't many situations that suction and PPV won't buy the time to figure out what the problem is or until people with much more experience intubating than you or I will arrive.

For my information:
What kind of emergency medications and equiptment do most dentists or oral surgeons keep in their office. I wouldn't think succinylcholine or any other paralytic would be common place in the office emergency kit. I would hope that at the very least they do have a bag/mask and your typical ACLS drugs along with an AED. I would also imagine that they have a lot of expired drugs that have never been out of the cart.

 

[Extraction]

Well, I have always heard the arguments on this forum about how dentists are doctors too and how we are holding our pt's lives in our hands...

After the first day of my ACLS course I have to say that we don't know crap about emergency medicine. If I truly am holding my pt's life in my hands it would at least be nice to know a little more about an EKG. I have the feeling little johnny is going to die in my megacode tomorrow

P.S. Thanks toofache for mentioning rapid interpretation of EKG's in another post... it helped a ton.

P.P.S. don't jump on my case and get defensive about our profession... I'm too overwhelmed right now to take the time to make this more P.C.

Non-emergency personel do not remember this stuff either..... Typically, you only remember what yor practice... and about 10% of the rest. Unless you regularly run codes or sedate patients you will never remember the ACLS.

 

[GatorDMD]

Non-emergency personel do not remember this stuff either..... Typically, you only remember what yor practice... and about 10% of the rest. Unless you regularly run codes or sedate patients you will never remember the ACLS.

Yeah I just took it this weekend and I cant say I remember everything... except a bunch of acronyms and confusing Torsades des Pointe and Ventricular Fibrillation 😱 No, seriously though, it was actually a fun experience and I felt good after it was over... i was looking around on my way home trying to find someone to "help" 👍

 

[esclavo]

I agree as well, I didn't mean that PPV will fix everything but it will take care of 95% of problems for the 10 minutes until parametics arrive. Many times people are way to eager to intubate when a little support is all that a patient needs. I don't know what the circumstances were when that patient died but there aren't many situations that suction and PPV won't buy the time to figure out what the problem is or until people with much more experience intubating than you or I will arrive.

For my information:
What kind of emergency medications and equiptment do most dentists or oral surgeons keep in their office. I wouldn't think succinylcholine or any other paralytic would be common place in the office emergency kit. I would hope that at the very least they do have a bag/mask and your typical ACLS drugs along with an AED. I would also imagine that they have a lot of expired drugs that have never been out of the cart.

Try bagging a 27 year old female history of mild asthma and 4 months pregnant with a BMI of 34, with a unilateral submandibular/parapharyngeal space infection having a laryngospasm and a bronchospasm. She was out of shape with poor reserve. She was actively infectived which makes all those inflammatory mediators sensitizing the bronchi. She was fat (with a short fat neck), big tongue, making it an already tough airway...secretions... She was a Mallampati IV with the mild trismus and infection. She only had 2 of versed and 25 mics of fentanyl....Trust me, my buddy did a year of anesthesia before he did his OMFS residency. When you can't get the past the first step in your algorithm you have no algorithm. If you can't ventilate a patient in anyway shape or form, you are S C R E W E D... When you scream for an LMA and no one in the office knows what you are talking about, you are screwed. When you yell for the 14 guage needle or a cric kit and the 19 year old assistant who graduated less than a year ago from high school says we don't have a needle bigger than a 20 in the practice you are screwed. When she says she doesn't know if there is a cric kit in the office then you are screwed. Patient getting bluer by the second.... pulse ox in the 50's .... your almost ready to code yourself....I don't want to rain on Tuscon's comment but I don't consider it a tough airway if you can ambu bag someone. What do you do for 10 minutes if you can't bag someone or bag them very well? Positive pressure rarely breaks a true laryngospasm in an adult, a kid probably but an adult? I don't think so, it is usually the hypoxia that breaks the laryngospasm... if it is truly a laryngospasm not just the patient holding their breath....

 

[TucsonDDS]

Try bagging a 27 year old female history of mild asthma and 4 months pregnant with a BMI of 34, with a unilateral submandibular/parapharyngeal space infection having a laryngospasm and a bronchospasm. She was out of shape with poor reserve. She was actively infectived which makes all those inflammatory mediators sensitizing the bronchi. She was fat (with a short fat neck), big tongue, making it an already tough airway...secretions... She was a Mallampati IV with the mild trismus and infection. She only had 2 of versed and 25 mics of fentanyl....Trust me, my buddy did a year of anesthesia before he did his OMFS residency. When you can't get the past the first step in your algorithm you have no algorithm. If you can't ventilate a patient in anyway shape or form, you are S C R E W E D... When you scream for an LMA and no one in the office knows what you are talking about, you are screwed. When you yell for the 14 guage needle or a cric kit and the 19 year old assistant who graduated less than a year ago from high school says we don't have a needle bigger than a 20 in the practice you are screwed. When she says she doesn't know if there is a cric kit in the office then you are screwed. Patient getting bluer by the second.... pulse ox in the 50's .... your almost ready to code yourself....I don't want to rain on Tuscon's comment but I don't consider it a tough airway if you can ambu bag someone. What do you do for 10 minutes if you can't bag someone or bag them very well? Positive pressure rarely breaks a true laryngospasm in an adult, a kid probably but an adult? I don't think so, it is usually the hypoxia that breaks the laryngospasm... if it is truly a laryngospasm not just the patient holding their breath....

Sounds like that person fell into the 5% that won't bag well. It also sounds like that patient wasn't a prime candidate for surgery in an office setting with an unequipted, undertrained staff. I really feel for him but it doesn't sound like he learned much from his year of anesthesia. Sounds like a paralytic would have fixed the problem but he probably didn't have that either. The whole point of this thread is how some are saying that dentists don't need to know ACLS. Your senario above definitely shows that this is not the case. Dentists do have patients lives in their hand and with that comes the responsibility to know what to do with it.

I know what you mean when you say about wanting to code yourself. It is amazing how just trying to access a port on a line is so much more difficult when your patient is laying there dead.

 

[txdent2be2007]

(I'll be applying to OMS in a few months, so no bashing here... )

When talking about d-school not preparing you for ACLS -- did you have to go back and learn new basic science topics not covered in dental school? For example, our dental school gross anatomy course doesn't cover anything on the anatomy of the upper limb (won't I need to know this to start IVs?). Our gross course also didn't cover the legs, feet, pelvis, or back. And we don't learn a thing about EKG interpretation, auscultation, or general physical examination.

So, did you bust out the Netter's and study on your own to "catch up" with your med school classmates, or did you sit in on MS1 courses to fill in the gaps (since most OMS residents start med school in the MS2 year)? Did you feel like you were at a disadvantage as compared to your med school classmates, or do you guys feel like you're at comparable levels?

(For what we need to know to practice general dentistry, I feel as though we're well trained; it's the basic science/medicine courses I think are lacking, at least at my d-school.)

Great post -- very intersting. Whets my appetite for ACLS!

 

[ItsGavinC]

I was ACLS certified last year and I can say that I have pretty much forgotten everything. If you are not in the ER or a paramedic you will not be using the info enough to retain it

Exactly, and that goes for plenty of physicians, from dermatologists to psychiatrists and on down the line. As with anything in our professions, if you don't use it you'll lose it.

 

[bobby6]

Besides anesthesia residents, OMFS residents intubate more than anyone else....including general surgery and ENT who each tend to assume that they are the last work in airways. I intubated over 200 tracheas (and a few esophagus's) during my anesthesia rotation. There's no way anyone else besides anesthesia has done this much.

I'm going to have to call out toofache32 on this one. This sounds rather pompous from an oral surgery resident. You may have intubated 200 tracheas in a controlled setting in ideal patients on your anesthesia rotation but are you still doing it routinely? Oral Surgery residents are not called to evaluate an emergent airway, its anesthesia and ENT. Of course anesthesia has the most experience in intubation as they do it daily. However, ENTs perform laryngoscopies all the times in difficult patients and once finding the vocals cords, its just a matter of passing the tube. ENTs take airway call for both pediatric and adults patients during there residency. Next thing you are going to tell me is that an oral surgeon does more trachs than anyone else. While oral surgeons are highly trained, the training is just one year of general surgery where you get scutted out and not operating and the other 3 years of oral surgery. This is less than any surgical specialty. Why do dentists feel the need that they have to prove themselves better than physicians? Its an inferiority complex ..... Comparing a dentist and a residency trained physician is comparing apples and oranges, there is no comparison. The only thing in dentistry that comes close to a physician is an oral surgeon.

 

[Extraction]

Why do dentists feel the need that they have to prove themselves better than physicians? Its an inferiority complex ..... Comparing a dentist and a residency trained physician is comparing apples and oranges, there is no comparison. The only thing in dentistry that comes close to a physician is an oral surgeon.

What kinda complex do you have?

 

[ItsGavinC]

The only thing in dentistry that comes close to a physician is an oral surgeon.

Thank heavens and amen to that. That very fact makes a lot of us very happy. The majority of us don't want to be physicians, that's why we're dentists. 🙂

I'll give credit to the OMFS guys though, they're good at what they do and know their stuff.

 

[OMFSCardsFan]

Next thing you are going to tell me is that an oral surgeon does more trachs than anyone else.

I guess it depends on the hospital. My buddy is an ENT resident, and while on a Neuro rotation, had to consult my service for a trach. When he asked to consult ENT, they wouldn't let him. We get more trach consults than I care to have because we do them faster and more efficiently than ENT and GenSurg (BOTH intraoperatively AND from the time of consult to time of surgery). We have a really good relationship with the SICU and MICU staff, and they always comment on our surgical technique being better than the rest. I'm not saying that we do more than everyone else, but we do a ton.

We do not, however, get consulted often for emergent airway management. That tends to be heavily anesthesia/GenSurg/ENT.

I'm not trying to compare johnsons (my two incher couldn't measure up), just merely pointing out a fact. I agree that there are times that oral surgeons act like they have something to prove, but there are also plenty of those that, like yourself, have the same agenda, only reversed.

 

[bobby6]

I guess it depends on the hospital. My buddy is an ENT resident, and while on a Neuro rotation, had to consult my service for a trach. When he asked to consult ENT, they wouldn't let him. We get more trach consults than I care to have because we do them faster and more efficiently than ENT and GenSurg (BOTH intraoperatively AND from the time of consult to time of surgery). We have a really good relationship with the SICU and MICU staff, and they always comment on our surgical technique being better than the rest. I'm not saying that we do more than everyone else, but we do a ton.

We do not, however, get consulted often for emergent airway management. That tends to be heavily anesthesia/GenSurg/ENT.

I'm not trying to compare johnsons (my two incher couldn't measure up), just merely pointing out a fact. I agree that there are times that oral surgeons act like they have something to prove, but there are also plenty of those that, like yourself, have the same agenda, only reversed.

Sounds funny that an ENT resident would be on a Neuro rotation unless he/she was a Designated ENT prelim who is a general surgery intern, who basically knows nothing accept how to take orders. There aren't any programs in the country that has an ENT resident rotate through another service after their intern year. This is untrue of oral surgery as they rotate through anesthesia and general surgery sometime during their training after the oral surg intern year. To think of it, oral surgeons spend approx 4 years in clinical training, 1 year that includes general surgery and 3-6 months of anesthesia which is basically nonoperative time. That only leaves 2 1/2 years of actual oral surgery. Sure an oral surgeon learns general dentistry while in school but once a dental specialist, he/she is not able to practice general dentistry anymore so that doesn't count.

It might be true that oral surgery would do a good amount of trachs, that is at a place that has a weak/non-existent ENT and General Surgery programs like Nebraska or LSU Shreveport which are in the middle of nowhere.

I have no agenda, I'm just stating the facts. It just irks me when dentists think they know more medicine than a physician. I don't to presume to know anything about dentistry. I respect dentists and what they do as my father is one but they are not physicians.

 

[toofache32]

...There aren't any programs in the country that has an ENT resident rotate through another service after their intern year. This is untrue of oral surgery as they rotate through anesthesia and general surgery sometime during their training after the oral surg intern year. To think of it, oral surgeons spend approx 4 years in clinical training, 1 year that includes general surgery and 3-6 months of anesthesia which is basically nonoperative time. That only leaves 2 1/2 years of actual oral surgery....

It's true that we do things in a different order than other surgical residencies, but I'm not sure you understand our specialty and our training. Our residency is basically a continuation of what we have already been doing during the last 2 years of dental school. It's common for med students to discount our dental school clinical experience because it's very different from med school. And, yes, we do a ton of surgery in dental school, whereas I was only holding the sticks in med school.

On my ENT rotation, the 1st and 2nd year residents were stuck in the clinic all day while the upper-levels operated. It was "non-operative time" as you put it. Meanwhile, the OMFS clinics are nothing but procedures ranging from simple tooth extractions to tibial bone grafts and rhytidectomy/lipo. All under deep sedation/general anesthesia that we provide ourselves. Looking through the ENT chief's log book, he ended up with about the same number of cases as my OMFS chief. But at some point, the number of cases doesn't matter anymore. Most of the cases were different anyway.

... I have no agenda, I'm just stating the facts. It just irks me when dentists think they know more medicine than a physician. I don't to presume to know anything about dentistry. I respect dentists and what they do as my father is one but they are not physicians.

Nobody is trying to be a physician here, I'm not sure where you got that idea. And nobody is claiming to "know more about medicine than a physician."

 

[superchris147]

I don't to presume to know anything about dentistry.

Then why are you posting on a dental forum?