Friday, November 1, 2013

On Conciousness and Teeth Man dies from wisdom teeth being removed, my opinion as a Respiratory therapist .

I think what happen in this Case, is the man woke up and coughed, in a sedated state. But, since this was a very healthy man with a strong cough, it was strong enough to loosen the gauze in his mouth, which then moved into this throat where the Dentist could not see Gauze .

Then the Dentist gave the man " Propofol " , the same drug that killed Micheal Jackson, which is a good Drug, but Problem with this Drug is, you have to use Telemetry ( heart and respiration monitor ) and a Oximeter ( finger probe that can sense through skin and read Hemoglobin oxygen saturation )or if you choose not to use this, you the have to keep a eye on Respiration and skin color of the patient .

The problem with doing the second, is that a persons abdominal area can actually move, and make a person think the patient is moving air, when under the right conditions of sedation and airway blockage the patient is not moving air past the obstruction; so if you counted Respiratory rate by visually looking at the patient's diaphragm, ( which the Dental Assistant should be doing, because the Dentist is Focus is not on his procedure ) You can be fooled, thinking the patient is breathing fine .

But, after a period of time of air not moving, the heart without oxygen, will go into Arrhythmia ( Ventricular tachycardia or Ventricualar Fib, both of which do not pump Blood )

But even telemery can be fooled by the abdominal area moving and the chest moving, but air not actually moving . A Strong healthy person can keep up Respiration's, and not actually be moving air by blockage of the airway .

I have seen hundreds of Doctors and Nurses and even Respiratory therapist in the Hospital setting Fooled by what I call false Respiration's .

A conscious person knows when they are not moving air and will Cough, but a sedated person will not Cough and is now aware of not moving air.

So to prevent this, number one a Oximter should be use and all Procedures like this, which could be set to go off at 92%, which is 3-5 mins before the heart would go into arrhythmia from lack of oxygen .

The patient had to have had a O2 sat of 50-70% ( or possible lower ) for 2-4 or more min's for the heart to go in arrhythmia .

Two Better teaching about the sedated Patient and false respiration's needs to be schooled .

Three, Dentist if they are going to do sedation, need to be trained better at incubation( the ability to put in a airway to breath for the patient ) and defibulation ( the ability to shock the heart back to it's proper rhythm ).

In all hospital procedures of potential deep sedation, a Doctor and nurse and Respiratory therapist are at the procure, with telemetry and oximetery .

Sure a dentist is trained as good as a doctor and therapist, but He can not always stay focused on Breathing, since he is so intensely focused on his dental procedure .

Also, if you don't use Intubation and airway management skills, in the emergency situation, you will not be prepared when the worst happens .

When the squad came, they tried to intubate the patient with a Scope with a light on it, to see deep into the throat, and saw the gauze, which was blocking Trachea, which is where they were going to insert the tube so they could pump air into the lungs with a tube .

By this point, it's too late in most cases .


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