25 March 2024
Ingestion and aspiration emergencies
An inhaled or swallowed object can become a medical emergency and pose a major risk to the patient. We are seeing an increased number of such incidents and for this reason it is paramount not to become complacent and ensure good protocols and prevention strategies are implemented in clinical practice.
Preventive measures:
- Thorough medical history to identify at risk patients
- Predetermined emergency management and protocol known to all staff
- Use of rubber dam
- Careful and unrushed approach
- Patient in a reclined position rather than supine
- Instruments ready that can retrieve objects from the oropharynx
- Tie dental floss to objects that can be dropped (if appropriate such as implant drivers, rubber dam clamps etc). Where a sterile field is required a suture thread [needle removed] may be used to secure items such as an implant drivers.
- Check all instruments for wear and fatigue (burs locked in, mirrors/triplex tips tightened)
- Have emergency referral details ready-eg hospital where full service available
- Place gauze in the back of the mouth to trap small items such as implants/drivers
- Rotate patient’s head so objects fall to the side of the mouth
- Use high volume suction
- Good lighting
Should an object no longer be visible in the mouth and there is a risk it may have gone down the oropharynx calm and proper protocols should be followed.
- Stop treatment and reassure the patient
- Check the patient’s mouth, clothes or surrounding areas to remove the object if found
- Sit the patient up in an upright position
- If the patient is asymptomatic, stabilise the dental treatment and refer the patient for further tests and management.
- Time is of the essence as the higher up the gastrointestinal tract it is found the less invasive the procedure to remove the object.
- See the flow chart below for management of possible inhaled objects.
- Referral to the emergency department is ideal as various tests and procedures can be undertaken in a timely fashion.
In the event the patient is struggling to breathe, 000 should be called and the flow chart below should be followed.
Foreign Body Airway Obstruction (Choking)
Informed consent
Before commencing any procedure, a practitioner is to obtain informed consent from the patient in a considered appropriate manner the patient can understand.
This consent needs to be documented thoroughly in the clinical records. Without thorough documentation it is difficult to defend should a claim be made against the practitioner.
Open disclosure
Failing to disclose is a breach of the practitioner’s duty to his/her patient which could result in negligence regarding disclosure.
Adverse events can happen to anyone
The management following an adverse event is crucial to the outcome.
Once the patient has been attended to and is safe, it is important to always follow up and see how the patient is feeling later that evening and in a couple of days. The more the patient feels supported the likelihood of a claim being made against the practitioner is reduced. These follow up communications should be documented in the clinical records.
Always notify your insurer promptly, as these incidents have the potential of becoming a claim. If you are insured with Guild, contact the ADAVB and speak to one of the CRO’s who can notify on your behalf and offer guidance and support.
Dr Loula Konidaris BDSc, Master of Health and Medical Law (Melb)
Community Relations Officer/Professional Consultant
