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Permanent link  Are you ready for a medical emergency? Our interview with Midwinter speaker Dr. Stanley Malamed


Dr. Stanley F. Malamed, professor of Anesthesia and Medicine at University of Southern California's School of Dentistry actually hopes it snows in Chicago during the Midwinter Meeting! He'll be teaching two courses, "Is Your Practice Ready for a Medical Emergency?" and "The Renaissance of Local Anesthesia."

This transcript is edited from an e-mail exchange that took place in November 2009.

Q: What drew you to the topic of medical emergencies in the dental office?

Dr. Stanley F. Malamed: I am a dentist anesthesiologist, a member of a small group--several hundred in the U.S.--of dentists who have completed an anesthesiology residency. Given that background, and being in an academic environment, one of the subjects that is closely associated to anesthesia is emergency medicine--essentially how to keep a person alive, which is what anesthesiologists do on a daily basis.

Q: Are there any recent events that make this a particularly important topic today?

SFM: On a regular basis we hear, through the media, of "disasters" that occur in the dental office. In Chicago in 2007 the principal of an elementary school died in a dental office while having root canal treatment. It made the national press. Unfortunately, when a person dies in a dental office, it comes as a surprise to non-dental people, who make up most of the world. Yes, unfortunately this does happen, albeit rarely.

Q: What are the most common medical emergencies that occur in dental offices?

SFM: Syncope, or fainting, is far and away number one, accounting for about 50 percent of the emergencies we see. Other common emergency situations include mild allergy, anginal chest pain, seizures, asthmatic attacks, and low blood sugar.

Q: Which emergencies do you think dental offices are least prepared to handle?

SFM: From surveys I have done asking doctors about their level of confidence in recognizing and managing specific emergency situations, the lowest levels of confidence occur with local anesthetic overdose, sedative overdose, and bronchospasm, or acute asthmatic attack.

Q: What is the number-one preventative step you will be discussing?

SFM: Knowing your patient-medical history, monitoring vital signs, knowing when not to treat. Having said that, about 75 percent of all medical emergencies seen in dentistry are preventable; however 25 percent are not. Stuff still happens.

Q: Do you have any anecdotes relating to emergency medicine?

SFM: At the Hinman Dental Meeting about four years ago, as I was walking into the Georgia World Congress Center to give a talk on medical emergencies, a man walking about 20 feet in front of me collapsed on the ground in cardiac arrest. Helping the paramedics, I ventilated, and the man survived. A memorable way to start a lecture on medical emergencies.

Q: You're coming from sunny southern California! How do you feel about visiting Chicago in February?

SFM: I love coming to the Midwinter in February. It's my four or five days of winter. I hope every year that it snows and is really cold. I like to run in the park in the snow … knowing that in three or four days I'll be able to return to L.A. and run in the nice warm "winter" weather at about 60 to 80 degrees.

Q: Would you be willing to share any anecdotes about your early experiences as a dentist?

SFM: Two anecdotes about my early experience as a dentist, before I became the "famous" Dr. Malamed, the expert on local anesthesia as well as emergency medicine:

Taking my state board examination in NY in 1969, a very good friend of mine was the patient. After getting an OK to start, I pulled out a local anesthetic syringe and proceeded to stick the needle right through his lower lip! We both started laughing, which broke the tension of the exam and I then proceeded to successfully pass it. Happily the examiner never found out!

Another story: While in my anesthesia residency, my wife was to have her four third molars extracted by a rather prominent oral surgeon. He asked me to help him by simply getting her "numb." Needless to say I missed all four teeth!

About ten years later while I (by now an "expert" on local anesthesia) was giving a lecture on "How to Teach Local Anesthesia to Dental Students," a hand went up in the audience. The question, from the oral surgeon mentioned above, was "Would you tell the audience about the day I asked you to get your wife numb?" It was humbling.


rachel zanders , midwinter meeting 2010 ,