We all learned that the standard of care in dentistry includes taking vitals. Generally it is one of the first clinical skills that we learn in school, so why it is that it is one of the first things to go when we graduate? There are a number reason for excluding blood pressure from our appointments the most likely one being time, viewing it as unnecessary, the occasional non-compliant patient, or not having the proper armamentarium.
I would like to address some of these myths with the start of a story. One day I was temping as a dental assistant at an office where we had just administered local anesthetic for a procedure when about 1 min after delivery the patient complained of chest pain. It was sharp and he was clutching his chest. The patient seemed to be in agony and the doctor ran for his emergency kit that included a very dusty blood pressure cuff and sphygmomanometer. I am not sure when the last time it was used but needless to say it after several minutes of finagling with the cords and pump it was not working. Luckily after a few more minutes the patient was able to calm down and we were fine to continue. Still without a blood pressure reading I might add. We were so lucky that we didn’t have a medical emergency on our hands.
I learned from this situation to take vitals prior to beginning treatment. What if this patient had blood pressure that was elevated to the levels of dismissal or sending them to the emergency room. We would not have even gotten to the state of anesthetic administration.
We take blood pressure to save us from those rare emergency situations. You may never find yourself in this situation but what about that one time you could have saved someone’s life by taking blood pressure by referring them to their physician or preventing a heart attack. I have always questioned in my mind if not taking blood pressure eventually even come back upon you and your licensure. What if somehow you were found negligent in not taking blood pressure like we are supposed to and a medical emergency occurs in your chair that could have been avoided by following blood pressure guidelines. I know I wouldn't want to risk my career on that.
At times we may be deterred from taking blood pressure because a patient questions our motives. At the beginning of the appointment I tell patients that I am going to take your blood pressure to make sure you are healthy for treatment today. If they question me I tell that it is the standard of care and it is not to diagnose high blood pressure but to make sure they are healthy enough for treatment that day.
Some may find blood pressure time consuming but because it is a screening and not to diagnose I recommend using an automatic wrist blood pressure cuff and having a manual cuff on hand in case you need a second opinion. I have seen these at harbor freight for $15. The convenience of this is that if it is cold outside one only has to undress the wrist instead of the whole arm and because it fits around the wrist it will fit on all body types large too small. I slap it on the wrist and have them place their arm over their heart during the assembly of my radiographs or during my health history interview.
I hope by reading this that you will decide to take charge and add a vital assessment back into your appointment. It can be fast, easy and is necessary.
Taken from Ester Wilkins Clinical Practice of the Dental Hygienist 9th edition, page 129
Pulse: 60-100
Respiration:14-20
Normal: <120/<80
Prehypertension: 120-139/80-89
Hypertension stage 1: 140-159/90-99
Hypertension stage 2: >160/>100
I would like to address some of these myths with the start of a story. One day I was temping as a dental assistant at an office where we had just administered local anesthetic for a procedure when about 1 min after delivery the patient complained of chest pain. It was sharp and he was clutching his chest. The patient seemed to be in agony and the doctor ran for his emergency kit that included a very dusty blood pressure cuff and sphygmomanometer. I am not sure when the last time it was used but needless to say it after several minutes of finagling with the cords and pump it was not working. Luckily after a few more minutes the patient was able to calm down and we were fine to continue. Still without a blood pressure reading I might add. We were so lucky that we didn’t have a medical emergency on our hands.
I learned from this situation to take vitals prior to beginning treatment. What if this patient had blood pressure that was elevated to the levels of dismissal or sending them to the emergency room. We would not have even gotten to the state of anesthetic administration.
We take blood pressure to save us from those rare emergency situations. You may never find yourself in this situation but what about that one time you could have saved someone’s life by taking blood pressure by referring them to their physician or preventing a heart attack. I have always questioned in my mind if not taking blood pressure eventually even come back upon you and your licensure. What if somehow you were found negligent in not taking blood pressure like we are supposed to and a medical emergency occurs in your chair that could have been avoided by following blood pressure guidelines. I know I wouldn't want to risk my career on that.
At times we may be deterred from taking blood pressure because a patient questions our motives. At the beginning of the appointment I tell patients that I am going to take your blood pressure to make sure you are healthy for treatment today. If they question me I tell that it is the standard of care and it is not to diagnose high blood pressure but to make sure they are healthy enough for treatment that day.
Some may find blood pressure time consuming but because it is a screening and not to diagnose I recommend using an automatic wrist blood pressure cuff and having a manual cuff on hand in case you need a second opinion. I have seen these at harbor freight for $15. The convenience of this is that if it is cold outside one only has to undress the wrist instead of the whole arm and because it fits around the wrist it will fit on all body types large too small. I slap it on the wrist and have them place their arm over their heart during the assembly of my radiographs or during my health history interview.
I hope by reading this that you will decide to take charge and add a vital assessment back into your appointment. It can be fast, easy and is necessary.
Taken from Ester Wilkins Clinical Practice of the Dental Hygienist 9th edition, page 129
Pulse: 60-100
Respiration:14-20
Normal: <120/<80
Prehypertension: 120-139/80-89
Hypertension stage 1: 140-159/90-99
Hypertension stage 2: >160/>100
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