Introduction In an ageing society, the frequency of medical emergencies in a dental setting appears to be increasing because of a growing number of medically compromised patients. However, we currently have no dental‐specific simulation environment with advanced reproducibility for medical emergencies. Therefore, we used the robot patient in objective structured clinical examinations (OSCEs) for testing student competence in emergency management. This study aimed to evaluate student responses to medical emergencies in the dental setting. Material and Methods We used 98 fifth‐grade dental students at Showa University as subjects and implemented the OSCE task entitled ‘Management of medical emergency using a robot patient’. Candidates were asked to manage an emergency situation immediately after local anaesthesia, with one robot patient configured to develop vasovagal syncope and the other to experience adrenaline hypersensitivity. A questionnaire on the educational value of the robot patient was completed after the examination. Results Thirty‐two per cent of students could not accurately count her pulse because of an inappropriate method. Moreover, 78% could not correctly attach either the tonometer or pulse oximetry to the patient. Accurate diagnoses were given by only 22% of students, with vasovagal syncope diagnosed by 33% and adrenaline hypersensitivity by 8%. From a questionnaire, 78% of students recognised the usefulness of the robot patient in medical emergency training. Conclusion We found that student responses to the emergency situation were poor. The robot patient is useful in dental education for medical emergency training and assessment not only for situation management but also for differential diagnosis.

We found that the increase in intravascular fluid volume caused by intravenous fluid administration was not correlated strongly with the volume of infused fluid. Instead, the amount of fluid leakage into the interstitial space depended on the infused fluid volume. This clinical result supports the revised Starling law, which suggests that intravascular fluid may often leak into the interstitium. More work is needed to better understand the factors governing leakage of infused fluid into the interstitial space.

When patients on antiplatelet therapy (APT) require minor invasive surgery, APT is usually continued to limit the risk of thrombosis. However, the possibility of hemostatic difficulties necessitates the monitoring of platelet aggregation to prevent unexpected bleeding. We examined whether whole blood aggregometry as a point-of-care testing (POCT) could be useful as a tool for predicting hemostatic difficulties. Sixty-five patients receiving APT and 15 patients who were not receiving APT were enrolled in the present study; all patients were scheduled to undergo a tooth extraction. Whole blood samples were obtained and were examined using multiple electrode aggregometry. The aggregometry was performed using arachidonic acid (AA), adenosine diphosphate (ADP), and thrombin receptor activating peptide. Hemostatic difficulty was defined as a need for more than 10 minutes of compression to achieve hemostasis. The AA test results were significantly lower in patients treated with aspirin (control: 97.7 [29.0] U, aspirin: 14.5 [7.2] U, P < .001). The ADP test results were also significantly lower in patients treated with a P2Y inhibitor (control: 77.7 [21.7] U, P2Y inhibitor: 37.3 [20.4] U, P < .01). Six of the examined cases exhibited hemostatic difficulties. The cutoff values for the prediction of hemostatic difficulty were 16.5 U for the AA test (sensitivity, 0.833; specificity, 0.508) and 21 U for the ADP test (sensitivity, 0.847; specificity, 0.500). Our study showed that whole blood aggregometry was useful as a POCT for the prediction of hemostatic difficulties after tooth extraction in patients receiving APT.

An estimation of the appropriate tubing depth for fixation is helpful to prevent inadvertent endobronchial intubation and prolapse of cuff from the vocal cord. A feasible estimation formula should be established. We measured the anatomical length of the upper-airway tract through the oral and nasal pathways on cephalometric radiographs and tried to establish the estimation formula from the height of the patient. The oral upper-airway tract was measured from the tip of the incisor to the vocal cord. The nasal upper-airway tract was measured from the tip of the nostril to the vocal cord. The tracts were smoothly traced by using software. The length of the oral upper-airway tract was 13.2 ± 0.8 cm, and the nasal upper-airway tract was 16.1 ± 0.9 cm. We found no gender difference (p &gt; .05). The correlations between the patients' height and the length of the oral and nasal upper-airway tracts were 0.692 and 0.760, respectively. We found that the formulas (height/10) − 3 (in cm) for oral upper-airway and (height/10) + 1 (in cm) for nasal upper-airway tract are the simple fit estimation formulas. The average error and standard deviation of the estimated values from the measured values were 0.50 ± 0.66 cm for the oral tract and 0.39 ± 0.63 cm for the nasal tract. Thus, considering the length of the intubation marker of each product (DM), we would like to propose the length of tube fixation as (height/10) + 1 + DM for nasal intubation and (height/10) − 3 + DM for oral intubation. In conclusion, the estimation formulas of (height/10) − 3 + DM and (height/10) + 1 + DM for oral and nasal intubation, respectively, are within almost 1 cm error in most cases.