The presentation includes a brief review of the various medical emergencies encountered in pediatric dental clinic and its management.

1. MEDICAL
EMERGENCIES IN
PEDIATRIC DENTISTRY
Dr. PRATIMA KOLEKAR
1

2. CONTENTS
• INTRODUCTION
• MEDICAL RISK DETERMINATION
• RATIONALE IN EMERGENCY MANAGEMENT
• MEDICO-LEGAL ASPECTS
• STEPS IN PREPARATION OF THE EMERGENCY IN DENTAL OFFICE
• TREATMENT PROTOCOLS IN MEDICAL EMERGENCY
• EMERGENCY KIT
• EMERGENCIES IN PEDIATRIC DENTAL PRACTICE
• CONCLUSION
• PREVIOUS QUESTIONS
• REFERENCES
2

3. INTRODUCTION
• Sudden, urgent, usually unforeseen
occurrence requiring immediate action.
{Dorland’s Medical dictionary}
• Can occur anywhere even in a dentaloffice.
• Due to a variety of causes- child’s pre-
existing medical condition, an airway
obstruction caused by dental material or
problems related to a sedationprocedure. 3

4. • Prompt and organized therapy can usually save
a life.
• Responsibility of the pediatric dental surgeon
to be prepared to recognize a medical
emergency & render appropriate care.
• Many medical emergencies in dental office
are fear-related. Therefore, if fear and
apprehension are reduced, the chances of
having a medical emergency are also
reduced.
4

5. MEDICAL RISK DETERMINATION
 The best treatment for medical emergencies is prevention.
 By consulting the physician of the patient, emergency
complications can be minimized or the severity of the
complication can be reduced.
 Hospitalization may be required sometimes due to
seriousness of the illness for the dental procedure to be
carried out.
 A best practice dictates that dental personnel must be
prepared to provide effective basic life support and seek
emergency medical services in a timely manner.
5

6. RATIONALE IN EMERGENCY MANAGEMENT
Recognize that a problem exists .
Diagnose the problem correctly .
Activate the emergency medical service (EMS) system immediately.
Keep the patient alive until better trained personnel arrives .
Remain calm and act swiftly and definitely.
Never administer drugs without definite indication
6

7. MEDICO LEGAL ASPECTS
For medico legal aspects, a written record of the following should
be kept:
Time of onset
Vital signs elicited
during the
emergency
Effects of drugs
and therapy
provided
Time, Name, Dose
and Route of
drugs
administered
Time of initiation
of
Cardiopulmonary
Resuscitation
Status of the
patient at the
time of transfer to
EMS system
7

8. PREPARATION OF THE EMERGENCY IN
DENTAL OFFICE
• It is imperative that all dentists and staff members master BLS at the
health care provider (HCP) level of training.
• Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life
Support (PALS) are required if providing office -based sedation.
I. PERSONAL PREPARATION
• The dentist must be prepared to quickly carry out an action plan to
manage the situation.
• Personal preparation for the dentist should include, at a minimum, a
working knowledge of the signs, symptoms, course, and therapy for
common treatable conditions.
8

9. II. STAFF PREPARATION
• The office should have an emergency plan in place.
• Responsibilities of the team include :
 Assisting the dentist providing patient care
 Staff to call 108
 Staff for documentation
 Staff for assisting other patients and family members
 Staff to direct EMS to the patient
• Regularly scheduled mock medical emergency drills will keep the
team protocol running smoothly and reduce panic in an actual
emergency. 9

10. III. BACKUP MEDICAL ASSISTANCE
• The dentist and staff should be expected to manage a medical emergency
until EMS arrives.
• Dentists and staff should not rely on other physicians in close proximity
to help manage emergencies.
• It is the dentist’s responsibility to be prepared to handle the emergency
until EMS arrives on the scene.
IV. OFFICE PREPARATION: EMERGENCY EQUIPMENT
• Emergency equipment for pediatric patients must be appropriately sized
(infant through adolescent) and available.
10

11. TREATMENT PROTOCOLS IN MEDICAL
EMERGENCIES
Emergency
Guidelines
P → C → A →
B → D
Position
(P)
Circulation
(C)
Airway
Manitenance
(A)
Breathing
(B)
Definitive
Care
(D)
11

12. I. POSITION
 For a conscious patient: Whatever position is
comfortable for the patient.
 For an unconscious patient: All unconscious patients
should be placed in a position to increase cerebral flow
with minimal interference with ventilation.
 Place the patient in a supine position
 Head at the same level as the body
 Feet slightly elevated (10-15 angle)
12

13. II. CIRCULATION
• If the infant or child is
unresponsive and not breathing
• Preferred : In adults and children :Carotid pulse
In infants :Brachial pulse
• If within 10 secs no pulse Begin chest
compressions
• If pulse <60/min with signs of poor perfusion despite
support of oxygenation and ventilation Begin
chest compressions 13
Take up to 10 secs to
attempt to feel for a
pulse

14. 14

15. B.AIRWAY MANAGEMENT
• Most common cause of airway obstruction – Tongue
• Children with enlarged tonsils are particularly more vulnerable.
• To open obstructed airway: head-tilt-chin-lift maneuver
• For unconscious patients : oral or nasal airway devices
• These devices not to be used in conscious as it tends to induce gagging
and vomiting.
15

16. C. BREATHING
• Once a patent airway is established adequate
breathing should be ensured.
• Breathing should be checked by feeling and listening
to the chest, nose and the mouth.
{LOOK, LISTEN & FEEL}
• If patient is not breathing rescue breathing should be
initiated , initially four breaths are given and later
one breath for every 3 sec to expand the chest.
• It can be accomplished using mouth-mouth or bag-
valve-mask. 16

17. • Mouth to moth ventilation gives only 18% of oxygen and so its
efficacy is less.
• Bag-valve-mask which fits tightly over the patients mouth will deliver
100% of oxygen.
• This mask is a one way valve which allows oxygen to enter the patient
when it is squeezed.And the empty bag gets refilled with the oxygen.
17

18. E. DEFINITIVE THERAPY
• Once the patient is positioned and circulation, airway, and
breathing are managed, then various treatment options,
including drug administration, should be considered.
• If the cause is clear or was precipitated by a treatment or
drug administration, definitive therapy may be indicated
and essential.
18

19. • VIDEO : HOW TO DO CPR ON CHILD (1-12 yrs)?
19

20. EMERGENCY KIT
20
• The drugs and equipment in the emergency
kit are intended for use in patients of any age
(pediatric, adult, or geriatric).
• Doctors must be aware of the distinction in
therapeutic doses between patients of
different ages; pediatric doses are smaller
than adult doses.

21. EMERGENCY DRUGS
Recommended emergency drugs for pediatric office:
21
Epinephrine Glucose Oxygen
Albuterol Aspirin
Naloxone
Midazolam Flumazenil Nitroglycerine
Diphenhydramine

22. 22

23. DIPHENHYDRAMINE
23

24. 24

25. 25

26. 26

27. CRITCAL EMERGENCY EQUIPMENT
• Oxygen delivery system :
Self-inflating bag-valve-mask
Bag-valve-mask device
Pocket mask
• Automated external defibrillator
• Syringes
• Suction and suction tips
• Patient monitoring devices:
Stethoscope
Pulse oximeter
Glucometer
Blood pressure cuffs (pediatric and adult)
27

28. SECONDARY EMERGENCY EQUIPMENT
• Oropharyngeal and
nasopharyngeal airways
• Laryngeal mask airway
• Laryngoscope and
endotracheal tubes
• Scalpel or
cricothyrotomy needle
28

29.  Whenever possible, drugs in solution should be in a prefilled syringe.
 The use of intravenous (I V) drugs indental practice should be
discouraged.
 Inhalational, sublingual, buccal and intranasal routes should be
preferred.
 All drugs should be kept in an “emergency drug” container.
 Oxygen cylinders should be of sufficient sizes to be easily portable,
but also allow adequate flow.
29

30. EMERGENCIES IN PEDIATRIC DENTAL
PRACTICE
Unconsciousness
 Syncope
 Orthostatic
hypotension
 Adrenal
insufficiency
Respiratory difficulty
 Airway
obstruction
 Hyperventilation
 Asthma
Drug related
emergencies
 Anaphylaxis
 Sedation overdose
Cardiac emergencies
• Acute coronary
syndrome
• Cardiac arrest
Diabetes mellitus
• Hperglycemia
• Hypoglycemia
Neurologic emergency
• Seizures
30

31. I. UNCONCIOUSNESS
 VASOVAGAL SYNCOPE
 ORTHOSTATIC HYPOTENSION
 ADRENAL INSUFFICIENCY
31

32. UNCONCIOUSNESS / SYNCOPE
• Unconsciousness is rarely noticed in younger children
except in the presence of some underlying disease.
• Psychogenic reactions are infrequent in this age group,
because children are unable to express their feelingstowards
dentist.
• Causes of fainting are :
 Vasovagal syncope
 Orthostatic hypotension
 Adrenal insufficiency
32

33. VASOVAGAL SYNCOPE
• Loss of consciousness secondary to stress and anxiety.
• Defined as transient loss of consciousness due tocerebral ischemia
caused by less blood supply to brain.
33

34. • Sign and symptoms :
34
PRESYNCOPAL
• EARLY : Feeling of Warmth, Pale or ashen-gray skin tone, Heavy perspiration, Feeling of
fainting, Nausea, Tachycardia
• LATE : Pupillary dilation, Yawning, Hyperpnea, Cold hands and feet, Hypotension,
Bradycardia, Dizziness, Loss of consciousness
SYNCOPAL
• Breathing may become : Irregular, jerky & gasping or quiet & shallow
• Pupil Dilatation with Patient showing Deathlike appearance
• Convulsive movements and Muscular twitching of hands, legs, or facial muscles
POST-SYNCOPAL
• Pallor, Nausea, Weakness and Sweating lasting for few minutes to several hours
• Immediate Postsyncopal Phase: Patient may experience a short period of Confusion
or Disorientation
• BP, Heart rate return back to normal slowly

35. MANAGEMENT
35
1-0-8

36. ORTHOSTATIC HYPOYENSION
 Postural hypotension is defined as a drop in systolic blood pressure
(BP) of at least 20 mm Hg or of diastolic BP of at least 10 mm Hg within
3 minutes of standing when compared with blood pressure from the
sitting or supine position.
 Only infrequently associated with fear and anxiety.
 Etiology:
 Poor physical condition
 Obesity
 Medications: Anti hypertensive's, Antidepressants, Narcotics,
Antiparkinson drugs
 Prolonged supine position
36

37. Dental therapy considerations:
• Patients who have been in a supine or semisupine position throughout
long appointments cautioned against rising too rapidly.
• These patients should resume an upright position slowly at the
conclusion of treatment.
• As the patient stands, the clinician may want to stand close to the chair
until the patient is able to stand without feeling dizzy.
• If the patient does become weak or faint, however, dental staff
members are close enough to prevent the patient from falling and
possibly suffering injury. 37

38. • Prodromal signs and symptoms associated with vasodepressor syncope are
rarely noted.
• Clinical signs and symptoms more often - in patients with other predisposing
factors for postural hypotension, such as the administration of drugs.
• Such patients may show some or all of the prodromal signs and symptoms of
vasodepressor syncope before consciousness is lost.
• Blood pressure is quite low.
• The heart rate remains at the baseline level or somewhat higher
• If unconsciousness persists for 10 or more seconds-patient may exhibit
minor convulsive movements secondary to cerebral hypoxia/anoxia.
• Consciousness returns rapidly once the patient is returned to the supine
position.
38
Signs and symptoms

39. MANAGEMEMT
39

40. ACUTE ADRENAL INSUFFICIENCY
 Least likely to be seen in the dental office.
 The condition, though uncommon, is potentially life
threatening, but readily treatable.
 Acute adrenal insufficiency is a true medical emergency in which the
victim is in immediate danger because of glucocorticoid (cortisol)
deficit.
40

41. • Before dental treatment :
• Thorough medical and dental evaluation should be completed
• Provisional treatment plan established
• Patient’s primary care physician consulted
• A history of past or present tuberculosis, HIV, or histoplasmosis
increases the risk of acute adrenal insufficiency secondary to
opportunistic infections that can attack the adrenal gland.
41

42. Signs and symptoms :
• In potentially stressful situations such as
dental surgical procedures, patients with
hypofunctioning adrenal cortices may
exhibit clinical signs and symptoms of
acute glucocorticosteroid insufficiency.
• The result of this acute insufficiency may
be the loss of consciousness and possible
coma.
42

43. MANAGEMENT
43

44. II. RESPIRATORY DIFFICULTIES
 AIRWAY OBSTRUCTION
 HYPERVENTILATION
 ASTHMA
44

45. I. AIRWAYOBSTRUCTION
• Severe or complete upper airway obstruction due to a
foreignbody rapidly progresses to unconsciousness.
• Causes : food (50%) and small objects (50%)
45

46. 46
SIGNS:
 Tachypnea
 Wheezing
 Patient sitting upright
using accessory
respiratory muscles
 Cyanosis
 Agitation and
confusion
SYMPTOMS:
 Dyspnea
 Increased cough
 Feeling of chest
congestion or tightness
 Feeling of suffocation

47. MANAGEMENT :
• If patient conscious- allow him or her to expel the object with his or her
own efforts by coughing.
 If this is ineffective & patient shows Universal signs of choking than
deliver abdominal thrusts (Heimlich maneuver)
 For patient on dental chair- abdominal thrusts is modified by delivering
the thrust with the heel of the hand from the side or front of the
patient.
47

48. Abdominal thrust not to be performed in infants because of
their relatively large abdominal organs (especially the liver),
which could be damaged.
In these cases, a chest thrust maneuver and back blows should
be delivered.
48

49. • If a foreign body is visible- remove it (do not perform blind
finger sweeps as it may push obstructing objects farther into the
pharynx and may damage the oropharynx).
• Attempt to give two breaths and continue with cycles of chest
compressions and ventilations.
• If ventilations are difficult because of the obstruction, reattempt
head-tilt/jaw-thrust and consider an oral or nasal airway.
• Caution when placing an airway so as not to distalize the
foreign object, worsening the obstruction. 49

50. • Dentists with training may perform laryngoscopy, endotracheal
intubation or cricothyroidotomy, if skilled in these techniques.
50

51. 51

52.  PREVENTION:
 Use of rubber dam isolation
 Rotary files preferred over hand files
 If using hand files tie dental floss 18” or more
 Avoid working in wet environment which may
cause slippage of instrument
 Use of gauze throat pack
 Use of high velocity suction
 Use of more upright position if possible
52

53. Video : FIRST AID FOR CHOKING
53

54. II. HYPERVENTILATION
• Increased spontaneous ventilation beyond that required to
maintain homeostatic concentrations of oxygen and carbon
dioxide.
• Often triggered by an anxiety provoking event such as local anesthetic
administration.
• The patient is usually unaware of the fact that he or she is breathing
rapidly.
• Rarely seen in children
54

55. Clinical features :
• RR > 24-30
• Elevation of pao2 and decreased paco2
• Respiratory alkalosis
• Stabbing chest pain
• Numbness and tingling of the extremities and
perioral area
• Muscle twitching
• Cramping
• Seizures
• Patientrarely looses consciousness
55

56.  PREVENTION
 Anxiety – preoperative identification and reduction
 Record vital signs
 MANAGEMENT
 Stop dental procedures
 Remove materials from mouth
 Reassure the patient
 Comfortable position of patient
 Guide breathing
 Rebreathing exhaled air
 Use of paper bags
 Cupping one’s hand
 Oxygen is not indicated
56

57. ASTHMA
• Disease characterized by an increased responsiveness of the
trachea and bronchi to various stimuli and manifested by
widespread narrowing of the airways that changes in severity
either spontaneously or as a result of therapy. (American Thoracic
Society)
• Classification:
According tocausative factors:
 Intrinsic : No H/O allergy
 Extrinsic: H/O allergy
• Extrinsic asthma common in children
57

58. Signs and symptoms
• Coughing
• Wheezing
• Dyspnea
• Chest congestion
• Use of accessory muscles
• Anxiety, restlessness, apprehension
• Tachypnea, tachycardia
• Increase in blood pressure
• Diaphoresis, confusion
• Nasal flaring
• Cyanosis
58

59. MANAGEMENT OF ASTHMA
• Begins prior to anemergency !
• Evaluate severity of patients asthma
• Free access to metered dose inhaler (MDI).
• Dentist should be well verse with the technique of
taking MDI
• Reduce any predisposing factors from the environment
such as stress, airway irritants
• Remove any objects present in the mouth that
can obstruct airway or be aspirated. 59

60. 60

61. SIEZURES
• Seizures are clinical manifestations of paroxysmal excessive
neuronal brain activity.
• Generalized tonic-clonic seizures (Grandmal epilepsy)may be life-
threatening.
61

62. • 4 phases of tonic clonic seizures:
 Prodromal phase :
 Subtle changes that occur over minutes to hours
 Usually not clinically evident to the practitioner or the patient
 Aural phase :
 Neurologic experience that the patient goes through immediately
before the seizure
 May consist of a taste, a smell, a hallucination, motor activity, or other symptoms.
 Ictal phase :
 Rapid jerking of the extremities and trunk.
 Breathing may be labored and patients may injure themselves.
 Usually lasts 1 to 3 minutes.
 Post ictal phase :
 Muscles relax and movement stops.
 A signifiant degree of CNS depression
 Caution must be exercised in the postictalphase as there may be respiratory depression
62

63. MANAGEMENT
• P. Position supine.
• C, A, B. Assessed as adequate (respiratory and cardiovascular
stimulation are noted during the seizure).
• D (definitive care):
 Protect victim from injury. Keep victim in the dental chair; gently hold
arms and legs, preventing uncontrolled movements, but do not hold so
tight as to prevent all movement.
 If parent or guardian is available, bring them to the treatment room to
assist in assessing the victim.
 Summon EMS if the parent or guardian of the patient suggests it, or if the
seizure continues for more than 2 minutes.
• Most tonic-clonic seizures stop within 1 minute and almost always
within 2 minutes (thus the recommendation for EMS with prolonged
seizure activity). At the conclusion of the seizure, P → C → A → B → D
must be reassessed.
63

64. PREVENTION :
• Comprehensive knowledge
• Avoidance of situations provoking seizures
• Verify that patient continues anti-seizure medication on
the day of dental treatment
• Decrease stress and anxiety
64

65. DRUG RELATED EMERGENCIES
• ANAPHYLAXIS
• SEDATION OVERDOSE
65

66. I. ANAPHYLAXIS
 It is a potentially life-threatening immune reaction to a foreign
body.
 The anaphylactic reaction is mediated by the release of the
histamine from sensitized mast cells.
 Known triggers :
 Penicillins
 Latex
 Sulfite antioxidants in local anesthetics containing
vasoconstrictors
 Ester-type local anesthetics
66

67.  Skin reaction:
• Intense itching
• Erythema,Angioedema
• Urticaria over face and upper chest
 Gatrointestinal reactions:
• Abdominal cramps
• Nausea ,vomitting & diarrohea
• Urinary incontinence
 Respiratory reactions:
• Cough, wheezing and dyspnea
• Chest tightness
• Cyanosis
• Brochospasm
 Cardiovascular system:
• Palpitations, Hypotension
• Tacycardia
67

68. MANAGEMENT OF ANAPHYLAXIS
• Depends on time, course and severity of symptoms
• FOR MINOR REACTIONS:
 Oral Diphenhydramine 25 to 50 mg or 1 mg/kg.
 The patient should be monitored to make sure symptoms do not
worsen
• FOR ANAPHYLAXIS :
 Terminate the suspected agent, begin basic life support protocol
activate EMS, and administer 0.15 mg of epinephrine
 Administration may need to be repeated every 5 to 15 minutes if
symptoms reoccur and EMS is not yet on the scene.
 Oxygen therapy, two puff of the albuterol inhaler, and
diphenhydramine may also be administered.
 The patient who suffers from severe anaphylaxis must be
transported to the hospital for additional treatment with
antihistamines and corticosteroids.
68

69. II. SEDATION OVERDOSE
• An overdose of sedation is general anesthesia (though general
anesthesia represents a “controlled state of unconsciousness”),
whereby with oversedation unconsciousness is achieved
unintentionally.
• Effective management of a patient receiving general anesthesia
is predicated on airway management and ventilation.
69

70. MANAGEMENT
• P. Position supine.
• C, A, B. Assessed and managed as necessary.
• D (definitive care):
 Monitor the patient with a pulse oximeter, blood pressure, heart rate and
rhythm.
 Stimulate the patient periodically (verbally or by pinching the trapezius
muscle), seeking response.
 Antidotal drug therapy: administer IV flumazenil in a dose of 0.2 mg (2
mL) in 15 seconds, waiting 45 seconds to evaluate recovery.
 If recovery is not adequate at 1 minute, an additional dose of 0.2 mg may
be administered.
 Titrate IV naloxone at 0.1 mg. (0.25 mL) per minute to a dose of 1.0 mg if
an opioid was administered.
• EMS may, or may not, be summoned, depending on the clinical situation
70

71. DIABETIC EMERGENCIES
• Diabetes Mellitus is a disorder involving poor insulin
production and hence elevated blood glucose levels.
• Type 1 or insulin-dependent diabetes mellitus occurs most
commonly in children.
• Emergencies in children may be the result of hypoglycemia or
hyperglycemia.
71

72. HYPERGLYCEMIA
72
DIABETIC KETOACIDOSIS
• Ketoacidosis requires several days to develop, during which time the
patient appears ill.
• It does not occur suddenly in a previously alert and well patient.
• Therefore, this disorder will generally not lead to an acute emergency
in the dental office.
• If the diabetic patient does not look well, and particularly if the breath
has an acetone-like odor, he or she should be instructed to seek
medical attention immediately.

73. MANAGEMENT OF HYPERGLYCEMIA:
• Test blood glucose using glucometer
• Notify parents if over 250mg/dL
• Hydrate patient using oral fluids
• Administer insulin dose according to medical plan.
73

74. HYPOGLYCEMIA
• Blood sugar less than 40mg/dl (children)
• Rapidly occuring
• Clinical features:
 Tachycardia
 Sweating
 Nervousness
 Irritability
 Confusion and slurred speech
74

75. MANAGEMENT OF HYPOGLYCEMIA
• Place the patient in a position of comfort and assess (CABs) the
patient.
• Definitive therapy:
• If patient conscious – Oral glucose tab 37.5g & repeated as
necessary.
• Sugar dissolved in juice or a sugar-containing soft drink may
also be used
• If patient unconscious : Initiate BLS & give IV 50% dextrose
• Never attempt to administer glucose orally in unconscious
patient.
75

76. CARDIAC EMERGENCIES
• ACUTE CORONARY SYNDROME
• CARDIAC ARREST
76

77. I. ACUTE CORONARY SYNDROME
• Pediatric dentists will not see many patients with acute coronary
syndrome (ACS).
• However, parents and grandparents who accompany the patient
may develop these symptoms.
• CLINICAL FEATURES :
Chest pain,tightness or pressure in the chest
The severity can range from minimal to a severe crushing-type of
discomfort.
Pain may radiate to the neck, back, jaw, and down to one or both
arms.
Associated symptoms include dyspnea, nausea, vomiting,
diaphoresis, profound weakness.
77

78. MANAGEMENT
• Place the patient in a position of comfort and perform physical
assessment with vital signs.
• Activate EMS and administer aspirin (81 mg × 4 chewable) and
nitroglycerin 0.4 mg (if the heart rate is between 60 and 100 and
BP is >100 systolic).
• Administer oxygen at 4 L/min if the pulse oximeter is less than
90%.
• Repeat nitroglycerin as needed every 5 minutes (up to three
times) as long as heart rate and blood pressure remain stable.
78

79. II. CARDIAC ARREST
• Cardiac arrest is the “cessation of cardiac mechanical activity,
determined by the inability to palpate a central pulse,
unresponsiveness, and apnea”.
• Uncommon event within the pediatric population, however, when
cardiac arrest does occur younger age group, its consequences
are devastating.
• Frequent causes of pediatric cardiac arrest: Undetected airway
obstruction, prolonged respiratory depression, and apnea
79

80. • Pediatric cardiac arrest in a dental environment is too often
associated with the administration of CNS depressant drugs, for
either behavior management (oral, intranasal, or IM sedation) or pain
control (local anesthetics).
• A significant difference from the adult victim is that at the time of
cardiac arrest the child’s myocardium is already depleted of oxygen.
• C/F:
• Sinus bradycardia(slowing of the normally rapid pediatric heart rate)
• Untreated or undetected bradycardia may convert to
asystole (“silent heart”)
80

81. MANGEMENT OF CARDIAC ARREST
• If the pulse rate of an infant or child is <60 per minute
and there are signs of poor perfusion despite support of
oxygenation and ventilation, chest compressions be
started.
• Defibrillation - less important in pediatric cardiac arrest. Of
prime importance is the implementation of basic life
support (P → C → A → B → D) as soon as possible.
81

82. Significant DifferenceIn The Basic Emergency
Protocol Of BLS For Adults And Children:
ADULTS
• When a single rescuer is
with the victim
with no one within shouting
distance, phone first.
• Activate EMS immediately
(before starting BLS) to
provide prompt
access to defibrillation.
CHIDREN
• Since the likely cause of
cardiac arrest is anoxia, BLS
is initiated immediately
• EMS is activated after
delivery of BLS
for 2 minutes (with one
rescuer)—phone fast.
• With two rescuers present,
one starts BLS while the
other activates EMS and
obtains the AED.
82

83. 83

84. 84

85. CONCLUSION
• Medical emergencies may be rare but they are challenging
occurrences in the dental clinic, tasking the knowledge,
skills and materials available to the practice.
• Adequate staff training and availability of appropriate
drugs and equipment are essential in the management of
emergencies that may arise in the dental clinic.
85

86. PREVIOUS QUESTIONS
• ESSAY : Emergencies in pediatric dental treatment & its
management
86

87. REFERENCES
• Malamed SF. Medical emergencies in the dental office. 7nd ed. St. Louis:
Mosby; 2015.
• Nowak A.Pediatric dentistry-infancy through adolescence.6th
edition.Philadelphia:Mosby;2019
• Vranić DN, Jurković J, Jeličić J, Balenović A, Stipančić G, Čuković-Bagić I.
Medical Emergencies in Pediatric Dentistry. Acta Stomatol Croat.
2016;50(1):72-80.
• Malamed SF. Emergency medicine in pediatric dentistry: preparation and
management. J Calif Dent Assoc. 2003 Oct;31(10):749-
55.
• Rosenberg M Preparing for medical emergencies: the essential drugs and
equipment for the dental offie.J Am Dent Assoc. 2010 May; 141 Suppl 1:14S-
9S.
87

88. 88
THANK YOU !