This document provides an overview of medical emergencies that can occur in dental practice and how to manage them. It begins with defining what constitutes a medical emergency and discussing prevention through thorough patient history and risk assessment. Potential emergencies from the respiratory, cardiovascular, and central nervous systems are then reviewed along with their signs, symptoms and management. Specific conditions covered include asthma, hyperventilation, emphysema, seizures, strokes, and syncope. The document emphasizes maintaining an open airway, administering oxygen, and recognizing signs of distress. It provides guidelines for treating acute episodes through the use of inhalers, epinephrine, benzodiazepines and other medications. Overall prevention and swift management of emerg

1. Medical
Emergencies in
Dental Practice
Presented by - Sakshi Joshi
(CNS and RS)

2. 01
What is
considered an
Emergency?
03
Preparation
Emergency
supplies and
equipment
02
Prevention
Incidence and
relative frequency
of emergencies
04
Medical
emergencies
05
Management of
emergencies
TABLE OF CONTENTS

3. What is an Emergency?
A medical emergency is defined as a
sudden unexpected condition
demanding urgent attention and
treatment

4. “An ounce of
prevention is
worth a pound of
cure.”

5. Recognition of
patients at RISK
A thorough medical history and drug history
(medical history questionnaires )
A detailed physical examination should be
carried out; this includes evaluation of vital
signs such as pulse, blood pressure,
respiration and temperature.

6. Asthma
Hyperventilation
Emphysema
Airway obstruction
Respiratory
System

7. Asthma

8. Manifestations of Acute Asthmatic Attack
Mild to Moderate
• Wheezing (high-pitched whistling)
• Dyspnea
• Chest tightness
• Tachycardia
• Coughing
• Anxiety
Severe
• Intense dyspnea, flaring of nostrils & use
of accessory muscles for breathing
• Cyanosis – mucous membrane and nail
bed
• Flushing of face
• Extreme anxiety
• Mental confusion
• Perspiration

9. Asthma
50% cases of Asthma due to –
External antigens
Expirations >>>> Inspirations
(Wheezing sound)
Precipitated by –
• Exposure to specific allergens
• Unusual excitement
• Emotional stress
• Infections

10. Management of
acute severe asthma
Oxygen – high conc. (humidified, if possible)
to maintain oxygen saturation above 92% in
adults
High doses of inhaled bronchodilators –
Short-acting beta-2 agonists. (Salbutamol)
Metered-dose inhaler via a space device.
Systemic corticosteroid – to reduce
inflammation; Prednisolone is given orally,
Hydrocortisone IV.

11. Pt position – erect or semierect position
O2 administration
When aerosol therapy is ineffective – Epinephrine
(0.3 ml of a 1:1,000 dilution IM or SC)
Start IV line and drip of crystalloid solution
(30mL/min)
If pt fails to improve –
IV Mg – to provide additional bronchodilation
Aminophylline/Theophylline 250 mg IV given over
10 mins + Cortione 100 mg IV

12. Hyperventilation
RR - > 20 breaths/min
pCO2 - <35 mmHg
pH - > 7.45

13. Manifestations of Hyperventilation syndrome
Neurogenic
Dizziness
Tingling or
numbness – lips,
toes, fingers
Syncope
01 02
Cardiac
Palpitations
Tachycardia
05
Psychologic
Extreme anxiety
04
Musculoskeletal
Myalgia
Muscle spasm
Tremor
Tetany
03
Respiratory
ed rate and depth
of breaths
Feeling of
shortness of
breath
Chest pain
Xerostomia

14. Management of Hyperventilation
01
Terminate all dental treatment and remove
foreign bodies from mouth
02
Pt position – fully upright
03
Verbally calm the patient
04 Pt breath – CO2 enriched air (paper bag)

15. Management of Hyperventilation
05
If symptoms persist - Diazepam 10 mg IM or
titrate slowly IV until anxiety is relieved
06
OR Administer – Midazolam 5 mg IM or titrate
slowly IV until anxiety is relieved
07
Monitor vital signs
08 Perform surgery using Anxiety- reducing
protocols

16. Acute or chronic characterized by abnormal
dilatation of the alveoli and distal bronchioles
Emphysema

17. Emphysema Management
Bronchodilator spray (1:1,000
Epinephrine or 1:200 isoprotenol)
Give afternoon appointments

18. Foreign body
aspiration

19. Management
1
Pt. is asked to cough
3
In adults –
Heimlich maneuver
2
In pediatric patients – turn
the pt.’s head downwards +
5 back blows followed by
5 chest thrusts
4
Otherwise, direct
laryngoscopy to
detect the cause of
obstruction
+
Magill forcep

20. Heimlich manoeuvre
•Reach around the person's waist.
•Position one clenched fist above the navel
and below the rib cage.
•Grasp your fist with your other hand. Pull
the clenched fist sharply and directly
backward and upward under the rib cage 6
to 10 times quickly.
•If the person is obese or in late
pregnancy, give chest compressions.
•Continue uninterrupted until the
obstruction is relieved or advanced life
support is available.

21. Central Nervous
System
Seizures
Cerebrovascular accidents
Syncope

22. Seizures

23. Seizure
Seizure or convulsions is an abnormal electrical activity of brain, resulting in attack
involving changes in consciousness, motor activity or altered sensory phenomenon
Other causes –
Hypoglycemia,
hypoxia
and local anesthetic overdose
Most of the patients have epilepsy as a cause for
convulsions.
NEVER try to restrain the
movements or put any object
in the patient’s mouth.
Patients should be turned to their
side to protect airways and
protective padding may be
placed below the head to
prevent injury
Self-limiting – usually lasts 1–2 minutes

24. Grand mal convulsions/ Generalised tonic-clonic seizures
A loss of consciousness, involuntary and excessive muscle movements, and muscle rigidity
Symptoms -
Headache
Vomiting
Muscle soreness

25. Petit mal convulsions/ Typical absence (< 30s)
❏Loss of consciousness
❏Postural tone intact
❏Age – 4-10 years
❏Lasts – few seconds
❏Vacant stare - daydreamer

26. Management of Convulsions
Maintain a patent airway
Prevent body injury
Well- paded tongue blade
In pt. who is able to warn the dentist
of an impending attack –
IV Pentobarbital sodium (Nembutal)
Or
Secobarbital sodium (Seconal)
Severe convulsive episodes –
20-40 mg Succinycholine
chloride IV

27. Diazepam 10 mg can be
administered intravenously
slowly over a 2-minute period
to stop the seizure activity
Management of Status Epilepticus
Diazepam in a dose of
0.2–0.5 mg/kg intravenously
Adults Children
A seizure > 5 minutes, or > 1 seizure within a 5 minutes
period, without returning to a normal level of
consciousness between episodes is called status
epilepticus.

28. Cerebrovascular
Emergencies
● Cerebrovascular accident (stroke) and transient ischemic
attack (TIA) is caused by interruption of blood supply to brain

30. Risk Factors
Elderly pt. with –
Uncontrolled hypertension
DM
Atherosclerosis
Symptoms of TIA
 episodes of slurred
speech
 temporary numbness
 paralysis of face arm
or leg.
 monocular diplopia,
 loss of balance and
coordination.
Symptoms of Stroke -
 altered consciousness
 headache
 nausea
 vomiting
 inability to speak
 facial paralysis
 paraesthesia
 hemipalsy.

31. Management
❏Maintanance of patent airway
❏Adequate ventilation with oxygen
❏BLS measures - positioning to prevent aspiration,
suctioning to maintain airway, monitoring of vital signs

32. Syncope

33. Reflex Syncope (Neurally Mediated Syncope, Vasovagal Syncope,
Vasodepressor Syncope, the Common Faint)
❏ Syncope is defined as
sudden, transient loss of
consciousness due to
global impairment of
cerebral blood flow
❏ Reflex syncope is the
result of a reflex
response to some trigger
Inadequate supply of
blood to brain
Due to
Vagus mediated reflex
bradycardia
With or without
peripheral vasodilatation

34. Syncope
Symptoms -
Pallor
The patient complains of feeling strange
Loss of consciousness – extreme manifestation
Management
Trendelenburg position (head down)
If pt. is conscious – ask the pt. to take a
few deep breaths
Most frequent complication in dental office
Form of Neurogenic shock caused by Cerebral ischemia secondary to vasodilation
or an increase in the peripheral vascular bed, with a corresponding loss in blood
pressure

35. Isometric counterpressure manoeuvres

36. References
● Monheim’s (7th edition). Local Anesthesia and pain control in Dental Practice.
CBS
● Davidson (22nd Edition). Davidson’s Principles and Practice of Medicine. Elsevier
● KD Tripathi (7th Edition). Essentials of Medical Pharmacology. Jaypee
● Neelima Malik (2016). Textbook of Oral and Maxillofacial Surgery. Jaypee
● https://www.nature.com/articles/s41415-020-1789-y.

37. Thank you!