- Medical emergencies can occur in dental clinics, often due to increased patient stress and anxiety. - Emergencies are classified as urgencies, which require prompt response but are not immediately life-threatening, or emergencies, which are immediately life-threatening and require immediate action. - Common types of dental emergencies include unconsciousness, seizures, respiratory issues like hyperventilation and asthma, cardiovascular issues like myocardial infarction, allergic reactions to drugs, hypoglycemia in diabetic patients, and adrenal insufficiency. The document outlines signs, symptoms and management procedures for each emergency.

1. Medical emergency
in dental clinic
- MOHAMMED ABDULKAREEM.
- MOHAMMED SWUDAN.
- MOHAMMED TARQ.
- MOHAMMED AL-ASBAHI.
- MOHAMMED BAWAZEER.
SUPERVISOR / Dr. AHMED AL-ASHWAL

2.  Medical emergencies can and do occur in dental clinic.
 The overwhelming majority of emergencies encountered are
precipitated by the increase stress that is so often present in the
patient in the dental environment.
 Increased stress can result from fear and anxiety or inadequate pain
control.
INTRODUCTIO
N

3.  Urgencies versus Emergencies:
 Urgency: It a problem that requires prompt response; it
is not immediately life threatening but could become so if
not resolved promptly.
Example: Syncope, Hyperglycemia, Seizure, Asthmatic attack,
Hyperventilation, Angina pectoris, and Mild allergic reaction.
 Emergency: It is a problem that is immediately life
threatening and requires immediate action.
Example: Cardiac arrest, Anaphylaxis, and Obstructed airway.

4.  TYPES OF EMERGENCY :
ǀ - UNCONSCIOUSNESS:
1- syncope(fainting).
2- hypoglycemia and hyperglycemia.
3- hypotension.
ǁ - SEIZURES:
ǀǀǀ - RESPIRATORY EMERGENCIES:
1- Hyperventilation.
2- Asthma.
3- Airway obstruction.

5. V- CARDIOVASCULAR EMERGENCIES:
1- Myocardial infarction.
2- Angina pectoris.
3- Acute Adrenal Insufficiency or Adrenal Crisis.
IV- DRUGS RELATED EMERGENCIES(ALLERGY):

6.  Definition:
It is state of abrupt, transient loss of consciousness usually to insufficient blood flow
flow to the brine. It is also called ‘vasovagal episode’ or ’passing out’
 There are Sings and Symptoms before fainting:
1- Sweating.
2- Cold skin.
3- Weakness.
4- Loss of consciousness.
5- Visual disturbances.
6- Vertigo/dizziness.
7- Pallor.
8- Epigastric discomfort / nausea.
9- Lightheadedness.
Fainting(syncope)

7.  Types of syncope:
 Reflex syncope:
A- Vasovagal syncope(cardio-neurogenic syncope), causes:
- Prolonged standing.
- Emotional stress.
- Fright.
- Anxiety.
- Sever pain, especially sudden and unexpected.
- Sight of blood, surgical instruments, dental instruments (e.g. local .
. anesthetic syringe)
- Blood draw.
- Hot, humid, crowded environment.

8. B- Situational syncope : It is a type of vasovagal syncope, it happens
only during certain situation that affect nervous the system and lead to
syncope. Some of these situations are:
- Coughing.
- Sneezing.
- Micturition.
- Defecation.
- Post-exercise.
- Dehydration.
- Use of alcohol or drugs.
C- Carotid sinus hypersensitivity.

9.  Cardiogenic syncope:
A- Bradyarrhythmia:
- Sinus bradycardia.
- Atrioventricular block ( AV block).
B- Tachyarrhythmias:
- Ventricular tachycardia.
C- Mechanical:
- Aortic stenosis.
- Hypertrophic cardiomyopathy.
- Massive pulmonary embolism (PE).

10.  Postural syncope (postural hypotension):
o Postural syncope: Is caused by a sudden drop of blood pressure (postural
due to a quick change in position, such as from lying down to standing.
- Certain medication ( e.g. alpha blockers, antidepressants, antipsychotics).
 Symptoms and sings:
- Breathing – irregular , jerky, and gasping.
- Convulsive movements.
- Dilated pupils.
- Bradycardia (pulse rate < 50 beat/minute).
- Weak thread pulse.
- Loss of consciousness.
- Partial or complete airway obstruction

11.  Management:
_ Position: supine position with brine and heart at same level with feet elevated slightly
(10-15 degrees).
_ ABC ( Airway, Breathing, Circulation): basic life support.
_ Loosen clothing
_ Determine bradycardia by taking pulse at major vessel.
_ Delay dental treatment unless urgent.
 Definitive management:
Monitor vital signs (pule rate, blood pressure, respiratory rate).
Administer aromatic ammonia.
Atropine (0.1g/ml) my be needed.

12. If a diabetie patient collapses assume
hypoglycaemia unless you are certain the
cause is hyperglycaemia. You will not worsen
any hyperglycaemia by giving glucose Or
glucagon but failure to raise the blood sugar
level in hypoglycaemia may be potentially fatal.
COLLAPSE OF DIABETIC PATIENT

13. Remember that diabetic patients often have
severe atheroscle-rosis and SO ischaemic heart
disease is common: the collapse could be die
to a myocardial event. Hypoglycaemia may
result from excess insulin OF missing a meal (in
the excitement of attending the dentist), stress,
Or changing insulin requirements (e.g. dental
infection).

14.  HYPOGLYCAEMIA :
- BLOOD SUGAR LOW.
- RAPID ONSET
AGGRESSIVE/IRRITABLE
BEHAVIOR.
- MOIST SKIN.
- NORMAL IR RAPID -
BREATHING
 HYPERGLYCEMIA :
- BLOOD SUGAR HIGH.
- SLOW ONSET.
- DROWSY AND
DISORIENTATED.
- DRY SKIN.
- DEEP LABOURED
BREATHING.
 Symptoms And Signs

15. If conscious, administer oral
glucose.
Lie patient flat,
If unconscious or uncooperative:
Obtain venous access.
Administer 50 ml of 50% glucose
IV OF 1 mg glucagon IM
Urgent transfer to hospital.
 MANAGEMENT

16. ORTHOSTATIC HYPOTENSION
 Definition hypotension:
It is a form of low blood pressure that happens
when standing after sitting or lying.
 Symptoms:
- Dizziness.
- cold sweat.
- Loss of consciousness.
- Blurry vision.
- Syncope.

17.  Management :
- Put the pt. in supine position.
- Communicate with the pt.
- Clear the airway.
- Look for chest rises and listen for breathing.
- Check for radial pulse.

18. ǁ - SEIZURES:
It is paroxysmal disorder of cerebral function
characterized by an attack, involving changes in
the state of consciousness, motor activity or
sensory phenomoena.
Usually sudden in onset and of brief duration .
-EPILEPSY : A chronic disorder in which nerve cell
activity in the brain is disturbed, causing
seizures.

19. Signs and Symptoms :
- losing consciousness following by
confusion.
- Uncontrollable muscle spasms.
- Drooling or frothing at the mouth.
Biting the tongue.
- Sudden rapid eye movement.

20. Management :
-Self limiting emergency.
Position : supine with patient placed on flat surface .
- Remove dangerous objects from from the mouth and around the
patient .
-loosen any tight clothing .
Avoid restraining the patient.
- In case the ictus fails to sub side within a maximum of 10 minutes.

21. .DEFINITIVE TREATMENT:
1- Diazepam _ 10 mg i.v (2mg/min) repeat
every 10 minutes.
2 – Carbamazepiine.
3 – phenytoin.

22. RESPIRATORY EMERGENCY :
 Hyperventilation.
 Asthma.
 Airway obstruction.

23.  Symptoms
- Dizziness.
- Tingling in the fingers.
- Loss of consciousness.
- Cold sweats.
- chest muscle fatigue.
- Palpitation.
- Rapid breathing.
 Definition
itis a decrease in the level of carbon dioxide in the body occur lo
w levels of carbon dioxide the blood vessels that supply blood to
the brain.
Hyperventilation

24. * Prevention:
- Reduce patient’s stress and anxiousness by any
means.
- The operator should stay calm and also make the
patient be relaxed.
- Exhaled air is inhaled-in again using a paper bag.
- The point of breathing into a bag is to ‘re-breath’
your exhaled CO2 to bring the body back to a
normal state.

25.  Management:
- Calm the pt. down.
- Administration of Benzodiazepines:
-Diazepam (2-5 mg i.m/ i.v. every 3-4 hourly).
-Alprazolam (0.25 -0.5 mg).
-Triazolam (0.25-0.5 mg).
-Lorazepam (2-3 mg oral per day, BD/TD).

26. ASTHMA:
 Definition:
- Clinical state of hyperactivity of tracheobronchial tree
resulting in bronchospasm, characterized by recurrent
paroxysms of dyspnea.
 Signs and symptoms:
- shortness of breath.
- Coughing.
- Wheezing.
- If sever ,inability to speak.
- panic and fear

27.  Management:
 If asthma attach :
- Terminate: continue procedure.
- If not terminate: declare status asthmatics and the Pt. should be send
to medical causality unit .
1- Recognize symptoms.
2- stop dental procedure .
3- position Pt upright bending forward with arm
straight ahead .
4- Administer bronchodilators

28.  Treatment:
Albuterol / Salbutamol:
- Bronchodilator: stimulation beta -2 adrenergic
receptor causing bronchodilator.
- medical use in asthma .
- Route inhalation.

29. AIRWAY OBSTRUCTION:
 May occur duo to:
- pathology on the air way .
- Dental instruments.
- Tongue

30.  Symptoms:
 Pt demonstrates symptoms ranging :
- Coughing.
- gurgling .
- gagging .
-gasping with pain.

31.  Prevention :
- Use of rubber dam .
- Oral packing .
- Chair position.
- Dental assistant.
- Magill's intubation forceps
should be available.

32.  Managment:
Reestablishing airway:
- Forceful coughing .
- Back blows.
- Chest thrust .
- finger sweeps.
- Heimlich maneuver .

34. IV- DRUGS RELATED
EMERGENCIES(ALLERGY):
- It is hypersensitive state of skin and various mucosa
acquired through the exposure to a particular allergen,
re-exposure to which procedure to which produces a
heightened emergent capacity to react.
- Occurring via expression of IgE in response to allergen
exposure.

35. Signs And Symptoms:
- Red ,itchy, watery eyes.
- Sneezing, congestion, runny nose.
- Itchy or sore throat, postnasal drip, cough
.

36. MANAGEMENT:
- Reassure the patient .
- Initiate the BLS as needed .
- Administer antihestaminics,
epinephrine 0.123-0.3 ml of 1:1000
i.m.or s.c.
- Monitor vitals regularly.

37.  ACUTE ADRENAL INSUFFICIENCY OR ADRENAL CRISIS
• Signs and Symptoms
- Altered consciousness
- confusion, weakness,
- pain in abdomen
- nausea and vomiting
- hypotension and syncope.

38. • CAUSE
- Adrenal suppression (low adrenocorticotropic
- hormone) by exogenous steroids, so the adrenal
cortex will stop producing steroids and will undergo
atrophy.
- In case of stress (like in dental procedures)the adrenal
cortex cannot produce enough cortisol thus the patient
goes into adrenal crisis.

39. • TREATMENT
P: Positioning: Place patient in semireclined position and
raise feet slightly; call for help.
A: Airway: Ensure open airway.
B: Breathing: Should be adequate (i.e., predicted to be
adequate in this situation).
C: Circulation: Check pulse and confirm adequate
circulation.

41. - Then start IV administration of crystalloid solution and run
the IV drip as fast as possible.
- Also provide hydrocortisone 100 mg or dexamethasone 4 mg (IV).
- Give a vasopressor drug (e.g., epinephrine 1:1000, 0.5 mL).
E: Ensure that vital signs, drug administration, and patient
responses are properly monitored and recorded.
F: Facilitate or ensure next steps in medical care (transport
to hospital); reassure patient.

42. MYOCARDIAL INFARCTION
Signs and Symptoms
- Chest pain possibly radiating to the neck, shoulder, or jaw;
lasting longer than 15 minutes; and not relieved by nitroglycerin
tablets, in a conscious patient.
- Irregular pulse beat.
- BP may be normal or high or low.

43. • CAUSE

44. • TREATMENT
1- stope all dental treatment.
2- position the pt. in semi-reclined posture.
3- Give sublingual nitroglycerin (0.4) mg tablet.
4- Administer oxygen 5-6 L/min.
5- Check pulse and BP.
6- Aspirin 325-mg tablet and refer pt. to hospital.

45. Angina pectoris:
.A condition marked by sever pain in
the chest, often also spreading to the
shoulders, arms, and neck, owing to
an inadequate blood supply to the
heart.

46. Prevention:
1- stress reduction.
2- Reassurance.
3-Psychosedation.

47. MANAGEMENT:
1- Recognize the problem.
2- Discontinue dental treatment.
3- Activate office emergency team.
3- Position patient upright comfortably.
4- Assess and perform BLS.
5- Definitive management.
6- Use beta-blockers.

48. Equipment Drugs
Portable defibrillator (incorporating ECG print out). Oxygen
Potable oxygen delivary system. Nitrous oxid(very useful analgesic following MI
Ambu bag (self-inflating with valve and mask). Diazepam emulsion(Diazemuls 5 mg/ml
Oropharyngeal aireay (size 1,2, and 3). Flumazenil injection(100 µg/ml)
Cricothyroid puncture needle. Glucose (50% solution) for injection, and powder for
oral use.
High volume aspiration with suction catheters and
Yankauer sucker.
Epinephrine(Adrenaline)injection(1:1000 or 1mg/ml
Disposable syringes(2, 5, 10,and 20 ml size). Glucagon ingection (ideally) 1 mg
Needle (19, 21,and 23 gauge) and butterflies. Atropine sullphate injection (100 µg/ml)
Tourniquet, sphygmomanometer. Salbutamol inhaler.
Venous access cannulae( ‘venflons’ 16 and 20 ) Gyceryl trinitrate (GTN) aerosol spray.
IV infusion sets Colloid solution for infusion(e.g Haemacel 500ml
‘BM sticks’(for rapid assessment of blood sugar level Anti-histamine( tablets 4 mg, injection 10 mg/ml) (e.g
chlorghenamine)
Emergencies Equipment and Drugs:

49. THANK YOU
FOR YOUR
ATTENTION