This document contains information about managing various medical emergencies that may occur in a dental office setting. It includes summaries of how to assess and treat issues like loss of consciousness, postural hypotension, hyperventilation, allergic reactions, angina, myocardial infarction, and more. The guidelines emphasize recognizing the problem, stopping dental treatment, positioning the patient appropriately, assessing airway, breathing, and circulation, and activating the office emergency plan or EMS as needed based on the severity of the situation.

1. MEDICAL EMERGENCIES
HANDOUTS
RAJ K KHANNA DMD, MD
MUSOM
NOTE: THESE HANDOUTS ARE NOT TO BE USED
WITHOUT CONTENT OF FULL COURSE MATERIALS
and NOT INTENDED FOR REFERENCE WITHOUT
ATTENDING COURSE IN PERSON

2. ASSESSING FUNCTIONAL CAPACITY – METs

3. NO SPECIAL
PRECAUTIONS
ELECTIVE CARE
OK CONSIDER
TREATMENT
MODIFICATION

4. ELECTIVE CARE OK
SERIOUS
CONSIDERATIONTO
TREATMENT
MODIFICATION
ELECTIVE CARE
CONTRAINDICATED
EMERGENCY
TREATMENT ONLY
IN CONTROLLED
ENVIRONMENT

5. 4
MEMBER
TEAM
APPROACH
STAYS CALM !

6. EMERGENCY DRUGS AND EQUIPMENT
GLUCAGON
ATROPINE

7. SUGGESTED BASIC EMERGENCY DRUGS FOR THE
GENERAL DENTAL OFFICE

8. RECOGNIZE PROBLEM
(lack of response to sensory stimulation)
DISCONTINUE DENTAL TREATMENT
ACTIVATE OFFICE EMERGENCY PLAN
P – POSITION PATIENT IN SUPINE POSITION WITH FEET ELEVATED
A B C ASSESS BREATHING, PALPATE CAROTID PULSE, PROVIDE
CIRCULATION IF NECESSARY THROUGH CHEST COMPRESSIONS
ACTIVATE EMS IF RECOVERY NOT IMMEDIATE
D PROVIDE DEFINITIVE CARE
LOSS OF CONSCIOUSNESS

9. RECOGNIZE PROBLEM
(lack of response to sensory stimulation)
DISCONTINUE DENTAL TREATMENT
ACTIVATE OFFICE EMERGENCY PLAN
P – POSITION PATIENT IN SUPINE POSITION WITH FEET ELEVATED (Trendelenberg position)
C > A > B ASSESS CIRCULATION, ASSESS/AND OPEN AIRWAY ,ASSESS AIRWAY PATENCY AND BREATHING
D DEFINITIVE CARE
(OXYGEN, COLD TOWEL COMPRESSES, AMMONIA,GLUCOSE,VITAL SIGNS)
ADMINISTER ATROPINE IF BRADYCARDIA PERSISTS
POST SYNCOPIAL RECOVERY DELAYED RECOVER
POSTPONE FURTHER DENTAL TREATMENT ACTIVATE EMS
VASODEPRESSOR SYNCOPE - MANAGEMENT

10. ASSESS CONSCIOUSNESS
ACTIVATE OFFICE EMERGENCY SYSTEM
P – POSITION PATIENT SUPINE WITH FEET ELEVATED
C A B - ASSESS CIRCULATION, ASSESS/AND OPEN AIRWAY, ASSESS BREATHING
D – DEFINITIVE CARE (OXYGEN,MONITOR VITAL SIGNS)
PATIENT RECOVERS DELAYED RECOVERY
slowly reposition chair
MONITOR PATIENT ACTIVATE EMS
DISCHARGE PATIENT CONTINUE BLS AS NEEDED
POSTURAL HYPOTENSION
MANAGEMENT

11. RECOGNIZE PROBLEM
PLACE PATIENT IN UPRIGHT OR SEMIRECLINED POSITION
REMOVE ANY DENTAL MATERIALS FROM PATIENTS MOUTH
INSTRUCT PATIENT TO TAKE IN SHALLOW BREATHS AND HOLD AS LONG AS POSSIBLE
REPEAT THIS 6-10 TIMES
ALTERNATIVELY HAVE PATIENT REBREATHE EXPIRED AIR FROM A BAG
DO NOT ADMINISTER OXYGEN
PATIENT RESPONSIVE(breathing normal) PATIENT UNRESPONSIVE
CONTINUE TREATMETNT OR DISCHARGE ACTIVATE EMS AND BLS AS NEEDED
HYPERVENTILATION

12. MILD SEVERE
DISCONTINUE TREATMENT
UPRIGHT POSITION
CALM PATIENT
ABCD
ADMINSTER OXYGEN
ADMINSTER BRONCHODILATOR
(2-4 puffs initially repeat in 15 minutes)
IMPROVEMENT NO IMPROVEMENT
DISCHARGE/CONTINUE APPT ACTIVATE EMS
CONTINUE BLS
EPNEPHRINE .5 TO .1MG SOL SC
repeat 10-20 mins if needed
CONINTUE WITH BLS
AMINPHYLINNE 50 MG IV UPTO 250 MG IV, DECADRON 10MG IV
ASTHMA MANAGEMENT

13. RECOGNIZE PROBLEM
(ITCHING, HIVES,EDEMA,FLUSHEDSKIN)
DISCONTINUE DENTALTREATMENT STOP EXPOSURE
ACTIVATE OFFICE EMERGENCY PLAN
C > A > B ASSESSAND PERFORM BLS AS NEEDED
PROVIDE DEFINITETREATMENT AS NEEDED
MILD SEVERE
no cvs/respiratory involvement (cvs/respiratory involvement)
stridor ,wheezing, hypotension
OBSERVE SUMMON EMS
POSITION PATIENT
OXYGEN OXYGEN
HISTAMINE BLOCKER HISTAMINE BLOCKER IM
diphenhydramine 25-50mg im diphenhydramine 25-50mg im
BRONCHODILATOR BRONCHODILATOR
EPINEPHRINE
.3MG ADULT SC, .15MG PEDIATRIC SC
REPEAT IN 5-10 MINUTES IF NO IMPROVEMENT
DISCHARGE PATIENT CONTINUE BLS/EMT

14. ANGINA MANAGEMENT
TERMINATE TREATMENT
POSITION PATIENT COMFORTABLY LOOSEN CLOTHING
A B C
DEFINITIVE MANAGEMENT
OXYGEN/MONITOR AND RECORD VITAL SIGNS CONTINOUSLY
HISTORY OF ANGINA NO HISTORY OF ANGINA
VASODILATOR .4MG NTG SUBLINGUAL IF NO PAIN RELIEF ACTIVATE EMS STAT
IF NO RELIEF IN 5 MINUTES REPEAT NTG ACTIVATE EMS CONSIDER NITROGLYCERIN
IF NO RELIEF IN 10 MINUTES REPEAT NTG ADMINSTER ASPRIN ADMINSTER ASPIRIN
IF PAIN RELIEVED DISCHARGE/ PCP CONSULT CONTINUE BLS CONTINUE BLS

15. TERMINATE TREATMENT
PLACE PATIENT IN UPRIGHT/ SEMI-RECLINED POSITION
ACTIVATE EMS
ESTABLISH AND MAINTAIN AIRWAY
ADMINISTER 100% OXYGEN
SET UP AUTOMATED EXTERNAL DEFIBRILLATION
BE READY FOR BLS
ADMINISTER NON-ENTERIC COATED ASPIRIN 325MG (CHEWABLE)
NITROGLYCERIN –0.2-0.6 MG SUBLINGUALLY – REPEAT EVERY 5 MINUTES UP TO 3 DOSES OVER 15 MINUTES
MONITOR VITAL SIGNS / EKG
REASSURE PATIENT
ESTABLISH I.V. ACCESS
START BLS IF PATIENT LOSES CONSCIOUSNESS TRANSPORT PATIENT TO HOSPITAL
MYOCARDIAL INFARCTION MANAGEMENT