Medical Emergencies in Dental Practice discusses preparing for and managing medical emergencies that may occur during dental procedures. It outlines the responsibilities of dental practitioners to recognize emergencies and provide initial management. The document discusses common medical emergencies like syncope, hypoglycemia, angina, and their signs and symptoms. It emphasizes the importance of basic life support training for all dental office staff and having emergency equipment and medications readily available. The initial management of all medical emergencies in the dental office follows the P-C-A-B-D algorithm of positioning, circulation, airway, breathing, and definitive care.

1. Medical Emergencies in Dental Practice
Guided by –
• Dr. Sushma Das (HOD) MDS
• Dr. Padmakanth M MDS
• Dr.Pooja walia MDS
• Dr.Thaneshwar P MDS
• Dr. Lubna MDS
Dr.Yugal kishor
PG II year
Department of Periodontics
CDCRI
1

2. CONTENTS
• Introduction.
• Medical emeregencies condition
• Equipment.
• Skills.
• Management emeregencies condition.
• Drugs.
• Conclusion.
• References
2

3. • Immediate risk to health, life, property, or environment.
• Urgent intervention.
• Medical emergencies can and do occur in a dental practice setting.
3

4. • Oral health practitioners have a responsibility to put their patients’
interests first, and to protect those interests by practising safely and
providing good care. The practitioner’s ability to deal with medical
emergencies that arise in practice is a significant aspect of meeting
their responsibility to, and the expectations of, their patients.
Broadbent, J.M., Thomson, W.M. The readiness of New Zealand General Dental Practitioners for Medical Emergencies. NZDJ
97: 8286; 2001.
4

5. Practitioners’ legal and ethical responsibility
• Oral health practitioners have a legal and ethical responsibility to
provide good care to the public within their level of competence and
to put patient safety first at all times.
• The dentist has a responsibility to recognise them and initiate primary
emergency management procedures in an effort to reduce morbidity
and mortality when such adverse events arise.
5

6. • The Code of Health and Disability Services Consumers’ Rights
provides that every consumer has the right to have services provided
with reasonable care and skill (Right 4(1)) and that comply with legal,
professional, ethical, and other relevant standards (Right 4(2)).
• Council expects oral health practitioners to attend to a medical
emergency within their competence and skill levels, supported by
their current training to the level prescribed in the practice standard.
6

7. • Fast, T.B., Martin, M.D., Ellis, T.M. Emergency preparedness: a survey
of dental practitioners. J Am Dent Assoc 1986; 112: 499-501.
8

8. 9

9. • In a survey conducted in North America, dentists have reported 13,836
medical emergencies over a period of 10 years which occurred during
dental treatment procedures.
1. Vasovagal
2. Hypoglycemic syncope
3. Angina
4. Epilepsy
5. Asthmatic episode
6. Anaphylaxis .
Malamed SF, Haas DA, Rosenberg M, Reed KL. Managing emergencies. In: Glick M, Malamed SF, editors. What Dentist and Staff Need to Know to Save
Lives, Special Supplement. London: The Journal of the American Dental Association; 2010
10

10. • Wilson MH, McArdle NS, Fitzpatrick JJ, Stassen LF. Medical emergencies in dental practice. Journal of the Irish Dental Association 2009; 55
(3): 11

11. • The following age appropriate equipment must be readily available for dentists, dental
specialists, dental therapists, dental hygienists, oral health therapists, orthodontic
auxiliaries, and clinical dental technicians:
• Oxygen cylinder, regulator and associated equipment suitable for delivering high flow
oxygen
• Bag mask device with oxygen reservoir
• Basic airway adjuncts (oropharyngeal airways)
• The following age appropriate equipment must additionally be readily available for
dentists and dental specialists:
• Syringes and needles for drawing up and administering drugs .
• Spacer device to deliver Salbutamol.
• Dental Council of New Zealand. New Zealand: Practice Standard for Medical Emergencies in Dental Practice; c2005-2006. Available from: http://www.dcnz.org.nz.
[Last updated on 2008 Jan; Last revised on 2014 Sep; Last accessed on 2015 Sep 29
12

12. OXYGEN CYLINDER
• Oxygen administration is the process by which supplemented oxygen
is administered in high concentration than that of atmospheric air.
13

13. OXYGEN ADMINISTRATION BY MASK
Normal levels of arterial blood oxygen are between 75 and 100
mmHg . An oxygen level of 60 mmHg or lower indicates the
need for supplemental oxygen.
14

14. OXYGEN ADMINISTRATION BY NASAL CANNULA
15

15. ADVANTAGES
• Patients are able to talk, eat and drink with oxygen in place.
• Patients can vomit and let oral secretion out easily without any
interruption in oxygen delivery.
• It delivers low concentration of oxygen.
DISADVANTAGES
• It can easily dislodge from patient nostrils.
• It causes irritation in the nostrils.
• It causes dryness in the nostrils.
16

16. • VEDIO
17

17. Spacer device for bronchodilator
18

18. • Extensive studies have shown that in situations where emergency
administration of a bronchodilator is indicated for an acute
exacerbation of COPD or asthma in both children and adults, the use
of bronchodilator a with a spacer is at least as effective and safe as
nebulised therapy , and may indeed reduce emergency room .
• Walter Vincken, Mark L. Levy, Jane Scullion, Omar S. Usmani, P.N. Richard Dekhuijzen, Chris J. Corrigan on behalf of the ADMIT group ERJ Open
Research 2018 4: 00065-2018
19

19. Automated external defibrillator (AED)
20

20. 21

21. 22

22. 23

23. • VEDIO
24

24. 1. Portable suction with suction catheters.
2. Intravenous (IV) fluids/lines, syringes, needles, and tourniquets.
3. Automated blood glucose measurement device.
4. Stethoscope.
5. Sphygmomanometer.
6. Magill intubation forceps.
7. Pulse oximeter with audible alarm.
25

25. 27

26. Head tilt- chin lift
28

27. Assess airway patency and breathing-
• SOUND HEARD
Snoring - Hypopharyngeal obstruction by tongue
Gurgling - foreign body
Wheezing - bronchial obstruction
31

28. Heimlich maneuver
32

29. Mouth to mouth ventilation
• Two methods
-mouth to mouth ventilation
-mouth to nose ventilation
33

30. 34

31. • vedio
35

32. Travers, A.H., Rea, T.D., Bobrow, B.J., Edelson, D.P., Berg, R.A., et al. Part 4: CPR overview: 2010 American Heart Association Guidelines for Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122 (Suppl. 3): S676-S684.
36

33. Deltoid intramuscular injection site. IV access to dorsal hand veins using a winged Venflon®
cannula.
37

34. • A medical emergency could occur at any time in the dental practice. The
General Dental Council (GDC) states it is important to ensure that:
• There are arrangements for at least two people to be available within the
working environment to deal with medical emergencies when treatment is
planned to take place. In exceptional circumstances the second person
could be a receptionist or a person accompanying the patient
• All members of staff, including those not registered with the GDC, know
their role if there is a medical emergency
• All members of staff who might be involved in dealing with a medical
emergency are trained and prepared to do so at any time, and practise
together regularly in a simulated emergency so they know exactly what to
do.
38

35. • Preparation
The dental office staff must be prepared to promptly recognise and
effectively manage those medical emergencies that arise. Proper
training of all staff, and the immediate availability of essential items of
equipment and emergency drugs, are essential for a successful
outcome to result. The four steps in preparation are: basic life
support training; office emergency team; access to emergency
medical services (EMS); and, emergency drugs and equipment.
39

36. Basic Life Support
• Annually
• BLS for Healthcare Providers
• ALL dental office employees
• In the dental office
• Ventilate mouth-to-mask, NOT mouth-to-mouth
Dental Office Emergency Team Member #1
• 1st on scene of emergency Stay with victim; yell for ‘HELP’; administer BLS,
as needed
Member #2, on hearing call for HELP . . . Obtains
• (1) emergency drug kit; (2) portable O2 cylinder; and (3) AED and brings to
site of emergency
Members #3, #4 and on,
• assigned ancillary tasks such as:
Guidelines for managing medical emergency in dental office General dental council guidelines on medical emergencies
40

37. • Monitoring vital signs (BP, heart rate & rhythm)
• Assist with basic life support
• Activate EMS
• Hold elevator in lobby while waiting arrival of EMS
• Prepare emergency drugs for administration
• Keep written time line record during emergency
Doctor remains the ‘responsible’ party during management of medical
emergencies.
• Tasks CAN be delegated.
• Office personnel should be interchangeable during emergency management.
Activation of EMS (Emergency Medical Services) WHEN: As soon as YOU, the doctor, think it is
necessary. For example: (1) unable to make a diagnosis; (2) know the diagnosis but are
uncomfortable with it (e.g. cardiac arrest); and (3) whenever you think EMS is warranted. Do not
hesitate to activate ems, if you feel it is needed. Whom to call: 9.1.1.; or a near-by physician or
dentist IF you know beforehand that they are well trained in the management of emergency
situations
41

38. • Risk assessment,’’ is key in determining the likelihood of
complications. The higher the ASA class, the more at-risk the patient
is both from a surgical and anesthetic perspective.
• ASA Class I. A normal healthy patient
• ASA Class II. A patient with mild systemic disease
• ASA Class III. A patient with severe systemic disease
• ASA Class IV. A patient with an incapacitating systemic disease that is
constant threat to life
• ASA Class V- A moribund patient not expected to survive 24 hrs with or
without operation
• ASA E- Emergency operation of any variety
43

39. • Although it is hoped that life-threatening medical emergencies will not occur in the dental
surgery, it is a fact that they do happen. Management of all medical emergencies adheres to the
same basic algorithm:
• P→C→A→B→D where
• P is positioning.
• C is circulation.
• A is airway.
• B is breathing. And
• D is definitive care.
The initial management of ALL medical emergencies is the same: P→C→A→B→D. These constitute
the steps of basic life support (CPR) and are designed to ensure that the patient’s brain receives an
adequate supply of blood .
Field, J.M., Hazinski, M.F., Sayre, M.R., Chameides, L., Schexnayder, S.M., et al. Part 1: executive summary: 2010 American Heart Association Guidelines
for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122 (Suppl. 3): S640-S656
44

40. • Positioning summary
Conscious – any position the patient finds is comfortable.
Unconscious – supine with feet elevated slightly.
• Circulation summary
Conscious – no need to palpate for carotid pulse.
Unconscious – check carotid pulse for not more than 10 seconds. If
pulse is not present, or if there is any doubt, initiate chest
compressions using a compression/ventilation ratio of 30
compressions to two ventilations. The compressions should be
delivered at a rate of at least 100 per minute.
46

41. • Airway summary
Conscious and speaking – airway is patent. No need for airway
management.
Unconscious – head tilt – chin lift should be performed
• Breathing summary
Conscious and speaking – no need to assess.
Unconscious – assess for effective breathing; if not breathing or if
breaths are ineffective, initiate rescue breathing.
• Definitive care may be subdivided into three other ‘D’ categories:
diagnosis; drugs; and, defibrillation. If a diagnosis can be made, then
subsequent management is usually straightforward
47

42. SYNCOPE
• It is defined as sudden, transient loss of consciousness that is
usually secondary to period of cerebral ischemia.
• Cerebral blood flow required for maintaining consciousness is about
30ml of blood per 100 gm of brain tissue per minute.
• Brain weighs about 1360 gms.
• Normal value of cerebral blood flow is 50 to 55 ml per 100 gm per
minute.
• So when this decreases, syncope occurs
Text book malamed 7th edition
48

43. Fredrick Jaeger, DO et al Published: September 2018
• Prevalence and Incidence
• The prevalence of syncope differs based on the clinical setting and the age of the patient. It is
estimated that 3% of men and 3.5% of women experience syncope during their lifetime. Syncope
has been estimated to account for 1% to 3% of emergency department visits and 1% to 6% of
hospital admissions.
49

44. Arthur W, kaye GC the pathophysiology of common causes of syncope postgraduate medical journal ofAmerican Academy of Neurology2000;76:750-75
50

45. Cooper N. Blackout and collapse in older adults. Medicine. 2017 Jan 1;45(1):34-40.
51

46. Late symptom
• Pupillary dilatation
• Yawning
• Hyperpnoea
• Cold hands and feet
• Hypotension
• Bradycardia
• Visual disturbances
• Dizziness
• Loss of consciousness
53

47. • Management: Lay the patient down flat and elevate the legs. Loosen
tight clothing around the neck.
• Administer oxygen (8-10 litres per minute delivered via a mask and
reservoir bag.). Reassure patient when they regain consciousness. If
the patient does not regain consciousness promptly commence Basic
Life Support procedures ( ABCD)
• Medical emergencies in dental practice, Journal of the Irish Dental Association 2009; 55 (3): 134 – 143
54

48. Hypoglycaemia
• In people with diabetes, the most common cause is a relative
imbalance of the administered versus required insulin or oral
hypoglycaemic drugs.
• Acute hypoglycaemia may clinically occur in patients who have
diabetes and who fail to eat after taking insulin.
55

49. • The lack of blood glucose levels alters the normal functioning of the
cerebral cortex and manifests clinically as mental confusion and lethargy.
• Lack of glucose further manifests itself in the increased activities of the
parasympathetic and sympathetic nervous systems.
• Part of this response is mediated by increased epinephrine secretion,
which produces increases in the systolic and mean blood pressures,
increases sweating, and produces tachycardia.
• When the blood sugar level drops even further, consciousness may be lost,
the patient entering a state of hypoglycemic coma, or insulin shock.
• During this stage, diabetic patients frequently experience tonic-clonic
convulsions, which may lead to permanent cerebral dysfunction if not
treated promptly.
56

50. If glucose cannot be administered or if the administration of glucose is ineffective then Basic Life Support procedures (Drs
ABCD) should commence immediately.
Wilson MH, McArdle NS, Fitzpatrick JJ, Stassen LF. Medical emergencies in dental practice. Journal of the Irish Dental Association 2009; 55 (3):
57

51. HYPERGLYCEMIA
• Hyperglycemia ---- glycosuria------ polyuria ----------- dehydrated state -------
-- dry skin, and polydipsia .
• Weight loss initially is due to depletion of water, glycogen, and triglyceride
stores.--- muscle mass is lost as amino acids are converted into glucose and
ketone bodies. --- body’s muscles use these ketone bodies as fuel----- by-
product, which is responsible for the characteristic fruity, sweet breath
odor noted in this stage, called diabetic ketoacidosis.
• Tissues decrease their use of ketones ---- blood levels of ketones increase.
decrease in the blood’s pH--- ketones become detectable in the urine----
Ketoacidosis depresses cardiac contractility ---- Hyperglycemic coma
58

52. Text book of malamed 7th edition
59

53. ANGINA PECTORIS
• Angina pectoris is the result of myocardial ischaemia caused by an
imbalance between myocardial blood supply and oxygen demand.
Typically, angina is precipitated by exertion, eating, exposure to cold,
or emotional stress. It lasts for approximately one to five minutes and
is relieved by rest or glyceryl trinitrate.
• It can be classified as:
• Stable: induced by effort and relieved by rest.
• Unstable: occurring at increasing frequency or severity or at rest.
• Variant: caused by coronary artery spasm.
60

54. Wilson MH, McArdle NS, Fitzpatrick JJ, Stassen LF. Medical emergencies in dental practice. Journal of the Irish Dental Association 2009; 55 (3):
61

55. Myocardial infarction
• Myocardial infarction (MI) is the irreversible necrosis of heart muscle
secondary to prolonged ischaemia.
• This usually results from an imbalance of oxygen supply and demand.
Approximately 90% of MIs result from an acute thrombus that
obstructs an atherosclerotic coronary artery, resulting in complete
occlusion of the vessel.
62

56. 63

57. SEIZURE
• This is a recurrent tendency to spontaneous, intermittent, abnormal
electrical activity in a part of the brain, manifesting as seizures.
• Seizure types are characterised firstly according to whether the
source of the seizure within the brain is localised (partial or focal
seizure) or widely distributed (generalised seizures)
• A partial seizure may spread within the brain and become a
secondary generalised seizure. Generalised seizures are divided
according to the effect on the body but all involve loss of
consciousness. These include absence (petit mal), myoclonic, clonic,
tonic, tonic-clonic (grand mal) and atonic seizures
64

58. • Status epilepticus Traditionally, characterised by –
• 30 minutes of continuous seizure activity or by multiple consecutive seizures
without return to full consciousness between the seizures.
• It is now thought that a shorter period of seizure activity causes neuronal injury
and that seizure self-termination is unlikely after five minutes.
• As a result, some specialists suggest times as brief as five minutes to define
status epilepticus.
• The Resuscitation Council (UK) guidelines from 2006 recommend that
medications should only be administered if convulsive movements occur for
greater than five minutes or recur in quick succession.
• Intravenous diazepam is considered first-line treatment for control of prolonged
seizures; however, it may be more appropriate to administer a single dose of
midazolam via the buccal or intranasal route in a dental practice setting
depending on the experience of the dental clinician in gaining IV access.
65

59. 67

60. • Atherton et al. reported 13 dental office deaths over a 10-year
period. Interestingly, 11 of the 13 deaths occurred in the waiting
room prior to the start of dental treatment. The procedures
undergone by the two patients who died in the dental surgery were
‘dentures’ and ‘scaling’.
• Atherton, G.J., McCaul, J.A., Williams, S.A. Medical emergencies in general dental practice in Great Britain. Part 1: their prevalence over a 10-year period. Br Dent
J 1999; 186: 72-79.
68

61. ASTHMA
• Asthma is characterised by recurrent episodes of dyspnoea, cough, and wheeze
caused by reversible airway obstruction.
• Allergic reaction in which an antigen combines with an IgE antibody on the
surface of pulmonary mast cells in the submucosa of small peripheral airways and
in larger central areas at the luminal surface interdigitating with the epithelium.
• The reaction causes mast cell degranulation and the release or formation of a
number of chemical mediators, including histamine, prostaglandins,
acetylcholine, bradykinin, eosinophilic chemotactic factors, and leukotrienes .
• In addition, slow-reacting substance of anaphylaxis (SRS-A) has been shown to be
composed of the leuko trienes LTC, LTD, and LTE. In humans, LTC and LTD are the
most potent bronchoconstrictors— approximately 1000 times more potent than
histamine—with a duration of effect from 15 to 20 minutes.
69

62. 70

63. FOREIGN BODIES
• Choking Foreign bodies may cause either mild or severe airway
obstruction. A severe airway obstruction can progress to
unconsciousness and cardiac arrest within minutes.
• Mild obstruction: Patient can answer questions, speak, cough and
breathe.
• Severe obstruction: Inability to answer questions, dyspnoea, wheeze,
silent cough, cyanosis, unconsciousness.
71

64. 72

65. Invasive procedures: tracheostomy versus
cricothyrotomy
• Tracheostomy was once considered to be the primary technique for
the relief of acute airway obstruction. For a variety of reasons,
cricothyrotomy is now considered by many to be the surgical
procedure of choice for sudden airway obstruction.
• Laryngeal fracture
• Hemorrhage
• Pneumothorax
• Risk of accidental penetration of the isthmus of the thyroid gland
73

66. 13-gauge, 2-inch needle is used, the tissue is prepared and the thyroid cartilage stabilized the same as with the
scalpel, using the index finger to identify the cricothyroid membrane. The needle is inserted through this area and
directed toward the chest until it enters the tracheal lumen.
Text book of malamed 7th edition
74

67. ANAPHYLAXIS
• Anaphylaxis is a generalised immunological condition of sudden onset,
which develops after exposure to a foreign substance.
• It ultimately results in the release of inflammatory mediators (histamine,
prostaglandins, thromboxanes, platelet-derived growth factors and
leukotrienes) producing clinical manifestations.
• Early treatment with intramuscular adrenaline is the treatment of choice
for patients having an anaphylactic reaction. It is an alpha receptor agonist
and receptor binding reverses peripheral vasodilation and reduces edema.
It also has beta-receptor activity and activation results in dilation of the
bronchial airways, an increase in myocardial contractility, and suppression
of histamine and leukotriene release.
75

68. 77

69. HYPERVENTILATION
• Hyperventilation is breathing occurring more deeply and rapidly than
normal. The normal adult respiratory rate is 11-18/min but anxiety
can result in a hyperventilatory state. CO2 is ‘blown off’ and results in
a decrease in arterial pCO2. The resultant fall in arterial CO2
concentration causes cerebral vasoconstriction and respiratory
alkalosis.
78

70. 79

71. ADRENAL CRISIS
• An acute exacerbation of chronic cortisol insufficiency results in
‘adrenal crisis’, and is most commonly precipitated by surgical stress
or sepsis.
• Salivary cortisol studies have shown that non-surgical dental
procedures do not stimulate cortisol production at levels comparable
to those of oral surgery, and it is now accepted that routine non-
surgical dental treatment presents a negligible risk for the
development of an adrenal crisis, and steroid cover is no longer
necessary.
• Miller, C., Dembo, J., Falace, D., Kaplan, A. Salivary cortisol response to dental treatment of varying stress. Oral Surg Oral Med Oral Pathol Oral Radiol
Endod 1995; 79: 436-44
80

72. 82

73. Mohideen, et al.: Management of Medical Emergencies International Journal of Scientifi c Study | July 2017 | Vol 5 | Issue 4
83

74. 1. Oxygen.
2. Oral glucose solution/tablets/gel/powder.
3. Glucagon injection 1mg IM.
4. Salbutamol aerosol inhaler (100 micrograms/actuation).
5. Adrenaline IM injection (1:1,000, 1mg/ml).
6. Glyceryl trinitrate (GTN) sublingual spray (400 micrograms/dose).
7. Aspirin dispersible (300mg).
8. Midazolam 5mg/ml or 10mg/ml (buccal or intranasal)
Resuscitation Council UK, July 2006. Available at: www.resus.org.uk/pages/MEdental.pdf 84

75. ADA Guidelines for managing medical
emergencies
• The ADA council on Scientific Affairs Statement and the ADA/PDR Guide to Dental
Therapeutics gives the following guidelines to prepare the dentist for the
inevitable emergency.
1. “Courses on emergency medicine management are included in the curriculam of
all dental schools”.
2. “The Council on Scientific Affairs recommends that all dental health care
professionals receive regular training in BLS, because these skills are maintained
only through repetition”
3. “First and foremost in emergency management is the ability to effectively
provide BLS, when appropriate”
4. “For the practicing dentist, the Council recommends that emergency medicine
programs be offered as dental schools, dental societies etc.”
5. “Didactic and hands-on training in the prevention, recognition and management
of common emergencies also recommended”
85

76. A study carried out in state of Karnataka , located in Southern India,
has to its credit the largest number of dental colleges in India, Udupi
and Mangalore among 280 dentists .
They have following treatment facility: oxygen (24.0%), an AMBU bag
(17.1%), pocket mask (13.0%), bronchodilator spray (24.7%), diazepam
(20.5%), aspirin (20.5%), and glyceryl trinitrate (17.8%). Less than half
(39%) of the respondents reported having clinical staff members
trained to assist in emergency recognition and management.
only 5.8% carried out emergency drills in their workplace.
Gupta T, Aradhya MR, Nagaraj A. Preparedness for management of medical emergencies among dentists in Udupi and Mangalore, India. J Contemp Dent Pract. 2008
Jul 1;9(5):92
86

77. Conclusion
• Medical emergencies can occur in the dental office, and it is
important for the entire dental team to be prepared for them.
Regardless of their specific type, they are best managed following this
protocol: position the patient; assess the airway, breathing and
circulation; and provide definitive treatment. Medical Emergencies
can arise anytime, and it is extremely important that the dental staff
can recognize the emergence of such a situation and competently
fulfill their role in assisting the clinician during an emergency
situation.
87

78. References
• Text book of malamed 7th edition
• Dental Council of New Zealand. New Zealand: Practice Standard for Medical Emergencies in Dental Practice; c2005-2006.
Available from: http://www.dcnz.org.nz. [Last updated on 2008 Jan; Last revised on 2014 Sep; Last accessed on 2015 Sep
29
• Fast, T.B., Martin, M.D., Ellis, T.M. Emergency preparedness: a survey of dental practitioners. J Am Dent Assoc 1986; 112:
499-501
• Malamed SF, Haas DA, Rosenberg M, Reed KL. Managing emergencies. In: Glick M, Malamed SF, editors. What Dentist and
Staff Need to Know to Save Lives, Special Supplement. London: The Journal of the American Dental Association; 2010
• Wilson MH, McArdle NS, Fitzpatrick JJ, Stassen LF. Medical emergencies in dental practice. Journal of the Irish Dental
Association 2009; 55 (3):
• Walter Vincken, Mark L. Levy, Jane Scullion, Omar S. Usmani, P.N. Richard Dekhuijzen, Chris J. Corrigan on behalf of the
ADMIT group ERJ Open Research 2018 4: 00065-2018
• Atherton, G.J., McCaul, J.A., Williams, S.A. Medical emergencies in general dental practice in Great Britain. Part 1: their
prevalence over a 10-year period. Br Dent J 1999; 186: 72-79
• Field, J.M., Hazinski, M.F., Sayre, M.R., Chameides, L., Schexnayder, S.M., et al. Part 1: executive summary: 2010
American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation
2010; 122 (Suppl. 3): S640-S656
• Arthur W, kaye GC the pathophysiology of common causes of syncope postgraduate medical journal ofAmerican Academy
of Neurology2000;76:750-75
• Medical emergencies in dental practice, Journal of the Irish Dental Association 2009; 55 (3): 134 – 143
88