1. Medical Emergencies
in
Dental Practice
Prepared by:
Dr . Aia Al-Marsumy

2. What is an Emergency situations?
areEmergency SituationsCommon

Fainting (Vasovagal Syncope )

Diabetic Coma

Anaphylactic Shock

Epileptic Seizures

Cardiovascular Collapse (CVC)

Thyroid Crises

Adrenal Crises

Asthmatic Attack

Stroke (Cerebro-vascular Accident, CVA

3. emergencies:ofPresentationClinical
- Sudden loss of consciousness
- Chest pain & dyspnea
- Convulsions (fits)

4. Basic Emergency Procedures
-Monitor BP and pulse
Clear, secure & maintain Airway
cardiopulmonary resuscitation
intravenous cannulation
↓
Basic Life Support (BLS)
A- Airway
B- Breathing
C- Circulation

5. Collapse
• shock
• Steroid crisis
• Myocardial Infarction
• Cardiac Arrest
• CVA

6. Acute Chest Pain or Difficulty of
Breathing
Angina
Myocardial Infarction
Asthma
Anaphylactic Shock

7. Convulsions
Epilepsy
Any other cause of loss of
consciousness
including fainting

8. Fainting
•Predisposing factors:
Stress Conditions
Anxiety
Pain
Injection
Fatigue
Hunger

9. Pathophysiology
Stress
↓
Release of catecholamine
↓
Changes in tissue blood perfusion; decreased
peripheral vascular resistance, increased
blood flow to tissues
↓
leads to pooling of blood in tissue
↓
fainting

10. Mechanism
• Signs & Symptoms
Premonitory dizziness, weakness & nausea
Pale, cold moist skin
Pulse initially

11. Management
•Lay flat & lift legs
•Loosen tight clothing around neck
»Give sweetened drink on regaining
consciousness
•Prolonged fainting, atropine 600 mcg/ml
slow iv (1 ml only)

12. prevention
• Good history
• Reassurance
• General Anxiety (Stress) Reduction Protocol
• Well fed prior to treatment
• Glucose drink
10 mg Temazepam nocte (prior to appt) & 1hour before
treatment
• Delay the procedure

13. Anaphylactic shock
• Drugs e.g. penicillin
• Insect stings
• Foods, nuts, shellfish, materials
Quicker onset the more severe the reaction
• Widespread vasodilatation & increase in
capillary permeability, potentially fatal
• Hypotension

14. HypersensitivityType I
- Immediate
- IgE mediated
- Anaphylaxis
- Urticaria
- Angio-oedema
- Allergic Asthma
- Rhinitis

15. Adverse Reactions
• Hypersensitivity

16. • Angio-oedema

17. Anaphylaxis
•
• Signs & Symptoms variable
Rapid weak or impalpable pulse
• Facial flushing, itching, tingling, cold extremities
• Bronchospasm (wheezing)
• Loss of consciousness
Pallor going on to cyanosis
Cold, clammy skin
Facial oedema & sometimes urticaria
Deep fall in BP

18. Management of Anaphylaxis
•Lay flat with raised legs
•
•Give Adrenaline (1:1000) 0.3-0.5 ml SC or IM
•
•Hydrocortisone 200 mg i.v.
•
•Chlorpheniramine 10-20 mg slow i.v.
•
•Give oxygen 6L/min & assisted ventilation
•
•Consider Cricothyrotomy if NO quick
•improvement
•
•Call an ambulance

21. Accidental swallowing of foreign
bodies
• A case of swallowed dental root canal instrument
Esophagogastroduodenoscopy
•needle-like foreign body sticking deep in the
duodenal wall

22. • the object was removed by forceful extraction
with a rat tooth forceps and identified as a
dental root canal instrument, distinctly
changed by gastric acid.
Extracted instrument
Original instrument

23. • The patient then remembered that the pain was started
after a dental root canal treatment under local
anesthetics.
• The pain was probably due to the irritation of the
duodenal wall by needle while moving the upper part of
the body during ironing.
• Generally foreign bodies passes through the gastro
intestinal tract within 1 week, but might get stuck
especially when sharp.
• Earliest symptom is dysphagia.
• An ingestion of such an instrument is extremely rare i.e.
0.12/100,000 root canal treatments.

24. A case of swallowed
Dental Prosthesis
• Plain abdominal radiograph

25. • The Endoscopic view shows the extraction
from jejunum to the
mouth, here the image shows that foreign
body is at the esophagus.

26. Extracted Prosthesis
• The prosthesis was a successfully managed
endoscopically.
• Observe at the right of
• the dental bridge has a sharp edge.

27. Acute Hypoglycemia
:Causes
Overdose of insulin
Prevented from eating
at expected time
• MANAGEMENT:
• Glucose tablets/powder
• If unconscious give
• 50ml 50% glucose IV
SC glucagon 1mg

28. The Diabetic Patient
HyperglycemiaHypoglycemia
Slow onsetRapid onset
Dry skin & mouthMoist skin
Pulse slow & weakPulse full & rapid
Drowsiness/disorientationIrritability
RareMore common
more SevereLess Severe
Difficult to be managedEasy to be managed

29. THYROID CRISIS (STORM)
Sudden, Severe Exacerbation of Hyperthyroidism
• Precipitating Factors:
• Infection
• Surgery
• Trauma
Pregnancy
• Other Physiologic or Emotional Stress

30. Manifestations:
•
• Hyperpyrexia (Fever)
• Tachycardia
• Agitation
• Palpitation
• Nausia, Vomiting
• Abdominal pain
• Loss of
• Consciousness
• (Partial or Complete)

31. Management
• Terminate all dental ttt
• 
• Summon medical assist
• 
• Administer O2
• 
• Monitor VS
• 
• Initiate BLS, if necessary
• 
• Start IV line & Fluids
• 
• Transport to ER Care

32. STEROID CRISIS
Circulatory Collapse
The Pt Problem
Adrenocortical Insufficiency:Primary(Addison`s
Disease);Rare
Secondary(Exogenous);more common
(20mgcortisol
daily/2weeks/year)

33. • CAUSES: Stress Conditions
• GA
• Surgical/Other trauma
• Infection
• Other stress
• SIGNS & SYMPTOMS
• Pallor
• Weakness
• Nausea
• Rapid, weak or
• impalpable pulse
• Loss of consciousness
• Rapidly falling BP

35. • Steroid Crisis Management
• Lay flat and raise legs
• Hydrocortisone 200mg i.v.
• Give oxygen
• Monitor VS
• Start BLS if necessary
• Consider other possible reasons for loss of
• consciousness
• Ambulance & transfer to hospital

36. ASTHMA
• Causes
• Anxiety
• Infection or exposure to
• specific allergen
• Loss or forgetting to bring
• Salbutamol inhaler

37. Signs & Symptoms
• Breathlessness
• Expiratory wheezing may be
• disguised as shallow breathing
• Rapid pulse over 110
• Accessory muscles of
• respiration brought into use
• Cyanosis of mucous membrane
• & nail beds
• Mental confusion

38. Management •
• Reassure the patient
• DO NOT lay the patient flat
• Give the anti asthmatic drug
• normally used
• Give oxygen
• Give Adrenaline
• Hydrocortisone 200 mg i.v.
• Monitor VS
• If no response to Salbutamol 500
mcg i.m/s.c., CALL AN
• AMBULANCE

39. Angina
• Signs & Symptoms
• Acute chest pain which may
• radiate to left arm or shoulder
• Relieved by anti anginal drug
e.g
• .
GTN 0.5mg sublingually
• Aspirin 300mg
• If symptoms do not resolve
• rapidly with administration of
• GTN, consider it likely that the
• patient has suffered an MI

40. Myocardial Infarction
Signs & Symptoms
• Severe, crushing retro-
• sternal pain
• Feeling of impending death
• Weak or irregular pulse
• Pain may radiate to left
• shoulder, arm or jaw
• Shock, loss of consciousness
• Vomiting

41. Management
• Place patient in a comfortable position
• allowing easy breathing
• Send for an ambulance
• Give 50/50 Nitrous Oxide/Oxygen or Oxygen
only
• Aspirin 300mg
• Good pain control
• Constant reassurance

42. Cardiac Arrest
• Causes
• Myocardial Infarction
• Hypoxia
• Anaesthetic overdose
• Anaphylaxis
• Severe hypotension

43. Signs, Symptoms & Management
•
• Loss of consciousness
• Absence of arterial pulse
summon help
• Patient on flat, firm surface
• CLEAR AIRWAY (keep patent)
• Start CPR
• Defibrillation
• Transfer patient to hospital

44. • Chain of Survival

45. Stroke (CVA)
• Signs ,Symptoms & management
• Severe Headache
• Weakness or Paralysis of arms or legs
• of one side
• Unilateral Facial muscle Paralysis
• Difficulty or inability to Speak
• Partial or Total Loss of consciousness
• Patient is very anxious, needs
• reassurance and transfer to hospital
• immediately, BLS, Supine Position
• BUT Head slightly Elevated

47. CONVULSIONS (Epilepsy)
Grand mal, Petit mal (blank stare)
• Predisposing factors:
• Anxiety
• Hunger
• Menstruation
• Alcohol
• External stimuli, flashing lights etc
• Non compliance with medication

48. Convulsion
•Signs & symptoms
•Grand mal
•Warning cry
•Immediate loss of consciousness
•Rigid (tonic phase)
•Widespread jerking (clonic phase)
•Vomiting
•Flaccid after a few minutes
•Consciousness is regained after a variable period
•Patient may remain confused

49. Management
• Prevent patients from damaging themselves
• 
• Place in Supine position
• 
• Maintain patent airway
• 
• No medications, await recovery
• 
• Recovery position after fits have ceased
• 
• Suctioning & Monitor VS
• 
• Oxygen
• 
• Reassure on recovery
• 
• After fully recovered requires an escort home

50. Status Epilepticus
• Continuous or repeated convulsions for 15
• minutes (patient can have severe anoxia)
• 
• Give 10mg Midazolam IV repeat if no recovery
• within 10 minutes
• 
• Maintain airway & give oxygen
• 
• Call an ambulance, transfer to hospital

51. The Recovery Position

52. Emergency Kit
• Telephone
• Oxygen cylinder
• 
• Laerdal pocket
• mask/Ambubag for hand
• ventilation
• 
• Disposable airway
• (Sizes1-4) Guedel
• 
• Disposable syringes
• (2,5,50 ml)

53. • Disposable needles (23g)
• 
• Tourniquet
• 
• Cannulae (20g)
• 
• Portable suction
• equipment
•
• Sphygmomanometer/
• automatic BP machine
• 
• Pulse oximeter

55. • Adrenaline 1:1000, 0.5 ml ampoules
• Glyceryl trinitrate 500 mcg spray
• Aspirin 300 mg
• Hydrocortisone 100mg vials
• Chlorpheniramine 10 mg
• Salbutamol 100 mcg (metered inhaler)
• Morphine sulphate tablets 10 mg
• Midazolam 10 mg
• Glucagon 1 mg ampoules
• Glucose powder or dextrose injection 50%

56. Be Prepared
• Adequate training
• Protocols
• Medical history
• Prevention
• Checks& Updating

57. Reference
• Medical emergency in dental office DCNA july
• 199
• 5 by JEFFERY D BENNETT
• 
• Medical emergency in dental office : Malamed
• 6
• th
• edition
• 
• Text book of oral surgery by Bala JI

58. THANK YOU