Medical Emergencies PDF

Medical emergencies
in the dental practice

Lesson objectives
✓ What are medical emergencies
✓ How to prevent emergencies
✓ Signs, symptoms and management of medical conditions
✓ Codes to follow in an emergency
✓ Cardio pulmonary resuscitation
✓ Different type of medication
✓ Medical equipment available in the dental practice
Prevention of medical emergencies in the dental practice
• A medical emergency is any life threatening situation

• Anxiety can be one of the triggers of medical emergencies
• Examples of methods the dental team can use to reduce the anxiety
levels (reassurance, making conversation, showing empathy, hide
instruments, listening to music, regular breaks)
• Patients can complete a MDAS (Modified Dental Anxiety Scale)

questionnaire to identify their anxiety levels.
The Modified Dental Anxiety Scale (MDAS) (brantfordnorthdental.ca)
• Any of the dental materials, antibiotics or local anaesthetics used in

dentistry have the potential to cause an allergic reaction.
• Many dental treatments are carried out with the patient lying flat in the
dental chair, and this leaves their airway potentially vulnerable to
foreign object inhalation.
3
How do we identify medical conditions?
These patients will be identified by accurate

completion of medical histories before dental
treatment begins.
- How often to be updated? – at every single visit

- How should it be stored? – securely, in patient’s file
Prevention of medical emergencies
✓ Observe people around you - look for abnormal behaviour,

unusual face and lip colour, heavy breathing, sweating
inconsistent.
✓ Reassure nervous patients.
✓ Observe patients closely after they had local anaesthetic
administered.
Do CPD regarding medical emergencies
✓ Do a BLS course- always be prepared!

https://www.probls.co.uk/
5
Casualty assessment (evaluation)
• We need to know how to correctly treat the casualty.

• Casualty = victim / Rescuer
• This is done by being able to recognise “signs” and “symptoms” of an
emergency.
Sign – we can see
Symptom – they can feel
Examples of signs and symptoms?

Assessment of an unwell patient
▪ When a patient starts to show concerning signs

▪ Simple observations
▪ We have to follow ABCDE approach in line with the guidance
offered by the Resuscitation Council
Casualty assessment
There are two signs that indicate casualty’s life is at risk.

Unconsciousness may indicate that the heart has stopped beating or is beating
ineffectively
Abnormal breathing indicates a compromised airway and possible lack of oxygen
to the brain (hypoxia).
Basic life support
• To assess if BLS is required in an emergency situation we have to follow a different code:
• D for danger
• R for response (another code)
• S for Shout
• A for airway
• B for breathing
• C for circulation
ACVPU – To assess responsiveness
• R for response → to determine is the casualty

is responsive or not, we have the following
code:
• A for alert
• C for confused
• V for verbal
• P for pain
• U for unresponsive
Basic life support
• Rescue breaths and external chest compressions

The rescuer needs to apply 30 chest compressions for each
two rescue breaths given.
30 : 2
Modified Basic life
support
BABIES AND CHILDREN
• To be given 5 rescue breaths and 30 chest

compressions→ 30:5
• Give rescue breaths before chest
compressions!
Pregnant women and spinal injury
• A heavily pregnant woman needs to be laid slightly

on the left side with some support under the right
buttock so that the major blood vessels are not
squashed by the uterus.
• If a spinal injury is suspected, ideally, the casualty
should be left in the same position until
specialists arrive.
Devices to help clearing the airway and
delivering oxygen
Cardiac arrest
• Cardiac arrest – the heart stops beating

or it beats ineffectively (ventricular
fibrillation) – abnormal rhythm
SIGNS
- no breathing, unconscious,
unresponsive.
Automated external
defibrillators (AEDs)
• This is a portable device that delivers an electric

shock through the chest to the heart.
• The shock can potentially allow a normal heart
beat to resume.
• Annual training should be provided for staff.
How to Use a Defibrillator (AED) - First Aid Training - St John Ambulance –

YouTube
What is a defibrillator? - YouTube
Recovery position
• If the casualty is breathing but is unconscious, he/she should be

placed in the recovery position which will keep the airway open.
Fainting / Vasovagal syncope
• Fainting is a brief loss of consciousness due to a temporary

reduction in oxygenated blood to the brain
• The likeliest medical emergency encountered in the dental
surgery
• Anxiety, fear, missing a meal
• Unconscious- legs raised above the head level to restore

blood flow to the brain; loosen tight clothes, provide oxygen,
ventilate area.
• Conscious – sit casualty with head down, loosen tight clothes,
fresh air/oxygen.
Give Glucogel or Dextrose tablets to restore blood sugar level.
Asthma attack
• Hypersensitivity of the bronchi in the lungs. They become

irritated by certain triggers (dust, pollen, cold air, anxiety,
colds, detergents, aerosols)
• Signs include – wheezing respiration
▪ Administer Salbutamol inhaler

▪ Give oxygen
▪ Calm and reassure the casualty
Anaphylaxis
▪ This is a severe allergic reaction.

▪ The immune system over-reacts to an allergen, causing severe
swelling of the head and neck in particular, and a sudden fall in
blood pressure (hypotension) causing collapse.
▪ Ambulance must be called straightaway
▪ Signs include –hoarse voice, swelling, rash
✓ Intramuscular Adrenaline – administered by injection

✓ Give oxygen 10L/min
Epileptic fit
• This is a brief disruption of the

normal electrical activity within the
brain causing a fit:
• Mild fit → Pettit Mal → the
casualty looks like they are
daydreaming
• Major form → Grand Mal. (tonic-
clonic seizure)
Treatment
▪ Protect the casualty from injury, but do not attempt
to move them!
▪ Wait 5 minutes and allow their recovery, ensure
they are escorted home.
▪ call 999
▪ Midazolam gel or solution (as pills can cause
choking, do not touch patient’s teeth or attempt to
open the mouth, the gel to be administered in the
buccal sulcus)
Diabetic Hypoglycaemia and
Diabetic coma
• Hypoglycaemia = abnormally low level of blood

sugar (glucose).
• Patients with pre-diagnosed diabetes who have
either not follow their insulin regime correctly or
have eaten at the correct times.
✓ Conscious – give Glucose gel orally

✓ Unconscious – Glucagon injection
Angina
• This is a coronary artery disease, where the
arteries supplying blood to the heart muscles
become narrowed by a build-up of fatty
substances ( cholesterol ).
• An angina attack occurs when there is a demand
on the heart to work harder. Angina attack
triggers include:
• Exercise.
• Stress.
✓ Administer Glyceryl Trinitrate (GTN) spray

✓ Keep the casualty sitting upright
Angina- treatment
Myocardial infarction (heart
attack)
▪ The supply of blood to the heart is suddenly blocked, usually

by a blood clot.
▪ This will prevent oxygenated blood from supplying that part of
the heart muscle, which will then die.
✓ Administer Aspirin
✓ Crushed or mixed with water.
✓ Aspirin is an anticoagulant and will unblock the arteries,
making the blood thin (blood thinner)
✓ Keep the casualty sitting upright
✓ Calm and reassure casualty
Choking
• Blockage of the respiratory track
1. Encourage coughing
2. Give five back slaps between the shoulders blades to dislodge
the obstruction
3. Begin abdominal thrusts (Heimlich manoeuvre)
STROKE
❖ Cerebral infarction → a blood clot in the brain
❖ Cerebral haemorrhage → rupture of a brain blood
vessel
SIGNS - weakness of the face or limbs on one side of the

body
• maintain airway, provide oxygen

The casualty must not be given any food or drink.
Call 999
Adrenal crisis
• For patients who had steroid medication over a very
long period of time- affects the natural release of
adrenaline
• This + stressful situation = leads to low blood
pressure and clinical shock
SIGNS- low blood pressure, fast heart rate, pale, vomiting

SYMPTOMS- nausea, abdominal pain, feeling weak
• Lay the casualty supine
• Administer oxygen
• Call 999
Medical Emergencies videos
• Epileptic seizure :https://www.youtube.com/watch?v=Ovsw7tdneqE&ab_channel=StJohnAmbulance
• Choking: https://www.youtube.com/watch?v=PA9hpOnvtCk
• Fainting: https://www.youtube.com/watch?v=ddHKwkMwNyI
• Diabetic coma: https://www.youtube.com/watch?v=L06DNMRcy98&t=22s
• Anaphylactic shock: https://www.youtube.com/watch?v=ZYJPmC0DmQM
• Stroke: https://www.youtube.com/watch?v=PhH9a0kIwmk
• Adrenal crisis: https://www.youtube.com/watch?v=v3BsSishg0g
• Myocardial infarction and angina: https://www.youtube.com/watch?v=gDwt7dD3awc&t=65s
Questions?
Levison’s textbook: chapter 6

Q&A book: chapter 6

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Medical emergencies

in the dental practice

• A medical emergency is any life threatening situation

• Patients can complete a MDAS (Modified Dental Anxiety Scale)

• Any of the dental materials, antibiotics or local anaesthetics used in

These patients will be identified by accurate

- How often to be updated? – at every single visit

✓ Observe people around you - look for abnormal behaviour,

Do CPD regarding medical emergencies

✓ Do a BLS course- always be prepared!

• We need to know how to correctly treat the casualty.

Examples of signs and symptoms?

▪ When a patient starts to show concerning signs

There are two signs that indicate casualty’s life is at risk.

• R for response → to determine is the casualty

• Rescue breaths and external chest compressions

BABIES AND CHILDREN

• To be given 5 rescue breaths and 30 chest

• A heavily pregnant woman needs to be laid slightly

• Cardiac arrest – the heart stops beating

• This is a portable device that delivers an electric

How to Use a Defibrillator (AED) - First Aid Training - St John Ambulance –

• If the casualty is breathing but is unconscious, he/she should be

• Fainting is a brief loss of consciousness due to a temporary

• Unconscious- legs raised above the head level to restore

• Hypersensitivity of the bronchi in the lungs. They become

▪ Administer Salbutamol inhaler

▪ This is a severe allergic reaction.

✓ Intramuscular Adrenaline – administered by injection

• This is a brief disruption of the

• Hypoglycaemia = abnormally low level of blood

✓ Conscious – give Glucose gel orally

✓ Administer Glyceryl Trinitrate (GTN) spray

▪ The supply of blood to the heart is suddenly blocked, usually

• Blockage of the respiratory track

SIGNS - weakness of the face or limbs on one side of the

• maintain airway, provide oxygen

SIGNS- low blood pressure, fast heart rate, pale, vomiting

Levison’s textbook: chapter 6

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