Medical Emergency
In Dentistry
Definition
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A serious unpredictable ,un expected
potentially dangerous situation that require
immediate action it can progress to mortality
or neurological defect in a short of time if not
properly manage .
Physical status classification
American society of anesthesiologists
ASA I normal healthy patient
 ASA II A patient with mild to moderate systemic
disease
 ASA III A patient with severe systemic disease
that limits the activity but not incapacitating
 ASA IV A patient with severe systemic disease
that limit the activity and is threat to life
 ASA V morbid patient not expected to live long
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How to minimize medical
emergency
Evaluation of the medical history
 Current and previous medications
 Physical examination
 Determination of medical risk and anxiety
 Dental care plan staff training
 Emergency kit
 Written emergency plan to the clinic

Initial management
Airway
 Breathing
 Circulation
 Disability
Response to verbal command ,response to the
pain
Unresponsive
.Exposure (A,B,C)don’t ever forget glucose
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Common causes of unconscious
in dental surgery
Vasovagal syncope :
 Temporary loss of consciousness due to
generalized cerebral ischemia
 Precipitated by psychological factor such as
pain or fear
 Commonly in young fit adult males
Treatment
Terminate the procedure
 Supine position
 Loosen tight clothing
 Assess consciousness
 If the patient not recover in about five minutes
suspect another cause of syncope such as
hypoglycemia ,cardiac arrest

hypotension
Commonly seen in older people ,pregnancy
,Addison disease ,starvation and
antihypertensive drugs
 Management :
 Gradual upright of the chair
 the patient Keep sitting in the chair for few
minute

Acute adrenal insufficiency
Cortisol is important to adapt the body to stress
 Occur in patient with Addison's disease or long
term steroid therapy
 Clinical features :lethargy ,fatigue ,and weakness
,hypotension and loss of consciousness
 Management :
 Terminate the procedure .supine position
,monitor the vital signs. Oxygen .IV
hydrocortisone200mg

Airway obstruction
Can happen with inhaled teeth , equipment or
dentures .
 In conscious patient they are usually coughed
away
 Swallowed sharp objects can carouse
gastrointestinal tract problems
 Management :
 If the object can be visualized try to retrieve it
.
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If the patient can breath they are encouraged to
cough
Send the patient for chest / abdominal radiograph.
In complete obstruction :
Back blows to dislodge the object
Criothyrotomy
Call for help
Hyperventilation
Leads to alkalosis ,constriction of the cerebral
blood vessels and loss of consciousness
 Predisposing factors : anxiety
 Clinical features :
 Agitated patient start over breathing
 Patient are pink and tachycardia
 Loss of consciousness (rare)

Management:
 Terminate the procedure
 Reassure the patient
 Paper bag over the face to re breath expired air
.

Asthma
Stress & some medication can induce can
asthma attack
 Clinical features :
 Cough ,wheeze and fight for air
Management :
Terminate the procedure
Use the patient own bronchodilator ,oxygen
If no response call for help .IV hydrocortisone
200 mg

Diabetic coma
Hyperglycemic coma is unlikely at the dental
surgery
 Hypoglycemia can rapidly progress to un
consciousness .
 Usually arise if do not eat after anti diabetic
medication
 Clinical features:
 Mood changes ,Sweating ,Hunger ,confusion

Management
Stop the procedure
 Glucose by mouth to conscious patient
 IM glucagon or IV dextrose to unconscious
patient

Seizures (convulsions)
Paroxysmal disorder of cerebral function
characterized by change in consciousness
,motor activity .
 Epilepsy a term given to a group of disorders
can produce seizers due to change in brine
electrical activity .
 Management :
 Terminate the procedure

Get the patient away from any risk area to a
flat surface
 Gentle restrain to limbs to minimize injury
 Suck out the secretions
 Basic life support
 If it’s last more than five minutes ,call for help
and IV diazepam 2 mg per minute total 10 mg
 Once recover discharge the patient with
responsible adult or admit to hospital .

Other medical emergency can result in
seizures:
 1-vasovagel syncope
 2-hypoglycemia
 3-Cerbrovascular accident
 4-drug reactions

Allergic reactions
Minor allergic reactions :

Urticaria

Pruitus

Angioedema

Erythema
.

Anaphylactic reaction
All minor reactions
Bronchospsam and shortness of breath
Cyanosis
Throat and chest tightness
Altered consciousness
Vascular collapse
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Usually caused by medications used in dentistry
Latex allergy
Commonly seen in females and atopic (asthmatic)
individuals
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Management of minor allergic
reaction:
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Terminate the procedure
Basic life support oxygen as required
Antihistamines
Adrenaline
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Angina and myocardial infraction
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Retro-sternal crushing pain radiated to the lift
shoulder or mandible .
Patient clutch the right hand to the chest as they
describe the pain (Levine sing)
Sweating
Angina is short duration but myocardial infraction
pain last longer
Angina relived by nitroglycerine but pain in
myocardial infraction is not
Management
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Terminate the procedure
Upright the patient
Reassurance and BLS
Nitroglycerine under the tongue
Oxygen
Not recovery that means patient suffering from
myocardial infraction ,call for help and ambulance
Morphine and N2O
aspirin if not contraindicated
Cardiac arrest

Ventricular fibrillation
In children caused by respiratory illness
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Clinical feature :
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Sudden collapse
No pulse some time breathing my present
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Management :
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Call for help
CPR
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