The document provides an overview of medical emergencies that can occur in dental practice. It begins with an introduction defining medical emergency and classifications of emergencies. It then discusses the dental office emergency team and basic actions for any emergency. Common emergencies like syncope, postural hypotension, acute adrenal insufficiency, hyperventilation, asthma, diabetes, epilepsy and anaphylaxis are explained. Emergency equipment, drugs, and camp management are reviewed. Recent Indian studies on emergency preparedness and knowledge are summarized. The document aims to increase awareness of medical emergencies and their appropriate management in dental settings.

1. Good morning
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2. MEDICAL EMERGENCIES IN
DENTAL PRACTICE
Presented By
Deepika Jasti
1st year PG
Public Health Dentistry
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3. Contents
• Introduction
• Classification of medical
emergencies
• ASA physical status classification
system
• Dental office emergency team
• Basic action for every emergency
• Most common emergencies and
their Management
• Syncope
• Postural hypotension
• Acute adrenal insufficiency
• Hyperventilation
• Status asthmatics
• Diabetic emergencies
• Epilepsy
• Anaphylactic reactions
• Angina pectoris
• Myocardial infarction
• Cardiac arrest
• Basic emergency kit
• Basic emergency drugs
• Emergency management at camps
• Conclusion
• Recent studies conducted in India
• References
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4. Introduction
The emergency is derived from the Latin, meaning to
dip, Plung, Indundate, engulf or to bury.
Definition: A serious and unexpected situation requiring
immediate action.
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5. WHY WE SHOULD READ THIS
SEMINAR
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“When you prepare for an emergency,
the emergency cease to exist”

6. Classification of medical emergencies
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7. ASA Physical Status Classification System
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8. Dental Office Emergency Team
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9. Basic action for every emergency t/B
RR
UNCONSCIOUS - Look-Listen-Feel4/17/2014 9

10. Most common emergencies
• Syncope
• Postural hypotension
• Acute adrenal insufficiency
• Hyperventilation
• Status asthmatics
• Diabetic emergencies
• Epilepsy
• Anaphylactic reactions
• Angina pectoris
• Myocardial infarction
• Cardiac arrest
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11. Syncope
Syncope is defined as a transient loss of consciousness and
postural tone due to reduced cerebral flow and is associated
with spontaneous recovery
Temazepam 5mg orally
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12. Postural Hypotension/
• Definition: postural hypotension is
defined as a drop in systolic blood
pressure of 30 mm Hg or greater or
a 10 mm Hg or greater fall in
diastolic blood pressure that occurs
on standing.
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13. •Risk factors
•Clinical features - %BP
angina, lethargy, low back ache
•Diagnosis
•Management
Assessment of consciousness
P-A-B-C-D
Fludrocortisone – to raise BP
Discharge- Chair position
Postural Hypotension
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14. Acute Adrenal Insufficiency
• 25 steroids
• Cortisole regulates BP and glucose utilisation. K,ca
• Signs and symptoms- how to diagnose
• Management – 5-10l/min
oxygen
mix-o-vial
100 mg
2ml liquid
Hydro
cortisone
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15. Foreign Body Obstruction
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Universal
choking sign
Heimlich manever

16. Hyperventilation
Definition :
Hyperventilation is defined as ventilation in excess of that
required to maintain normal blood oxygen and carbon dioxide
partial pressures.
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17. Respiratory alkalosis –
Hypocapnia
Vasoconstriction in cerebral blood
vessels
Feeling of tightness in chest
Release of catecholamines due to
anxiety
Respiratory alkolosis – change in
blood pH – alters calcium.
Management
P-A-B-C-D
Calm the patient
Breath 4-5 times
Co2 -02
Paper bags
Diazepam/ midazolam4/17/2014 17

18. Status Asthmaticus
Hypercapnea –acidosis-respiratory failure
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19. Status Asthmaticus
Salbutamol -250mg iv
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20. Diabetic Emergencies
25-50 ml
1mg
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15 grms

21. EPILEPSY
• Definition: disorder of brain characterized by an
enduring predisposition to generate epileptic
seizures and by the
neurobiological, cognitive, psychological and
social consequences of this condition.4/17/2014 21

22. Classification
Partial seizure
Simple partial seizure
Complete partial seizure
Partial seizure with secondary generalization
Primarily generalized seizures
Absence seizure (petitmal seizure)
Tonic clonic seizure (grandmal seizure)
Tonic seizure
Atonic seizure
Myoclonic seizure
Unclassified seizures
Neonatal seizures
Infantile seizures
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23. Precipitating factors
Signs
Management
Status epilepticus – 15 min
D/M= 10/5
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Tonic phase
Clonic phase
Flaccidity
Incontinence

24. Anaphylactic Reactions
10-20 Mg 10ml blood
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25. Myocardial Infarction
50/50
Nitrous oxide and
oxygen
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26. Cardiac Arrest 4-5cm
80/min
50kgs
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27. Basic emergency kit
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28. Basic emergency kit
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29. Basic emergency drugs
• Oxygen
• Epinephrine
• Nitroglycerin
• Injectable
antihistamine
• Salbutamol
• Aspirin
• Oral carbohydrate
• Glucagon
• Atropine
• Corticosteroid
• Morphine
• Naloxone
• Nitrous oxide
• Injectable
benzodiaepine
• Flumazenil
• Aromatic ammonia
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30. Emergency Management At Camps
4/17/2014 30To be forewarned is to be forearmed

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Medico legal considerations
The standard of care can be defined as
“what the reasonable, prudent person with
the same level of training and experience
would have done in the same or similar
circumstances.”
“Ignorance of the law does not constitute
immunity from liability”

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33. Recommendations
• When an emergency arises call for EMS immediately
• If there is a problem, such as a dental dam clamp falling
into a patient’s throat, be honest with patients as to the
nature of the problem.
• Refer patients to medical professionals when necessary.
Never attempt to treat situations which require
physician or hospital management.
• Be knowledgeable about state dental practice acts and
your requirements for dealing with emergencies
• Current basic life support certificate for all dental office
staff
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34. • Take a complete health history for new patients
and update it at each visit. Maintain adequate
records. Document emergency treatment
rendered; generally, courts have maintained that if
it wasn’t written down, it wasn’t done.
• Take vital signs, especially if an anesthetic is to
be administered.
• Having an emergency kit in the office does not
prevent liability unless you know how to use it
properly.
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35. Conclusion
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36. Recent studies conducted in India
• Gupta et. al, preparedness of management of medical
emergencies among dentists in Udupi and Mangalore, India. J.
contemp dent practice 2008; 9(5); 92-9.
• Praveen et al, evaluation of knowledge, experience and
perceptions about medical emergencies amongst dental
graduates of Bangalore city, India. J clin expt dent. 2012; 4(1);
14-8.
• Mainak saha et al, emergency preparedness; a survey of dental
practitioners in Indore: JIDA, vol. 5, no. 12, dec 2011.
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37. Recent studies conducted in India
• Bhavana et al, a survey of medical emergencies in dental
practice in India. Paper presentation at 9th world congress on
preventive dentistry, 2009.
• Mohan das et al, knowledge, attitude and practice in
emergency management of dental injury among physical
education teachers: a survey in banglore urban schools. Dent
update, 2009, may, 36(4): 202-4. 207-8. 211.
• Santa et al, awareness of basic life support among
medical, dental , nursing students and doctors. Indian J.
Anaesth. 2010, March-April; 54 (2); 121-126.
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38. 4/17/2014 38
• Gupta T et al, in 2008 conducted a study to assess the
preparedness for management of medical emergencies among
dentists in the cities of Udupi and Mangalore in India and found
that Less than half (42.1%) of the dentists reported having received
practical training in management of medical emergencies during
their undergraduate and postgraduate education. Only about one-
third of the respondents felt competent in performing mouth-to-
mouth breathing (39.3%), cardiac compression (35.2%), foreign
body obstruction relief (32.8%), and in administering IV drugs
(34.5%) or supplemental oxygen (27.4%). The most commonly
available emergency drugs in treatment areas were oral glucose
(82.2%) and adrenaline (65.8%).

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However, less than one-fourth of the respondents had the
following on hand in their 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 and only 5.8% carried out
emergency drills in their workplace.

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Santa et al in 2010, conducted a cross sectional study to assess
the awareness of Basic Life Support (BLS) among
students, doctors and nurses of medical, dental, homeopathy and
nursing colleges and found that no one among them had complete
knowledge of BLS. Only two out of 1054 (0.19%) had secured
80 - 89% marks, 10 out of 1054 (0.95%) had secured 70 - 79%
marks, 40 of 1054 (4.08%) had secured 60 - 69% marks and 105
of 1054 (9.96%) had secured 50 - 59% marks. A majority of
them, that is, 894 (84.82%) had secured less than 50% marks.
Thus it is concluded that awareness of BLS among
students, doctors and nurses of medical, dental, homeopathy and
nursing colleges is very poor.

41. References
1. Stanlet F. Malamed, Medical emergencies in dental office, 6th
ed. page no: 12, 38, 60.
2. Medical emergencies in dentistry : Prevention and
Preparation, dentistry Iq, articles, volume-2, issue -10
3. Haas DA et al., Preparing dental office staff members for
emergencies: developing a basic action plan, J Am Dent
Assoc, 2010 May;141 Suppl 1:8S-13S.
4. Harrison’s text book of principles of internal medicine, vol.
1, 18th ed.
5. www.dentallearning.org/course/fde0011-
10/coursebook_ch09.pdf
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42. 6. Phil Jevon et al., Postural hypotension: symptoms and
management, nursing times, vol: 97, issue: 03, PAGE NO: 39.
7. Lapointe et al, Pocket guide to medical emergencies in dental
office. www.faculty.ksu.edu.com
8. cowson’s text book of oral pathology and oral medicine
, Emergencies in dental practice, – 7th ed. page no ; 385-390.
9. Burket’s text book of oral medicine: diagnosis and
treatment, page no. 519.
10. Fisher et al., epileptic seizures and epilepsy: definitions
proposed by International league against epilepsy (ILAE) and
the international bureau for epilepsy
(IBE), Epilepsia, Vol.46, No.4, 2005.
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43. 11. Harrison’s principles of internal medicine, volume II, 16th ed.
page no: 2357.
12. Kenneth et al, Allergy & Anaphylaxis, Inside
Dentistry, March 2011, Volume 7, Issue 3
13.Daniel A Haas et al., Management of Medical Emergencies in
the Dental Office: Conditions in Each Country, the Extent of
Treatment by the Dentist, Anesth Prog. 2006 Spring; 53(1):
20–24.
14.Rosenberg M et al., Preparing for medical emergencies. The
essential drugs and equipment for the dental office JADA, Vol.
141, May 2010.
15.Roberson et al., Are You (and Your Staff) Prepared for a
Medical Emergency?, fall 2009, vol 12, no.2
16.Office emergencies and emergency kits. JADA march
2002, vol 133.
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45. Thank you
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