Department of Periodontology

Lahore Medical & Dental College

Standard Operating Procedure (SOPs) in case of Medical Emergencies

Medical Emergency Signs & Symptoms Management

o Feels faint/light headed/dizzy o Airway Breathing Circulation

Syncope o Collapse& loss of consciousness Disability Exposure
o Pallor, slow pulse, sweating, low BP o Lie flat, elevate legs, loosen clothes,
o Nausea/Vomiting oxygen not necessary
o Once consciousness returns offer
glucose in water or sweet tea
o Slow recovery: consider alternative
diagnosis: unresponsive: check
signs of life
Hypoglycemia o Shaking & trembling o Airway Breathing Circulation
o Slurred speech & vagueness Disability Exposure
o Sweating & pallor o Offer 15 or 20 mg quick acting
o Blurred vision carbohydrate e.g 4 to 5
o Tiredness/lethargy Glucotabs or 1.5 to 2 tubes of
o Confusion/aggression Glucogel
o Stroppy/moody
o Unconsciousness In case of unconsciousness or unable to
swallow safely
o Call Medical Emergency
Response Team, recovery
position, Glucagon 1g IM
o Once consciousness returns,
offer oral carbohydrate
 o If able, measure blood sugar
level to confirm diagnosis
Pediatric Glucagon dose, less than 8
years of age or < 25 Kg: 0.5mg IM
Cardiac Emergencies Symptoms may vary but most commonly o Airway Breathing Circulation
o Chest pain or discomfort that Disability Exposure
suddenly occurs and does not go o Call Medical Emergency
away. It may feel like pressure, Response team, state “heart
squeezing or heaviness in your chest attack” SBAR
o Pain that may spread to your right or o Comfortable position (usually
left arm or that may spread to your sitting up)
neck, jaw, back or stomach o GTN spray 400 to 800mcg
o Feeling sick, sweaty, light headed or (typically 1 to 2 activations)
short of breath sublingual
o Dispersible aspirin 300mg to
chew (unless there is evidence
of allergy to it)
NB: Known angina: sit down, rest, GTN:
no relief after few minutes repeat
GTN.Still no relief after a few minutes
call response team: follow heart attack
protocol, SBAR and aspirin.
Epileptic Seizures o Sudden collapse and loss of o Airway Breathing Circulation
consciousness Disability Exposure
o Rigidity and cyanosis o Safe environment may prevent
o Jerking movement of limbs injury, do not put anything into
o Noisy breathing mouth, do not restrain
o Tongue may be bitten o Administer oxygen 15 litres/min,
o Frothing at mouth note timings of seizure
o Incontinence may occur o Once jerking movements seize:
recovery position

Prolonged convulsive disorder (more than 5

mins) or repeated rapidly
Midazolam oromucosal solution can be given
 via the buccal route as a single dose of 10mg
Pediatric dosage
1 to 4 years: 5mg, 5 to 9 years: 7.5mg, 10 to
18 years: 10mg
Anaphylaxis o Sudden onset o Airway Breathing Circulation
o Utricaria, pallor & flushing Disability Exposure
o Respiratory distress: stridor, wheeze, o Call Medical Emergency
& or hoarseness Response team, state
o Hypotension & tachycardia “anaphylaxis”, SBAR
Anaphylaxis likely: o Lie flat, elevate legs (if breathing
o Sudden onset & rapid progression of not impaired): administer
symptoms oxygen 15 litres/min
o Life threatning A &/ or B &/ or C o Administer Adrenaline 500mg
IM (0.5ml of 1:1000)
o Repeat adrenaline at 5 min
interval until response is
received
Pediatric dosage of adrenaline
<6 years: 150mg (0.15ml of 1:1000), 6 to
12 years: 300mg (0.30ml of 1:1000), >12
years: 500mg (0.5ml of 1:1000)

Asthma o Breathlessness & expiratory wheeze o Airway Breathing Circulation

o Severe: unable to complete sentence
in one breath RR>25/min,
Pulse>100/min
Life threatening: RR or cyanosis <8/min, pulse
<50/min, exhaustion, confusion, decreased
level of consciousness
Disability Exposure
o Sit upright: if available follow
patient personalized action plan
(PAAP)
o 2 puffs (100mg/puff)
bronchodilator e.g Salbutamol,
repeat doses may be necessary
(early use of spacer device)
o Unsatisfactory response, severe
or life threatening call Medical
Response team, SBAR
 While awaiting ambulance: Oxygen 15
litres/min, B2 bronchodilator given via
spacer one puff at a time, inhaled
separately via tidal volume, give another
puff every 60 seconds upto maximum of
10 puffs
Adrenal Crisis o Collapse, cold & clammy skin o Airway Breathing Circulation
o Hypotension & dizziness Disability Exposure
o Vomiting & diarrhea o Call Medical Emergency
Response team, state “adisonian
crisis”, SBAR
o Lie flat, administer oxygen 15
litres/min
Patients hydrocortisone emergency IM
kit at hand, hydrocortisone 100mg IM.
Stroke o Facial weakness o Airway Breathing Circulation
o Arm weakness Disability Exposure
o Speech problems o Act FAST & Call Medical Emergency
Response team
o Administer oxygen 15 litres/min
o Nil by mouth, appropriate position