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INTRODUCTION
A heart attack occurs every 20
seconds. About 25% of those who
have heart attacks do not realize
they are having them.

PREPARATION

You must find out from patients any medical conditions or

medications they are or have been taking.

The entire staff must be trained, a designated in-office

emergency team must also be trained,

Emergency equipment and drugs must be available and

current

The In-Office Emergency Team

Team member
1: The person who
first observes the
emergency.
Responsible for
staying with the
patient, performing
CPR as needed.

Team member
2: The person who
will get the
emergency
oxygen cylinder and
emergency drug kit

Team member
3:
All other staff
members. Handle
other tasks as
assigned by the
dentist during the
emergency.

Calling for Help

If you think that you need help, get it. If you do not know what is going on or are
concerned about the situation, call for help. When in doubt, call for help.
The dentist is legally responsible during a medical emergency to keep
the patient alive until he or she gets better or until someone who is better trained
arrives on the scene to take over.

EMERGENCY EQUIPMENT
1. Oxygen Tank
Oxygen must be available in an E cylinder, which is about three
feet high
and contains enough oxygen to ventilate a nonbreathing
adult for approximately 30 minutes.
2. Pocket Mask
By holding the mask on properly and putting your mouth onto the
mask, can ventilate a person with 16% oxygen.

Automated External Defibrillator (AED)

Defibrillation is very important and is carried out by placing special
pads on the torso that recognize a sudden cardiac arrest.

DRUG KIT
used when an anaphylactic reaction
occurs.

Injectable
Drugs

Epinephrin
e
Diphenhydramine
(or Benadryl)

Nitroglycerin

Noninjectable
Drugs

Bronchodilator

Histamine blockers are used in the management of

primarily non-life-threatening allergic reactions and
anaphylactic reactions after epinephrine
a vasodilator, must be included in the drug
kit. Patients who have angina will bring their
nitroglycerin with them, usually in tablet
form.

is used to treat an acute asthmatic

attack.

Glucose
(Sugar)
Aspirin

Secondary
Drugs

dosed in a 1:1000 (0.3 mg) concentration and

must be available in a preloaded syringe

Aromatic
Ammonia

One aspirin tablet (325 mg) chewed,

not swallowed, is recommended in any patient
who is suffering chest pain for the first time.

Management of Medical
Emergencies
Conscious
Patients

Unconciou
s Patiens

P. Positioning patient
A. Airway
B. Breathing
C. Circulation
D. Definitive

P: supine position
A: Headtilt chinlift
B: check whether the patient
is breathing
C: Checking circulation
D: diagnose the problem

Airway
management
Head Tilt/
Chin Lift

Breathing
Look, listen,
feel
Not breathing
2 complete
ventilation

Circulation
Check the
carotid artery
for a pulse. No
more than 10
sec
No pulse
chest
compresion

SPECIFIC MEDICAL EMERGENCIES

Symptoms: cold,
sweaty, shaking,
and mentally
disoriented.
Hypoglycemia

When did you last

take your insulin?
When did you last
eat?

Conscious diabetic

Management

position comfortably.
A,B, and C are not
required,
Definitive care is
simply the
administration of
sugar.
supine position

Unconscious diabetic

Check ABC

No drug should be
administered

What type of seizure do you have?

What medication(s) are you taking to control
your seizures and how effective are they?
What is your aura?
Review Med History

Have you ever had a seizure that did not

stop?
Have you ever been hospitalized for your
seizures?

If possible, remove the doughnut or pillow from the

dental chair.

Epilepsy

The PABCD protocol

Position the patient so that he or she cannot hit any sharp

objects.Maintain the patients airway by performing a Head
Lift/Chin Tilt.
Check for breathing (look, listen, feel),

check for the carotid pulse.

What type of asthma do you have?

The airway is narrowed,
and breathing becomes
extremely difficult.

Review Med
History

How often do you have asthmatic

attacks?
What triggers your asthmatic
attacks?
What are you allergic to?
What medications do you take for your
asthma?

Asthma
Have you ever had an asthmatic attack that
didnt stop and that requiredhospitalization?

The PABCD
protocol

Patient is positioned comfortably. For patient

having
an acute asthma attack : sit up.
No need ABC because the patient is breathing
(albeit with difficulty) and is conscious.
Definitive care is simply to give the patient his
or her own bronchodilator.

All patients will initially

be conscious, allowing
you to
position them
comfortably and move to
definitive care

If patients are
unconscious, place them
in the supine position

Immediate-onset allergies
are life-threatening, usually
involving the respiratory and
cardiovascular systems and
producing bronchospasm
and a drop in blood pressure.
Allergic Response:
Anaphylaxis

Assess airway and

breathing, and take any
necessary action
The PABCD protocol
Immediately get the
preloaded epinephrine
syringe and give the
injection in the deltoid,
tongue, or lateral thigh
Be prepared to monitor A,
B, and C until help is on
the scene and to
readminister epinephrine
in approximately five
minutes, if necessary.

tightness, heaviness, or a constricting

feeling in the chest and will often make
a fist and hold it against the chest to
describe this.
Angina Pectoris
Position the patient comfortably
PABCD protocol

A, B, and C need not be done

Definitive treatment :give patients
nitroglycerin. The average dose is two
tablets placed under the tongue

Chest Pain

Myocardial
Infarction (MI)

A patient tells you that the pain is getting

worse.
The patient takes three doses of nitroglycerin
at fiveminute intervals and the pain doesnt go
away.
Call EMS when

Cardiac Arrest

The patient takes nitroglycerin and the pain

goes away but comes back.
A patient with no prior history of
cardiovascular disease has chest pains
for the first time

conscious
feels crushing, intense, radiating pain
Classic myocardial pain radiates from the chest into the
stomach, giving a bloated feeling.
The pain radiates down the left arm, usually as a tingling sensation
in the arm and pinkie finger, and may radiate to the left side of the
patients neck and mandible.
The patients skin is normally an ashengray color.
Myocardial
Infarction

Sign Symptom

The mucus membranes may be cyanotic, and

the patient may be sweating profusely.

position the patient comfortably

PACB protocoll

No need ABC
Call EMS Immediately for definitive care
Oxygen
Nitroglycerin

Manage with
Aspirin: one dose, chewed

Notified EMS

Performing onerescuer CPR at a

ratio of 15:2

Carotid pulse is
checked but there is
none

Assistant and the

doctor work as a
two-person rescue
team,
continuing to
perform CPR at a
ratio of 15:2

Position the patient

supine

Breathing is
assessed

The other assistant

returns with the
emergency drug kit,
the oxygen cylinder,
and the AED.

shake and
shout.

The airway is
checked
by using a Head Lift/
Chin Tilt.

The oxygen cylinder

is turned on, and the
patient is ventilated
with positive
pressure oxygen.

Cardiac Arrest

Management

Paramedics should
transport
the patient to the
hospital for further
treatment.

The AED is placed

by the patients left
shoulder and turned
on.

CPR