MEDICAL

EMERGENCIES
HANDOUTS
RAJ K KHANNA DMD, MD
MUSOM

NOTE: THESE HANDOUTS ARE NOT TO BE USED

WITHOUT CONTENT OF FULL COURSE MATERIALS
and NOT INTENDED FOR REFERENCE WITHOUT
ATTENDING COURSE IN PERSON
ASSESSING FUNCTIONAL CAPACITY – METs
 NO SPECIAL
PRECAUTIONS

ELECTIVE CARE
OK CONSIDER
TREATMENT
MODIFICATION
ELECTIVE CARE OK
SERIOUS
CONSIDERATION TO
TREATMENT
MODIFICATION

ELECTIVE CARE
CONTRAINDICATED
EMERGENCY
TREATMENT ONLY
IN CONTROLLED
ENVIRONMENT
STAYS CALM !

MEMBER

TEAM

APPROACH
EMERGENCY DRUGS AND EQUIPMENT

GLUCAGON
ATROPINE
SUGGESTED BASIC EMERGENCY DRUGS FOR THE
GENERAL DENTAL OFFICE
 LOSS OF CONSCIOUSNESS
RECOGNIZE PROBLEM
(lack of response to sensory stimulation)

DISCONTINUE DENTAL TREATMENT

ACTIVATE OFFICE EMERGENCY PLAN

P – POSITION PATIENT IN SUPINE POSITION WITH FEET ELEVATED

A B C ASSESS BREATHING, PALPATE CAROTID PULSE, PROVIDE

CIRCULATION IF NECESSARY THROUGH CHEST COMPRESSIONS

ACTIVATE EMS IF RECOVERY NOT IMMEDIATE

D PROVIDE DEFINITIVE CARE

VASODEPRESSOR SYNCOPE -
MANAGEMENT

RECOGNIZE PROBLEM
(lack of response to sensory stimulation)

DISCONTINUE DENTAL TREATMENT

ACTIVATE OFFICE EMERGENCY PLAN

P – POSITION PATIENT IN SUPINE POSITION WITH FEET ELEVATED (Trendelenberg position)

C > A > B ASSESS CIRCULATION, ASSESS/AND OPEN AIRWAY ,ASSESS AIRWAY PATENCY AND BREATHING

D DEFINITIVE CARE
(OXYGEN, COLD TOWEL COMPRESSES, AMMONIA,GLUCOSE,VITAL SIGNS)

ADMINISTER ATROPINE IF BRADYCARDIA PERSISTS

POST SYNCOPIAL RECOVERY DELAYED RECOVER

POSTPONE FURTHER DENTAL TREATMENT ACTIVATE EMS
 POSTURAL HYPOTENSION
MANAGEMENT
ASSESS CONSCIOUSNESS

ACTIVATE OFFICE EMERGENCY SYSTEM

P – POSITION PATIENT SUPINE WITH FEET ELEVATED

C A B - ASSESS CIRCULATION, ASSESS/AND OPEN AIRWAY, ASSESS BREATHING

D – DEFINITIVE CARE (OXYGEN,MONITOR VITAL SIGNS)

PATIENT RECOVERS DELAYED RECOVERY

slowly reposition chair

MONITOR PATIENT ACTIVATE EMS

DISCHARGE PATIENT CONTINUE BLS AS NEEDED

 HYPERVENTILATION

RECOGNIZE PROBLEM

PLACE PATIENT IN UPRIGHT OR SEMIRECLINED POSITION

REMOVE ANY DENTAL MATERIALS FROM PATIENTS MOUTH

INSTRUCT PATIENT TO TAKE IN SHALLOW BREATHS AND HOLD AS LONG AS POSSIBLE

REPEAT THIS 6-10 TIMES

ALTERNATIVELY HAVE PATIENT REBREATHE EXPIRED AIR FROM A BAG

DO NOT ADMINISTER OXYGEN

PATIENT RESPONSIVE(breathing normal) PATIENT UNRESPONSIVE

CONTINUE TREATMETNT OR DISCHARGE ACTIVATE EMS AND BLS AS NEEDED
 ASTHMA MANAGEMENT
MILD SEVERE

DISCONTINUE TREATMENT

UPRIGHT POSITION

CALM PATIENT

ABCD

ADMINSTER OXYGEN

ADMINSTER BRONCHODILATOR
(2-4 puffs initially repeat in 15 minutes)

IMPROVEMENT NO IMPROVEMENT

DISCHARGE/CONTINUE APPT ACTIVATE EMS

CONTINUE BLS

EPNEPHRINE .5 TO .1MG SOL SC

repeat 10-20 mins if needed

CONINTUE WITH BLS

AMINPHYLINNE 50 MG IV UPTO 250 MG IV, DECADRON 10MG IV

 RECOGNIZE PROBLEM
(ITCHING, HIVES,EDEMA,FLUSHED SKIN)

DISCONTINUE DENTAL TREATMENT STOP EXPOSURE

ACTIVATE OFFICE EMERGENCY PLAN

C > A > B ASSESS AND PERFORM BLS AS NEEDED

PROVIDE DEFINITE TREATMENT AS NEEDED

MILD SEVERE
no cvs/respiratory involvement (cvs/respiratory involvement)
stridor ,wheezing, hypotension

OBSERVE SUMMON EMS

POSITION PATIENT

OXYGEN OXYGEN
HISTAMINE BLOCKER HISTAMINE BLOCKER IM
diphenhydramine 25-50mg im diphenhydramine 25-50mg im

BRONCHODILATOR BRONCHODILATOR

EPINEPHRINE
.3MG ADULT SC, .15MG PEDIATRIC SC
REPEAT IN 5-10 MINUTES IF NO IMPROVEMENT

DISCHARGE PATIENT CONTINUE BLS/EMT

ANGINA MANAGEMENT
TERMINATE TREATMENT

POSITION PATIENT COMFORTABLY LOOSEN CLOTHING

ABC

DEFINITIVE MANAGEMENT

OXYGEN/MONITOR AND RECORD VITAL SIGNS CONTINOUSLY

HISTORY OF ANGINA NO HISTORY OF ANGINA

VASODILATOR .4MG NTG SUBLINGUAL IF NO PAIN RELIEF ACTIVATE EMS STAT

IF NO RELIEF IN 5 MINUTES REPEAT NTG ACTIVATE EMS CONSIDER NITROGLYCERIN

IF NO RELIEF IN 10 MINUTES REPEAT NTG ADMINSTER ASPRIN ADMINSTER ASPIRIN

IF PAIN RELIEVED DISCHARGE/ PCP CONSULT CONTINUE BLS CONTINUE BLS

MYOCARDIAL INFARCTION
MANAGEMENT
TERMINATE TREATMENT

PLACE PATIENT IN UPRIGHT/ SEMI-RECLINED POSITION

ACTIVATE EMS

ESTABLISH AND MAINTAIN AIRWAY

ADMINISTER 100% OXYGEN

SET UP AUTOMATED EXTERNAL DEFIBRILLATION

BE READY FOR BLS

ADMINISTER NON-ENTERIC COATED ASPIRIN 325MG (CHEWABLE)

NITROGLYCERIN –0.2-0.6 MG SUBLINGUALLY – REPEAT EVERY 5 MINUTES UP TO 3 DOSES OVER 15 MINUTES

MONITOR VITAL SIGNS / EKG

REASSURE PATIENT

ESTABLISH I.V. ACCESS

START BLS IF PATIENT LOSES CONSCIOUSNESS TRANSPORT PATIENT TO HOSPITAL