Medical

Emergencies
By: Viktoriya Mynash, Hailey Skidgmore,
Emma Robitaille, Nicole Holovati
 Syncope 1.
Management of Emergency
Stop the procedure.
2. Notify a student nearest you via
“CODE 7” while always remaining
with the client.
Description 3. The student will then inform the
Sudden transient Steps for Prevention CDH or staff member of the
emergency saying, “CODE 7, CHAIR
loss of • Take an in depth __”. The CDH goes to the chair
medical and where the medical emergency is
consciousness taking place, and the student who
(fainting) (Darby & dental history is assigned the ‘runner’ brings the
Walsh, 2019). prior to starting emergency kit and remains at the
scene to assist with recording
treatment. vitals in the client’s chart.
Signs & Symptoms • Reduce anxiety 4. Place the client in a supine position
• Nausea and stress levels and loosen any tight clothing.
5. Assess and maintain the airway.
• Perspirations of the client. 6. Place cold, damp towel on forehead
• Dilated pupils • Treat the client in 7. Crush ammonia vaporole and place
under client’s nose.
• Loss of vision a supine position. 8. Administer oxygen by nasal
• Appearing pale cannula.
9. Reassure patient, especially during
recovery (Wilkins, 2020).
Hyperventilation
Signs and Symptoms
• Dizziness
• Light-headedness
• Tightness in chest
Description • Cold hands
• Palpitations
Respiratory alkalosis • Feelings of suffocation
resulting from an • Rapid or shallow
excessive loss of respirations
carbon dioxide (Darby
Steps for Prevention
& Walsh, 2019).
• Minimize stress
during the
appointment.
• Make the client
feel comfortable.
1.
2.
Management of Emergency
Stop the oral procedure.
Remove rubber dam and objects from
the mouth (Wilkins, 2020).
3. Notify a student nearest you via “CODE
7” while always remaining with the
client.
4. The student will then inform the CDH
or staff member of the emergency
saying, “CODE 7, CHAIR __”. The CDH
goes to the chair where the medical
emergency is taking place, and the
student who is assigned the ‘runner’
brings the emergency kit and remains
at the scene to assist with recording
vitals in the client’s chart.
5. Place the client in an upright position.
6. Explain what is happening.
7. Loosen tight clothing.
8. Reassure the client using a quiet voice
to calm them.
9. Encourage slow, normal breathing;
have the patient breathe through
pursed lips or into cupped hands.
10. DO NOT administer oxygen.
•
Steps for Prevention
taking an in depth
Asthma Management of Emergency
1. Stop the procedure.
2. Notify a student nearest you via “CODE 7”
while always remaining with the client.
medical and dental 3. The student will then inform the CDH or staff
Signs and Symptoms
history prior to starting member of the emergency saying, “CODE 7,
treatment, including a • Shortness of breath CHAIR __”. The CDH goes to the chair where the
medical emergency is taking place, and the
list of possible triggers. • Anxiety student who is assigned the ‘runner’ brings the
• allow the client to settle • Increased pulse rate emergency kit and remains at the scene to
• Wheezing assist with recording vitals in the client’s chart.
their breathing rate 4. Position the client upright with arms up and
prior to starting • Confusion due to lack supported forward.
treatment. of oxygen 5. Assist with patient’s own bronchodilator.
6. Administer supplemental oxygen by nasal
• give time for the client • Chest pressure cannula (Wilkins, 2020).
to use their inhaler • Sweating (Wilkins, 7. If client recovers care can be continued if
before treatment if 2020). appropriate, if not call 911 and initiate BLS as
needed.
necessary. 8. If the patient becomes unresponsive,
administer epinephrine 0.3mg of 1:1000
(Darby & Walsh, 2019).

Description
Narrowing of the branchial airways due to bronchospasm, excessive mucus, or
inflammation (Darby & Walsh, 2019).
 Cardiac Emergencies
Description
A cardiac emergency includes a heart attack, cardiac
arrest, angina or unstable angina. Cardiac arrest is a
sudden cessation of heart function caused by lack of blood
flow to the brain (Bowen and Pieren, 2019, p138). An
Angina attack is chest pain caused by lack of blood flow
through the heart muscles and is often triggered by
physical exertion or stress. There are 2 types of angina,
stable angina and unstable angina. Stable angina is more
common and is usually caused by stress and exertion (This
is important to note because often, people become very
stressed when visiting the dentist). Unstable angina is
more severe and does not always have a trigger, unstable
angina might also persist despite resting. Some people
may develop unstable angina after having stable angina
(NHS, 2023). A heart attack is “Necrosis of the
myocardium due to total or partial occlusion of an artery”
(Bowen and Pieren, 2019, p140)
Prevention
• Routine vital checks will help the
clinician to determine if the patient
should be referred to a doctor
• Advise the patient to stop smoking
and/or cut down on alcohol
• Advise the Patient to maintain a
healthy diet
• Try to keep patients' stress at a
minimum by making them feel as
comfortable as possible
• Always update medical history
• refer patient to seek help from
medical professionals if the vitals
that are taken, show they could be
at risk (ex. high blood pressure).
 Cardiac Emergencies Cont.
Signs and Symptoms Management
Cardiac arrest
Cardiac arrest: Heart attack 1. Call code 7 and have the instructor as well as another member of the pod come to your
• Fatigue • Sweating operatory.
2. Place the client in supine position
• Dizziness • Cold or clammy skin
• Shortness of breath • Blue or pale hands, knees 3. have another person retrieve the AED while you perform chest compressions on the
client until they get back. At the same time, have someone call 911.
• Nausea or lips
• Chest pain • Chest pain/discomfort 4. Once the AED has been retrieved, begin following the instruction from the defibrillator.
• Pounding heart that will not go away Angina attack
1. Call code 7 and have the instructor as well as another member of the pod come to your
• Loss of consciousness • Difficulty breathing
• Nonproductive cough • Rapid heartbeat or operatory.
2. Place the client in an upright position or a position that is comfortable for them.
• Cyanosis abnormally low or
• Dilated pupils irregular heart beat 3. Glyceryl trinitrate can be given to the client, after doing so, wait five minutes to see if the
• Absence of pulse • Pain down arms (most symptoms subside.
4. If the symptoms do not go away, you can provide the client with another dose of glyceryl
commonly left arm)
Angina Attack • Pain in neck, jaw, back or trinitrate. Again, wait five minutes
5. If the symptoms do not subside, call 911 and check for signs and symptoms of a heart attack.
• Perspiration stomach
• Shortness of breath • Seizures 6. In the event of a heart attack, you may give the client aspirin (if they're not allergic) and
• Tightness in the chest (may • Anxiety make the paramedics aware of the medications that were given prior to their arrival.
Heart Attack
spread to neck, jaw, arms, • Weakness
back or stomach lasting less • Burning feeling of 1. Call code 7 and have the instructor as well as another member of the pod come to your
operatory.
than 15 mins) indigestion
2. Place client in a semi supine position
3. have someone immediately call 911.
4. Give your client one aspirin tablet (unless they are allergic) and have them chew it. Do not
leave the client unattended until the paramedics arrive.
5. In the event that the client falls unconscious, preform BLS and have another person
retrieve the AED.
 Cerebrovascular Accident CVA
Description Signs and Symptoms
“Occlusion or hemorrhage of cerebral blood vessel resulting • Sudden weakness of one side of client’s body
in ischemia” (Bowen and Pieren, 2020, p138), also known as a • Severe headache
stroke. • difficult/ loss of speech
• Vision changes
• Dizziness
Prevention • Nausea
According to dentalcare.com "Short stress-free
• Convulsions
appointments scheduled in the morning reduce the risk for
complications. Dental providers should avoid placing a Management
retraction cord impregnated with epinephrine. Effective 1. Call code 7 and have the instructor as well
pain control during the procedure and post-operative will as another member of the pod come to
reduce stress and the risk for complications." your operatory.
2. Place client in semi supine position, and
call 911.
3. Check and monitor the clients vitals
and administer oxygen as needed.
4. Monitor and maintain airway use suction
if needed,
5. Keep client quiet and still,
6. Initiate bls if needed.
 Seizures

Description Management
“A seizure is a sudden, uncontrollable burst of electrical activity in 1. Call code 7 and have the instructor as well as another
the brain. It can cause changes in behavior, movements, feelings and member of the pod come to your operatory.
levels of consciousness” (mayo clinic, 2023) 2. Place the client in a supine position, lowering the dental
chair so the client will not get hurt if they fall off of the
Prevention chair,
• Be cautious about bright lights (try not to shine bright lights in 3. remove any objects that could harm the client and do not
the client's eyes) attempt to hold the patient down.
• Look for signs of an aura 4. After the seizure is over, assess and monitor the client's
Signs and Symptoms airways. you can roll the client into a recovery position if
• Staring spells needed. You can also administer oxygen as needed.
• Confusion 5. If the client has epilepsy, or the issue is unresolved, call
• Sudden crying 911. Arrange a medical follow up for the client.
• Possible involuntary defecation or urination 6. document all details of the emergency and arrange for the
• Uncontrollable jerking movements in the arms and legs client's transport assistance.
• Loss of consciousness
• Changes in emotion (fear, anxiety)
 Diabetic Emergency: 1. Hypoglycemia (Hyperinsulinism)
Diabetes is a chronic condition where the body does not produce enough insulin, or it cannot use the
insulin it produces as well as it should (CDC, 2009). There are 3 types of diabetes :
Type 1 - an autoimmune reaction where the body makes very little to no insulin
Type 2 - most common, where the body does not use the insulin produced properly and cannot keep Management of Emergency
blood glucose levels at a norm
Type 3 - gestational diabetes, which develops during pregnancy and usually goes away once baby is born 1. Terminate procedure.
2. Notify nearest student of emergency via
“Code 7”. The notified student informs the
Description Steps for Prevention CDH, saying “Code 7, chair __”. CDH attends
the chair where medical emergency is
Hypoglycemia is referred to occurring, and the student who is the
-ask client about most recently
blood sugar levels dropping “runner” retrieves the emergency kit and
measured glucose level &
below 3.9 mmol/L (CDHO, 2015). remains at the scene to assist with recording
frequency of an insulin reaction of vital signs in clients’ chart.
(CDHO, 2015).
Signs & Symptoms 3. If client is conscious, ask when ate last and
-ensure there is a sugar packet or whether has taken insulin. Raise chair into
-mood changes upright position and give concentrated form
-hunger some apple juice available of oral sugar (Darby & Walsh, 2015). Monitor
-headache and record vital signs. Remeasure blood sugar
-sweating -try scheduling client for morning in 15 mins and if levels remain below 4.0
appt when glucose levels are mmol/L, give another 15g of oral sugar (CDHO,
-nausea 2009). If client is unconscious, administer oral
-confusion highest after normal breakfast sugar (glucose paste under tongue) and call
-irritation (CDHO, 2015) for emergency services (Darby & Walsh, 2015).
-dizziness and weakness
-call client to remind them to take 4. Any client with symptoms of hypoglycemia,
-increased anxiety even if corrected in the dental office, should
-possible unconsciousness (Darby & regular medications prior to appt be referred to their medical doctor for a
Walsh, 2015) check-up (CDHO, 2009).

Diabetic Emergency:
Description
Hyperglycemia is where
blood sugar levels rise above
14mmol/L (CDHO, 2015).
Signs & Symptoms
-excessive thirst
-excessive urination,
-excessive hunger
-nausea
-low blood pressure
-weak and rapid pulse
-acetone breath (“fruity” smell) -
blurred vision
-headache
-unconsciousness (Darby &
Walsh, 2015)
2. Hyperglycemia (ketoacidosis)
Steps for Prevention
-try to minimize periods of waiting
and perhaps shorten treatment
times for client to reduce stress
level as stressed clients release
hormones that can affect insulin
uptake and blood glucose levels
(CDHO, 2015).
-ensure client brought insulin to
the appt to self-administer in case
of emergency
-call client to remind them to take
regular medications prior to appt
Management of Emergency
1. Terminate procedure immediately.
2. Notify nearest student of emergency
via “Code 7”. The notified student
informs the CDH, saying “Code 7, chair
__”. CDH attends the chair where
medical emergency is occurring, and
the student who is the “runner” retrieves
the emergency kit and remains at the
scene to assist with recording of vital
signs in clients’ chart.
3. Call emergency services immediately.
If client is conscious, ask when ate last,
whether has taken insulin and if client
brought insulin with them to the
appointment, client should self-
administer the insulin while their vital
signs are being monitored and recorded
(Darby & Walsh, 2015).
 Reactions to Local Anesthesia
Description
Adverse reactions to local
anesthesia could be due to
either toxicity from the local
anesthesia itself or toxicity
from the vasopressor or
vasoconstrictor used in the
local anesthetic such as
epinephrine (Darby & Walsh,
2015)
Signs and Symptoms
-weakness, light-headedness
-dizziness, confusion
-tachypnea, tachycardia or
bradycardia
-chest pain
-blurred vision and slurred
speech
-anxiety
-cardiac arrest
Management of
Steps for Prevention Emergency
1. Terminate procedure immediately.
-evaluate client’s health
history to assess and 2. Notify nearest student of
emergency via “Code 7”. The notified
identify any student informs the CDH, saying
contraindications, “Code 7, chair __”. CDH attends the
medications or need for chair where medical emergency is
alterations of local occurring, and the student who is
anesthetic (Darby & Walsh, the “runner” retrieves the
2015). emergency kit and remains at the
scene to assist with recording of vital
signs in clients’ chart.
- perform a pre-anesthetic
assessment to prevent any 3. Reassure client and position client
allergic reactions in the upright. Call for emergency
dental/dental hygiene services. CDH may need to
office (CDHO, 2019). administer oxygen if needed.
Monitor vital signs and provide BLS
(Basic Life Support) if needed. (Darby
& Walsh, 2015).
 Description
Anaphylaxis or anaphylactic shock is the most
life-threatening allergic reaction. It usually
develops quickly and reaches maximum
Anaphylaxis
intensity within 5 to 30 minutes of allergen
exposure (CDHO, 2019)
Steps for Prevention
-ensure that client properly fills out
Signs and Symptoms medical history to allow dental
professional to appropriately assess
-severe hives (urticaria)
any potential allergens as clients
-pruritus (itchy skin)
with multiple allergies such as
-swelling of mucous membranes such as lips, tongue and larynx
-respiratory distress asthma, hay fever, and food allergy
-wheezing, weak pulse are at an elevated risk for allergic
-low blood pressure reactions to medications, including
-may progress to unconsciousness and cardiac arrest (Darby & Walsh, 2015). local anesthetic agents (CDHO,
2019).

Management of Emergency -a medical note could be attached

1. Terminate procedure immediately. to client’s chart to notify of their
allergies and potential risks such as
2. Notify nearest student of emergency via “Code 7”. The notified student informs the CDH, saying “Code
7, chair __”. CDH attends the chair where medical emergency is occurring, and the student who is the
allergy to latex
“runner” retrieves the emergency kit and remains at the scene to assist with recording of vital signs in
clients’ chart.

3.Immediately call for emergency services. CDH may have to administer epinephrine (EpiPen) and
establish and maintain airway. CDH may also need to administer oxygen while client is placed in supine
position. Monitor vital signs and provide BLS (Basic Life Support) if needed. (Darby & Walsh, 2015).
 Adrenal Crisis Steps For Prevention:
• Schedule short visit/early morning
appointments
Description: • Monitor patients vital signs before,
an acute life threatening condition that during and after the procedure
occurs when there is not enough cortisol, • Take an appropriate medical and
which is a hormone produced by the clinical health history
adrenal glands located on the top of Signs and Symptoms
each kidney. • Sunken eye
Management Of Emergency • Confusion, loss of consciousness
If this happens in the dental office with the client • Dehydration
being conscious, you will stop any dental care • Nausea and vomiting
and sit client up. If signs of hypotension are • Rapid heart rate
evident, you will place the client in a supine • Headache, fever, server weakness
position with legs slightly elevated. You will then • Profuse sweating
check the vitals again for any high or low blood
pressure as well as heart rate. If client needs
oxygen, you will then provide them with some
oxygen. If client becomes unconscious, place the
client in a supine position, give emergency
medication that is needed and oxygen. You will
then call 911.
 Postural Hypertension Or Orthostatic
Hypotension
Signs and Symptoms:
• Dizziness, headaches
Description: • Sweating, nausea
It is a type of Steps For Prevention: • Lightheadedness
high blood • Sit client upon • Palpitations
pressure that completing each Management of
occurs when procedure for about 2 Emergency
someone goes minutes If this happens within the
from lying • Sit them in a supine dental office you will sit the
down to position with legs raised client slowly in an upright
standing about the level of the position while monitoring
up(increasing head their vital signs(BP,
BP upon • Monitor vitals throughout respiratory rate). When
assuming an the visit everything is stable you can
upright • Before sitting client up, them let stand up and
position wait until BP improves observe how they can walk,
then slowly sit them up if you do not feel comfortable
you can give them an option
of taking a ride home.
 Management Of
Description: Emergency
It is when a • Keep client in red
client has/had
Swallowing/inhaling a Foreign lined position
accidentally • If object found in
swallowed or oral cavity escort
inhaled an Object patient to medical
object that is not emergency room for
supposed to be radiograph, monitor
swallowed or maintain airways,
inhaled, for identify location of
example (top object
end of dental • If airway obstructed
instrument Signs and ask patient to cough
mirror). Steps for Prevention:
Symptoms: with back blows, if
• Always make sure
• Cough object still stuck call
you have a strong
• Stridor 911 and ask for
fulcrum
• Wheezing, choking assistance.
• Make sure your
of airway
instruments are
• Chest pain
tightly on and not
• Gagging
loose or loosened
• Drooling of saliva
• hematemesis

Description:
The part of the
Broken Instrument In Sulcus
instrument that has
been broken while
giving an oral
procedure just were
the tooth meets the
gum, due to an
improper application​
technique, undue
force, material fatigue
or material inherent
defects.
Management Of
Emergency
You must inform your
patient and stop all
procedures right away,
you will sit them up for an
assessment or if needed
Steps For Prevention: radiography to determine
• Always double check exactly where the
that the instrument you instrument is. If the broken
are using is not already piece is out of eye reach,
broken and ensure you you will then inform your
are putting them dentist and the patient will
together properly most likely need to have a
• Have full knowledge of surgical procedure.
the
instruments(shapes,
region of use, force and
material)
Signs and Symptoms:
• Inflammed gums
• Throbbing in teeth,
gums
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