Atlas · Plate XIII · Clinical Services
Medical Emergencies
Medical emergencies in the dental office are largely predictable: many grow out of stress and fear, and syncope is the most common. Prevention starts with a complete medical history, vital signs at every visit, ASA classification and stress reduction, backed by a stocked emergency kit, an AED, oxygen and a team trained in basic life support.
The NBDHE and clinical boards test recognition and first steps: how to position the patient, which drug to reach for and at what dose, and when to call EMS. High-yield items include nitroglycerin for angina, chewed aspirin for a suspected heart attack, epinephrine 0.3 mg IM for anaphylaxis, the rule of 15 for hypoglycemia, FAST for stroke and adult CPR at 100-120 compressions per minute.
Blueprint Provision of Clinical Dental Hygiene Services · Planning and managing care: emergencies · 52 facts
In this plate, we cover
01 · 6 facts
Prevention and the emergency kit
Prevention rests on a complete medical history, vital signs at every visit, ASA classification and stress reduction. The basic kit holds oxygen, epinephrine, nitroglycerin, diphenhydramine, an albuterol inhaler, aspirin and an oral glucose source, alongside an AED and BLS-trained staff who practice drills. Oxygen runs at about 2-6 L/min by nasal cannula or 10-15 L/min by non-rebreather mask.
- Prevention: a full medical history, vital signs at every visit, ASA classification and stress reduction.T8S29
- Basic emergency drugs: oxygen, epinephrine (auto-injector or 1 mg/mL), nitroglycerin, diphenhydramine, albuterol inhaler, aspirin and an oral glucose source.T8
- Every office needs staff trained in BLS, an AED, oxygen with masks, and practice drills; emergency numbers should be posted.T8S26
- Oxygen delivery: nasal cannula about 2-6 L/min; non-rebreather mask about 10-15 L/min.T8
02 · 5 facts
Syncope and hypotension
Vasovagal syncope, the most common office emergency, is usually set off by fear, pain or the sight of a needle. Warning signs are pallor, sweating, nausea, feeling warm and dizziness. Stop treatment, lay the patient supine with the legs slightly raised, loosen tight clothing and give oxygen. Prevent orthostatic hypotension by raising the chair slowly, especially for patients taking antihypertensives.
- Vasovagal syncope is the most common office emergency, often triggered by fear, pain or the sight of a needle.T8
- Early signs: pallor, sweating, nausea, feeling warm, dizziness, fast then slow pulse.T8
- Treat: stop treatment, place supine with legs slightly raised (Trendelenburg-like), loosen tight clothing, give oxygen, monitor; aromatic ammonia if office protocol uses it.T8
- Postural (orthostatic) hypotension: drop in BP when sitting up quickly, especially with antihypertensives; raise the chair slowly and pause before standing.T8
03 · 6 facts
Cardiac emergencies
Angina is chest pain under stress, treated with nitroglycerin 0.4 mg under the tongue every 5 minutes, up to three doses, after checking that systolic pressure is above about 90 mmHg. Pain that persists suggests a heart attack: call EMS, have the patient chew 162-325 mg of aspirin if not allergic, and prepare for CPR and the AED. Women, diabetics and older adults often have atypical symptoms.
- Angina: chest pain under stress lasting a few minutes; give nitroglycerin 0.4 mg sublingual (tablet or spray) every 5 min, up to 3 doses.T8
- Check BP before nitroglycerin; do not give it if systolic is under about 90 mmHg or after recent PDE-5 inhibitors (sildenafil within 24 h).T8
- Suspected MI: pain unrelieved by 3 doses of nitroglycerin, often radiating to the left arm, jaw or back; call EMS.T8S26
- MI management: give 162-325 mg chewed aspirin if not allergic, oxygen if hypoxic, keep the patient comfortable, prepare for CPR and the AED.S26T8
04 · 6 facts
Respiratory emergencies
During an asthma attack, sit the patient upright and give two puffs of their albuterol inhaler, adding oxygen and calling EMS if there is no improvement. Hyperventilation is driven by anxiety; coach slow breathing and do not give oxygen. A conscious adult who cannot cough or speak needs abdominal thrusts, and an aspirated instrument needs referral for a chest or abdominal radiograph.
- Asthma attack: sit the patient upright; 2 puffs of their albuterol (short-acting beta-2 agonist); repeat as needed; oxygen; call EMS if no improvement.T8
- Hyperventilation: anxiety-driven rapid breathing that lowers CO2; signs include lightheadedness and tingling or spasm of the fingers and lips. Treat by calming and coaching slow breathing; do not give oxygen.T8
- Conscious adult choking: if the person cannot cough or speak, give abdominal thrusts; use chest thrusts for pregnant or obese patients.S26
- Infant choking: 5 back blows then 5 chest thrusts, repeated.S26
05 · 5 facts
Diabetic emergencies
Hypoglycemia, a blood glucose under 70 mg/dL, comes on fast with shakiness, sweating, hunger and confusion. A conscious patient gets 15 g of fast carbohydrate and a recheck in 15 minutes; an unconscious patient needs EMS, glucagon if available and nothing by mouth. Hyperglycemia builds slowly with thirst and fruity breath. When unsure which it is, give sugar.
- Hypoglycemia is blood glucose under 70 mg/dL; signs include shakiness, sweating, hunger, confusion and irritability, and it develops fast.S28T8
- Rule of 15 (conscious patient): give 15 g of fast carbohydrate (4 oz juice, glucose tablets or gel), recheck in 15 minutes, repeat if still low.S28
- Unconscious hypoglycemic patient: call EMS, give glucagon if available, nothing by mouth.S28T8
- Hyperglycemia (DKA) develops slowly with thirst, frequent urination, fruity acetone breath and deep rapid (Kussmaul) breathing; it needs medical care, not sugar.S28T8
06 · 5 facts
Allergy and anaphylaxis
A mild reaction with rash, itching or hives is treated with oral diphenhydramine and observation. Anaphylaxis, with airway swelling, wheezing, hypotension and hives, needs 1 mg/mL epinephrine injected into the anterolateral thigh: 0.3 mg for adults and 0.15 mg for small children, repeated every 5-15 minutes if needed, followed by EMS, oxygen and monitoring. Screen for latex allergy on the health history.
- Mild allergy (rash, itching, hives): diphenhydramine 25-50 mg orally, monitor.T8
- Anaphylaxis: airway swelling, wheezing, hypotension, hives; give epinephrine IM in the anterolateral thigh: 0.3 mg adults, 0.15 mg small children (about 0.01 mg/kg).T8S26
- Epinephrine for anaphylaxis is the 1 mg/mL (1:1,000) concentration; it can be repeated every 5-15 minutes.T8
- After epinephrine: call EMS, oxygen, position supine (or seated if breathing is hard), monitor vitals, CPR if needed.T8S26
07 · 6 facts
Seizure and stroke
During a seizure, move instruments and objects away, do not restrain the patient or put anything in the mouth, time it and then use the recovery position. Call EMS for a seizure longer than 5 minutes, repeated seizures, injury or a first seizure. Recognize stroke with BE-FAST, note when symptoms began and call 911, because clot-dissolving therapy works only within hours.
- Seizure: remove instruments, move objects away, do not restrain or put anything in the mouth; time the seizure; recovery position afterward.T8
- Call EMS for a seizure lasting more than 5 minutes (status epilepticus), repeated seizures, injury, or a first seizure.T8
- Stroke recognition: BE-FAST or FAST (balance, eyes, face droop, arm weakness, speech difficulty, time to call 911). Note the time symptoms began.S26
- Clot-dissolving therapy for ischemic stroke works only within a few hours of onset, so speed matters.S26
08 · 4 facts
Other emergencies
Patients on long-term steroids can develop adrenal crisis under stress, with weakness, confusion, hypotension and abdominal pain. Opioid overdose causes pinpoint pupils and slow breathing and is reversed with naloxone. In late pregnancy, lying flat lets the uterus compress the vena cava, so turn the patient onto her left side. Thyroid storm brings fever, tachycardia and agitation.
- Adrenal crisis: in patients on long-term steroids under stress; signs are weakness, confusion, hypotension, abdominal pain; call EMS, oxygen, supine.T8
- Opioid overdose: pinpoint pupils, slow breathing; naloxone reverses it.S51
- Supine hypotensive syndrome in late pregnancy: the uterus compresses the vena cava; turn the patient onto her left side.T8
- Thyroid storm (hyperthyroid crisis) can be triggered by stress, infection or surgery; signs include fever, tachycardia and agitation.T8
09 · 9 facts
Basic life support
For an adult in cardiac arrest, recognize it and call EMS, then compress at least 2 inches deep at 100-120 per minute with full recoil, giving 30 compressions to 2 breaths. Children and infants switch to 15:2 when two rescuers are present. Check breathing and pulse for no more than 10 seconds, use the AED as soon as it arrives and keep pauses under 10 seconds.
- Adult CPR: compressions at 100-120 per minute, at least 2 inches (5 cm) but no more than 2.4 inches (6 cm) deep, allowing full recoil.S26
- Adult ratio: 30 compressions to 2 breaths without an advanced airway, for one or two rescuers.S26
- Child (1 year to puberty): depth about 2 inches (5 cm, one-third of chest depth); 30:2 one rescuer, 15:2 two rescuers.S26
- Infant (under 1 year): depth about 1.5 inches (4 cm); 30:2 one rescuer, 15:2 two rescuers.S26
Watch