MEDICAL EMERGENCIES

DR HASSAN IRFAN
 DEFINITION
• A medical emergency is
an injury or illness that
is acute and poses an
immediate risk to a person's life
or long-term health
Following emergencies may be
encountered in dental practice

• Hypoglycemia & Hyperglycemia

• Vasovagal attack
• Seizures
• Angina
• Asthma attack
• Myocardial infarction
• Anaphylaxis
• Cardiac arrest
 ROUTES OF DRUG
ADMINISTRATION
Route Onset of action Example
Oral 30-120 min Aspirin, glucose
Inhalation 1-5 min Oxygen, nitrous oxide, salbutamol
Sublingual/buccal 1-2 min GTN, glucose gel
Intramuscular 5-15 min Adrenaline (epinephrine; for
anaphylaxis)
Glucagon
Subcutaneous 15-20 min Hydrocortisone
Intravenous 20-30 s Adrenaline (epinephrine; for
cardiac arrest)
Diazepam
Rectal 6-20 min Diazepam suppositories
Intratracheal 1-5 min Adrenaline (epinephrine)
Intraosseous Up to 5 min Adrenaline (epinephrine)
MEDICAL EMERGENCIES AND
THEIR TREATMENT
DIABETIC EMERGENCIES
 HYPOGLYCEMIA
Severe hypoglycemia is the emergency
situation dentists are most likely to face when
providing oral surgery for a diabetic patient.
 HYPERGLYCEMIA
• Hyperglycemia can lead to serious health
complications
• Hyperglycemia often found in patients with history of
diabetes:
- Especially if they have not taken
prescribed medication.
• Hyperglycemia onset is usually gradual and develops
over several days.
 HYPERGLYCEMIA
Signs & Symptoms:
- Slow changes in mental status
- Rapid, deep breathing (kussmaul respirations)
- Sweet smelling breath (ketone breath)
- Warm, dry, flushed skin
- Weakness, nausea and vomiting
- Weak rapid pulse
- Increased urination, appetite and thirst
 KUSSMAUL
BREATHING
• Kussmaul breathing is characterized by a deep,
rapid breathing pattern. It is typically an indication
that the body or organs have become too acidic. To
expel carbon dioxide, which is an acidic compound in
blood, the body starts to breathe faster and deeper.
Management:
• Stop all the dental procedures.
• Administer O2 according to the protocol
• Obtain the patient’s vital signs
• Fluid replacement. Administer fluids — usually
through a vein (intravenously) — until the patient
is rehydrated.
• Replace the electrolyte along with the fluid
replacement. Administer Insulin.
• Call for help. Prepare for transport during the help
arrives
• Continue to monitor and provide reassurance till
the patient is transferred to a tertiary care facility.
Causes :
The following are the causes of chest pain
• Angina & Myocardial Infarction
• Pericarditis
• Musculoskeletal pain
• Esophagitis & esophageal spasm
• Pneumothorax
• Aortic dissection
• Pancreatitis & Cholecystitis
• Others
Ischemic heart disease:
Ischemic heart disease or coronary artery disease
occurs when there is insufficient blood flow to a part
of heart muscle due to blockage in the heart vessels
leading to the area. Any blockage in the coronary
arteries reduce the blood supply to heart muscle.

Types :
• Angina
• Myocardial infarction
CHEST PAIN
VASOVAGAL
SYNCOPE
Causes:
• Transient hypotension and cerebral
ischemia

Predisposing factors are:

• Hypoglycemia
• Anxiety
• Fear
• Pain
• Fatigue
Signs:
• Weakness
• Dizziness
• Pallor

• Sweating
• Nausea
• Confusion

• Tachycardia
• Loss of consciousness.
• Minor convulsions or incontinence
MANAGEMENT
Local anesthetic toxicity
Mild toxicity:
talkativeness, anxiety, slurred speech, confusion

• Stop administration of local anesthetics.

• Monitor all vital signs.
• Observe in the office for 1 hour.
Moderate toxicity:
Stuttering, speech, nystagmus, tremors,
headache, dizziness, blurred vision, drowsiness

• Stop administration of all local anesthetics.

• Place in the supine position.
• Monitor vital signs.
• Administer oxygen.
• Observe in the office for 1 hour.
• Severe toxicity:
seizure, cardiac dysrhythmia, or arrest

• Place in the supine position.

• If a seizure occurs, protect the patient from nearby
objects; suction contents of the oral cavity if vomiting
occurs.
• Have someone summon medical assistance.
• Monitor all vital signs.
• Administer oxygen.
• Start an intravenous line.
• Administer diazepam 5–10 mg slowly or midazolam 2–
6 mg
Slowly.
• Institute basic life support (BLS),
• Transport to an emergency care facility.
ASTHMA
• Asthma is characterized by recurrent attacks of
breathlessness & wheezing, which vary in severity &
frequency from person to person. In a person it may
occur from hour to hour and day to day.
• This condition is due to the inflammation of the air
passages in the lungs and effects the sensitivity of
the nerve endings in the airway, so they become
easily irritated. In an attack , the lining of the
passages swell causing the airway to become narrow
and reducing the flow of air in and out of the lungs.
Causes:

• Pre-existing disease that is poorly

controlled

• Anxiety

• Infection

• Exercise

• Exposure to an antigen
FOREIGN BODY
ASPIRATION
 VOMITING &
ASPIRATION OF
GASTRIC CONTENT
ANAPHYLAXIS
Causes:
• Exposure to an antigen to which
the patient has been sensitized

• Commonly drugs (most notably

penicillin) or natural rubber latex.

• Anaphylaxis to local anesthetic is

extremely rare
MANAGEMENT
MANAGEMENT
ANAPHYLAXIS MANAGEMENT
HYPERVENTILATION
SYNDROME
• The most frequent cause of respiratory difficulty is
anxiety that manifests as hyperventilation, usually
seen in patients in their teens, 20s, and 30s, and can
frequently be prevented through anxiety control.
• Patients with extreme anxiety should be managed with
an anxiety reduction protocol. In addition,
pharmacologic anxiolysis may be necessary.
• The first manifestation of hyperventilation syndrome is
frequently a complaint of an inability to get enough air.
• The patient breathes rapidly (tachypnea) and becomes
agitated.
• The rapid ventilation increases the elimination of
carbon dioxide (CO ) through the lungs.
2

• The patient soon becomes alkalotic; may complain of

becoming lightheaded and of having a tingling
sensation in the fingers, toes, and perioral region; and
may even develop muscle twitches or convulsions.
• Eventually, the loss of consciousness occurs
Causes:
• Stress

• Pain

• Expectation of pain. This is often a response to

unfocused fears.

• Can be associated with chronic generalized

anxiety disorder
EPILEPTIC SEIZURE
Causes:

• Known epileptic

• Poorly controlled or non-compliance with drug regime

• Stress

• Hypoglycemia; may accompany a faint.

• Overdose of local anesthetic may cause seizures.

Adrenal shock (Addisonian crisis)

Adrenal insufficiency is when the adrenal glands

do not produce enough hormones, particularly
cortisol and sometimes aldosterone. This can
lead to symptoms like fatigue, weakness, weight
loss, low blood pressure, and low blood sugar.
Autoimmune diseases, infections, or certain
medications can cause it.
Adrenal shock, often referred to as adrenal crisis,
is a severe and potentially life-threatening
condition that can occur in individuals with
adrenal insufficiency. It happens when the body
is under significant stress—such as during
illness, surgery, or trauma—and the adrenal
glands cannot produce enough cortisol to meet
the body’s needs. Symptoms include extreme
fatigue, confusion, severe low blood pressure,
and even loss of consciousness
 EMERGENCY DRUGS USES
Drug Indications (dose) Mechanisms of action Comments
Oxygen Any medical To supplement oxygen Oxygen can be used
emergency intake and prevent cerebral in most emergencies
hypoxia
Adrenaline (IM) Anaphylactic shock This directly acting IM route in much
1:1000 (1mg/ml) (0.5 mg. sympathomimetic amine more effective than
Repeated at 5 min Causes vasodilation in the SC route
intervals if required) essential organs,
vasoconstriction of skin and
mucosa.Also causes opening
of airway (bronchodilation)
Adrenaline (IV) Cardiac arrest (1 mg This directly acting IV route preferred
sympathomimetic amine
1:10 000 (1mg/10ml) Repeated every 3 Has a- and ß-adrenergic
min) activity. The objective is to
increase cerebral and
coronary perfusion
Glucagon (IM) Diabetic This polypeptide hormone IV or SC routes can
hypoglycaemia increase scrum glucose by be used, but very few
(unconscious) (1mg) mobilizing glycogen stores dentists are skilled in
IV access and
absorption is delayed
with the SC route
Salbutamol (inhaler) Asthma (100 µg) ß2-adrenergic agonist activity
relaxes bronchial smooth
muscle
Glyceryl trinitrate Cardiac/chest pain Vasodilatation of the
Spray (sublingual) (400 µg metered coronary arteries occurs
dose)
Glucose (oral) The conscious Rapid absorption elevates Glucose gels for
hypoglycaemic scrum glucose levels rapid buccal
patient absorption are
available
 EMERGENCY DRUGS USES
Glyceryl trinitrate Cardiac/chest pain Vasodilatation of the
Spray (sublingual) (400 µg metered coronary arteries occurs
dose)
Glucose (oral) The conscious Rapid absorption elevates Glucose gels for
hypoglycaemic scrum glucose levels rapid buccal
patient absorption are
available
Diazepam (IV) Status epilepticus (10 Benzodiazepine that cause Caution: slow IV
mg) blocking or slowing of nerve injection, risk of
impulses respiratory
depression. Other
anticonvulsants may
be required
Chlorphenamine (IV) Adjunctive treatment Helps reverse histamine- Slow IV injection,
for anaphylaxis (10- mediated vasodilatation can give IM. This is a
20 mg) second-line drug
Hydrocortisone (IV) Adjunctive treatment Helps reduce late sequelae of Can give IM
for anaphylaxis anaphylaxis by reducing
Adrenal shock (200 capillary permeability,
mg) reducing leukocyte and
macrophage migration and
inhibiting the mediators of
inflammation
Aspirin (oral) Myocardial infarction Anti-platelet action If given, inform
(150-300 mg) decreases platelet paramedics/hospital
aggregation; antithromboric staff
effect reduces mortality after
cardiac infarction
Solvents (e.g. water) Solvents may be required to
dissolve drugs that are
presented as powder (e.g.
glucagons, hydrocortisone)
 EMERGENCY DRUGS USES
Aspirin (oral) Myocardial infarction Anti-platelet action If given, inform
(150-300 mg) decreases platelet paramedics/hospital
aggregation; antithromboric staff
effect reduces mortality after
cardiac infarction

Solvents (e.g. water) Solvents may be required to

dissolve drugs that are
presented as powder (e.g.
glucagons, hydrocortisone)
THANK YOU