1. Overall Classification: UNCLASSIFIED//REL TO NATO/ISAF

2. Definition:  A serious unpredictable, unexpected potentially dangerous situation that require immediate action.  It can progress to mortality or neurological deficit in a short space of time if not properly managed

3.  Prevention is accomplished by conducting a thorough medical history with appropriate alterations to dental treatment as required.

4.  Practice, Practice, Practice  Check Emergency Drugs and Oxygen At Least Monthly  Know Who to Call in Case of Emergency  Arrange for Assistance in Advance with Nearby Medical Personnel

5.  Review Medical History at EACH Appointment  Determine Medication Compliance ◦ Did the Patient Take Their Medication Today??

6.  Take Vital Signs, Particularly Older Patients  Determine Apprehension Level  How Are You Feeling Today??

7.  Blood Pressure  Heart Rate  Respiratory Rate  Temperature

8. Stress  Is the major cause of medical emergencies in the dental office

9.  Good Patient Relations  Morning Appointment  Most emergencies occur during or immediately after the admistration of local anesthesia or at the beginning or a procedure.

10. The types of procedures during medical emergencies most frequently arise: Tooth Extractions  Endodontic treatment

12. Oxygen:  The most frequently used “drug” in medical emergency

13. Epinephrine 1:1000  Allergic reaction

14. Diphenhydramine (Benadryl)  Allergic reaction

15. Nitroglycerin  Angina

16. Glucose  Hypoglycemia

17.  Syncope  Hyperventilation  Foreign Body Aspiration  Allergy & Anaphylaxis  Acute Asthmatic Episode  Hypoglycemic Shock  Chest Pain  Seizure  Stroke

18.  Basic Life Support (BLS-C)  Emergency Management Protocol and Plan  Recording of Vital Signs

20.  Vasovagal Syndrome  Most Common Emergency in Office  Men > Woman  Younger Ages  14 - 35  Frequently During LA Injection

21. Symptoms:  Feeling of warmth  Nausea  Perspiration  Pale skin color  Lower blood pressure

22. Response Steps:  Place the patient in supine position (with the head lower than the feet)  Loosen any binding clothes  Have oxygen ready to administer  Monitor and record vital signs  If unresponsive, call for emergency assistance

23.  Occur when the patient assumes an upright position too quickly  Symptoms: ◦ Low blood pressure ◦ Altered state of consciousness

24. Response steps:  Place the patient in supine position (with the head lower than the feet)  Slowly move the patient into an upright position  Monitor and record vital signs  If unresponsive, call for emergency assistance

25. If postural hypotension:  Turn onto her left side

26.  A cerebrovascular accident (CVA), commonly referred to as a stroke  Is a interruption of blood flow to the brain

27.  If blood flow is interrupted for a sufficient duration, damage to the brain may occur, resulting in loss of brain function.

28.  Most CVAs occur in older individual who have other predisposing diseases, such as arteriosclerosis, heart disease, or uncontrolled high blood pressure.

29. Signs and Symptoms:  Paralysis  Speech problems  Vision problems  Possible seizure  Difficulty swallowing  Headache  Unconsciousness

30. Response Steps:  Call for emergency assistance  Initiate basic life support (CPR) if the patient becomes unconscious  Monitor and record vital signs

31. Is It Angina Pectoris, Myocardial Infarction Or Something Else???

32.  Pain from angina usually last 3 to 8 minutes  Angina pain is relieve or eased promptly by the administration of sublingual nitroglycerin (spray or tablet)

33.  A patient with history of angina usually carries some form of nitroglycerine to relieve the symptoms of an attack  Even if a patient has a history of angina, when an attack strikes, it is important to remember that the patient could be having a heart attack

34. Symptoms:  Tightness or squeezing sensation in the chest  Pain radiating to the left shoulder  Pain radiating to the left side of the face, the jaws and the teeth

35. Response steps:  Call for emergency assistance  Position the patient upright  Help the patient to medicate himself with nitroglycerin  Administer oxygen  Monitor and record vital signs

36.  During a heart attack, the muscle of the heart are damaged because of an insufficient oxygen supply

37.  Any unexplained chest pain should be treated as a potential heart attack

38. Symptoms:  Chest pain ranging from mild to severe  Pain in the left arm, the jaws and the teeth  Shortness of breath and sweating

39. Symptoms:  Nausea and vomiting  Pressure, aching or burning feeling of indigestion  Generalized feeling of weakness

40. Response steps:  Call for emergency assistance  Initiate basic life support (CPR) if the patient becomes unconscious

41. Response steps:  Medicate with nitroglycerin and an aspirin tablet from the office’s emergency kit  Administer oxygen  Monitor and record vital signs.

42.  Is precipated (initated) by stress and anxiety  Is an increase in the frequency or depth of respiration  Patient usually remains conscious

43. Signs and Symptoms:  Rapid, shallow breathing  Panic-stricken appearance  Lump in the throat

44. Response Steps:  Place the patient in a comfortable position  Use quiet tone of voice to calm and reassure the patient

45. Response Steps:  Have the patient breathe into cupped hands

46.  Airway narrows, causing difficulty in breathing, coughing and a wheezing sound  An allergic reaction, severe emotional stress or respiratory infection may cause an asthma attack

47. Signs and Symptoms:  Coughing  Wheezing  Pallor  Cyanosis (bluish skin)

48. Response Steps:  Call for assistance  Position the patient upright  Help the patient self- medicate with an inhaler  Administer oxygen as needed  Assess and record vital signs

49.  Altered state of reactivity  Every drug or dental material introduced to a patient can produced a reaction

50. Two factors to consider when managing an allergic reaction:  The speed which symptoms appear  The severity of the reaction The symptoms of anaphylaxis can be life threatening and may develop very quickly. Without appropriate care the patient could die within a few minutes.

51. Localized Rash: Signs and Symptoms:  Itching  Skin redness  Hives

52. Localized Rash: Response Steps:  Identify area of rash  Monitor vital signs  Prepare an antihistamine for administration or we can give Benadryl to the patient  Be ready for Basic life support  Refer for medical consultation

53. Anaphylaxis: Signs and Symptoms:  Feeling physically ill  A feeling of warmth  Nausea and vomiting  The sensation of a lump in your throat

54. Anaphylaxis: Signs and Symptoms:  Constriction of the airways and a swollen tongue or throat, which can cause wheezing and trouble breathing  Irregular heartbeats  Sudden drop in blood pressure  Loss of consciousness

55. Anaphylaxis Response Steps:  Call for emergency assistance  Place the patient in a supine position  Start Basic life support (CPR) if the patient becomes unconscious

56. Anaphylaxis Response Steps:  Prepare to administer epinephrine (epipen)

57. Anaphylaxis Response Steps:  Administer oxygen  Monitor and record vital signs

58.  Is a neurologic disorder that is characterized by recurrent episodes of seizures  Types: ◦ Grand mal seizure ◦ Petit mal seizure

59. Grand mal seizure:  Is characterized by a temporary loss of consciousness accompanied by uncontrollable muscular contractions and relaxation

60. Petit mal seizure:  Is a brief lapse of consciousness that may last only a few second  A patient may just stare or may no movement during the period  The patient usually does not collapse

61. Grand mal seizure:  Aura. feeling a sense of unexplained dread, a strange smell or a feeling of numbness.  A scream. Some people may cry out at the beginning of a seizure  Loss of bowel and bladder control. This may happen during or following a seizure.  Unconsciousness

62. Grand mal seizure:  Unresponsiveness after convulsions. Unconsciousness may persist for several minutes after the convulsion has ended.  Confusion. A period of disorientation often follows a grand mal seizure.  Fatigue. Sleepiness is common after a grand mal seizure.

63. Grand mal seizure: Response steps:  Call for emergency assistance  Quickly remove all material from the mouth and place the patient in a supine position  Do not place nothing in the patient’s mouth

64. Grand mal seizure: Response steps:  Protect the patient from self-injury during movements  Initiate Basic life support if necessary  Monitor and record vital signs  Note how long the seizure lasts.

65. Petit mal seizure: Signs and Symptoms:  Intermittent blinking  Mouth movements  Blank stare  Seems to be in his or her “own world”

66. Petit mal seizure: Response Steps:  Protect patient from self-injury  Monitor and record vital signs  Refer patient for medical consultation

67.  Is a metabolic disorder that results from disturbances in the body’s normal insulin mechanism.

68.  When the balance shifts, with too much or too little food ingested, insulin levels can change, resulting in hyperglycemia (too much blood sugar) or hypoglycemia (too little blood sugar).

69.  Abnormal increase in the glucose (sugar) level in the blood.  If untreated, may progress to a life- threatening diabetic coma

70. Signs and Symptoms:  Excessive urination  Excessive thirst, dry mouth and dry skin  Acetone breath (fruity smell)  Blurred vision and headache  Rapid pulse  Lower blood pressure  Loss of consciousness

71.  If the patient is conscious ask he or she last ate, whether the patient had taken insulin and whether he or she brought insulin along to the dental appointment.  If the patient has already eaten but has not taken insulin, he or she needs insulin immediately.

72.  Retrieve the patient’s insulin if is available. If Able, the patient should self-administer the insulin  Call for emergency assistance if necessary

73.  Provide Basic life support (CPR) if the patient becomes unconscious  Monitor and record vital signs

74.  Hypoglycemia results from an abnormal decrease in the glucose level in the blood.  The most common causes of hypoglycemia consist of skipping a meal, taking too much insulin without adequate food intake and exercising excessively without appropriate adjustment of insulin and food intake.

75. Signs and Symptoms:  Mood changes  Hunger  Perspiration  Increase anxiety  Possible unconsciousness

76. Response Steps:  If the patient is conscious ask he or she last ate, whether the patient has taken insulin and whether he or she brought insulin along to the dental appointment.

77. Response Steps:  Give a concentrated form of carbohydrate, such as a sugar packet, cake icing or concentrated orange juice. These substances will be absorbed rapidly into the bloodstream.

78. Response Steps:  Call for emergency assistance if necessary  Provide Basic life support (CPR) if the patient becomes unconscious  Monitor and record vital signs

79.  When a medical emergency arises in the dental clinic, full documentation of the details is essential.

80.  Anticipate Problems  Always Review Patient’s Medical History  Obtain Pre-op Vital Signs  Patient Supine for Injections

81.  Have an Emergency Plan  Have Regular Office Emergency Drills  Have Appropriate Emergency Drugs and Know How to Use Them  Keep Current in BLS

82. Overall Classification: UNCLASSIFIED//REL TO NATO/ISAF