BDA WALSALL HEALTHCARE :MEDICAL EMERGENCIES IN THE DENTAL PRACTICE

MEDICAL EMERGENCIES IN THE DENT
MEDICAL EMERGENCY SIGNS & SYMPTOMS TREATMENT
Adrenal crisis • Collapse • Airway Breathing Circulation Disability Exposure
• Pallor • Call 999
• Cold & clammy skin • Lie flat
• Hypotension and Dizziness • Oxygen 15 litres/min
• Vomiting & diarrhoea

Anaphylaxis Signs & symptoms (can vary) can • Airway Breathing Circulation Disability Exposure
include: • Call 999
• Oxygen 15 litres/min
• Urticaria&/or angioedema • Lie flat, elevate legs (if breathing not impaired)
• Flushing & pallor • Adrenaline 500 micrograms IM (0.5ml of 1:1000)
• Respiratory distress • Repeat adrenaline at 5 minute intervals if no improvem
• Stridor, wheeze &/or hoarseness
• Hypotension & tachycardia Paediatric doses of adrenaline:
< 6 yrs - 150 micrograms (0.15ml of 1:1000)
Anaphylaxis likely: 6-12 yrs - 300 micrograms (0.3ml of 1:1000)
• Sudden onset & rapid progression > 12 yrs -500 micrograms (0.5ml of 1:1000)
of symptoms
• Life-threatening A &/or B &/or C
• Skin &/or mucosal changes

Asthma Breathlessness & expiratory wheeze • Airway Breathing Circulation Disability Exposure
• Sit upright
Severe (adult): inability to complete • 2 puffs (100 micrograms/puff) of short acting beta agon
sentences in one breath, RR>25/min, repeat doses may be necessary
HR>110/min • If patient unable to effectively use inhaler: additional d
• Call 999 if unsatisfactory/no response or if severe/ life th
Severe (child): inability to complete • While awaiting ambulance: oxygen 15 litres/min; up to
sentences in one breath or too using a spacer device should also given (repeated every
breathless to talk or feed, RR > 40 (2-5 • Reassure patient
yrs) or > 30 (> 5 yrs), HR > 140 (2-5 yrs)
or > 125 (> 5 yrs)

Life threatening: cyanosis, poor
respiratory effort, fall in HR, altered
level of consciousness/confusion,
exhaustion

Cardiac emergencies Symptoms can vary; commonly: • Airway Breathing Circulation Disability Exposure
• Tightness, heaviness or pain in the • Call 999
chest • Comfortable position (usually sitting up)
• Pain may radiate to neck, jaw • GTN spray 2 activations sub lingual
shoulders, left arm & back • Aspirin 300 mg orally (crushed or chewed) (unless there
• Pallor& sweating •E nsure automated external defibrillator (AED) is immed
• Nausea/vomiting Resuscitation Council UK guidelines
• Breathlessness
NB If history of angina: GTN & rest; where symptoms are
necessary

Epileptic seizures • Sudden collapse& loss of • Airway Breathing Circulation Disability Exposure
consciousness • Safe environment: prevent injury, do not put anything
• Rigidity & cyanosis • Note timings of fit
• Jerking movements of limbs • Oxygen 15 litres/min
• Noisy breathing • Once jerking movements cease: recovery position & che
• Tongue may be bitten
• Frothing at mouth Prolonged convulsive seizures (5 minutes or more) or rep
• Incontinence may occur • Midazolam oromucosal solution can be given by the bu
[unlicensed]
Depending on response to treatment, the person’s situat
call 999 particularly if:
• Seizure is continuing 5 minutes after the emergency m
• The person has a history of frequent episodes of serial s
this is the first episode requiring emergency treatment
• There are concerns or difficulties monitoring the person
signs
Paediatric doses of buccal midazolam:
1-5 years - 5mg
5-10 years - 7.5mg
> 10 years – 10mg

Hypoglycaemia • Shaking/trembling • Airway Breathing Circulation Disability Exposure

• Slurred speech • Offer 15-20g fast acting glucose e.g. 3-4 glucose tablets