Life threatening emergencies can occur in dental office. Dental surgeon must be aware of such emergencies and possess adequate knowledge to diagnosis and deal with them. Best way to handle medical emergencies is to take every precaution to prevent them.

Important consideration for prevention of medical emergencies:

   a).  Close review of dental / medical history.
   b).  Checking patients vital signs such as body temperature, pulse, respiration, B.P etc.
   c).  Unconsciousness is common manifestation of most emergencies.
   d).  Maintenance of patients’ airways, breathing & circulation are of utmost importance

Emergency Kit Should Include:

   a).  AMBU Bag: Ambulatory Manual Breathing Unit
   b).  Oropharnyngeal airways.
   C).  i.v. drugs
   d).  Emeregency drugs
   e).  Oxygen delivery system
   f).  High volume suction
   g).  Disposable syringes & needles
   h).  Torniquet
   i).  I.V Cannula
   j).  I.V. Infusion set

Various Medical Emergencies


   a).  Result of serve allergic reaction to substance, to which person has already been sensitized.
   b).  Life threatening emergencies.
   c).  Occurs within section patient is exposed to allergic.

Signs & Symptoms

   a).  Itching and burning of skin with flushing
   b).  Cyanosis around lips.
   c).  Swelling of face & tongue.

   d).  Laryngeal odema causing respiratory distress.
   e).  Pale extremities
   f).  Swelling of blood vessels below skin
   g).  Weak, rapid pulse
   h).  Low blood pressure
   i).  Dizziness, restlessness, nausea, vomiting, diarrhea
   j).  Pain & feeling of tightness in chest, difficulty in breathing, respiratory wheezing
   k).  Abdominal cramps


1:1000 epinchrine i.m. (0.01 mg/ kg) administrated after which patient should be in supine position.

   a).  Diphenhydramine 10 – 25 mg given (slows down release of histamine)
   b).  O2 given if child shows signs of respiratory distress.

   c).  Hydrocortisone 100 mg given i.v. followed by oral corticosteroids 6 hourly.
   d).  I.V. fluids can be given if required to treat fluid imbalance.


Transient loss of consciousness resulting due to a temporary decrease in perfusion of essential nutrients to brain.

It results in fall in blood pressure and Bradycardia

Sign & Symptoms

   a).  Bradycardia
   b).  Pallor
   c).  Cold & clammy skin
   d).  Dilated pupils
   e).  Weak pulse
    f).  Unconsciousness


Discontinue the procedure

   a).  Patients should be placed in semi reclined position to facilitate blood flow to brain.
   b).  Clothes are loosened.
   c).  100% O2 admitted to increase O2 supply to brain.
   d).  NH3 inhalant may be used as respiratory stimulant.
   e).  Get immediate medical help if patients does most respond.

Epileptic Seizure

Disorder which results due to a sudden discharge of stimuli by cerebral neurons resulting in convulsive movements.


Grand-mal seizure: Characterized by tonic clonic convulsion, cyanosis and loss of consciousness.


Petit-mal seizure: Trance like state with lack of motor disturbances.

Simple partial seizure

Signs & Symptoms

   a).  Body becomes rigid and then jerks violently.
   b).  Jaws are clamped and shut.
   c).  Foaming at corners of mouths.
   d).  Loss of consciousness can occur.


   a).  Discontinue treatment.
   b).  Make sure that patient does not injure himself.
   c).  Maintain airways by positioning patient laterally.
   d).  Loosen patient’s clothes and allow patient to relax.
   e).  I.V. diazepam 0.03 mg/ kg slowly may be administered.
   e).  Get immediate medical help of seizure continues.

Acute Asthmatic Attack

   a).  Occurs due to pulmonary incompetence, which results from bronchoconstriction and mucous plug formation.
   b).  Characterized by expiratory wheeze.

Signs & Symptoms

   a).  Difficulty in breathing.
   b).  Expiratory wheeze
   c).  Sneezing, gasping sounds when attempting to breath.
   d).  Spasmodic & unproductive cough
   e).  Cyanosis


   a).  Keep patient in upright position (supine position will make patient breathless)
  b).  Bronchodilator – Salbutamol 100 mgms/ puff, 2 puffs may be given through a nebulizer.

   c).  0.5 ml 1:1000 epinephrine should be administered S/C
   d).  100% O2 administered
   e).  Maintain airways potency
   f).  Medical advice taken before planning further treatment
  g).  Patient asked to carry his routine medication along with him to clinic at every appointment.

Respiratory Obstruction

Upper or lower respiratory tract obstruction may result due to patient position and use of small sized instruments during dental procedures which increases risk of accidental slippage and aspiration of foreign objects.

Signs & Symptoms

   a).  Choking
   b).  Coughing
   c).  Cyanosis
   d).  Neck holding
   e).  Unconscious


   a).  For Upper Airways Obstruction:
   b).  Suction should be done using a high volume pump.
   c).  If suction does not help “omesis maneuver” tried (child is rolled to a side and asked to cough forcefully)
   d).  Insert a finger in patient’s mouth and finger sweep is performed.
   e).  Patient’s mouth is opened wide to see if any object is visible. If seen, it should be removed with forceps.

If object is not cleared, “Heimlich maneuver” employed. (done by encircling patient from behind with arms of operator below sternum of patient. A sudden squeeze if forcefully delivered in upward direction. This pushes diaphragm creating negative pressure that results in assisted cough and helps in expelling foriegn object)

   a).  For Lower airways obstruction:
   b).  Inform parents.
  c).  Refer child for radiographic examination of chest / abdomen so as to evaluate position of object.
   d).  Object may be removed by bronchoscopy by the trained physician.


   a).  Emergency seen in children suffering from juvenile diabetes.
   b).  Predisposing Factors
   c).  Insulin overdose
   d).  Stress
   e).  Missed meal

Sign & Symptoms

   a).  Disorientation
   b).  Irritability
   c).  Drowsiness
   d).  Unconsciousness


   a).  If patient is conscious, administer oral glucose in any form.
   b).  If patient is unconscious, administer 50 ml of 20% dextrose i.v. or / ml glucagons i.m.
   c).  Call for medical assistance.


Seen in children with juvenile diabetes along with ketosis

Predisposing factors:

   a).  Vomiting
   b).  Hyperventilation

Signs and symptoms

   a).  Dehydration
   b).  Acetone breath
   c).  Dry mouth
   d).  Hypotension


   a).  Rehydration with i.v. fluids
   b).  Call for medical assistance

Adernal Crises

Manifests if stud to discontinued abruptly.

Sign & Symptons

   a).  Pallor
   b).  Decrease in B.P
   c).  Rapid, weak pulse
   d).  Unconsciousness


   a).  Place patient in supine position
   b).  Administer 200 mg hydrocortisone i.v.
   c).  Maintain patent airway
   d).  Administer O2
   e).  Call for medical assistance

Drug Toxicity

   a).  Due to administration of incorrect dose of drugs.
   b).  Extent of compliance depends on concentration of drug in serum and route of administration of drugs.

Signs & Symptoms

   a).  CNS stimulation or depression.
   b).  Anxiety, restlessness, tremors, rapid breathing.
   c).  Increased B.P.
   d).  Convulsions, loss of consciousness, visual disturbance.
   e).  Cyanosis, respiratory failure, weak pulse.


   a).  Place patient in supine position.
   b).  Maintain airway potency.
   c).  O2 therapy can be given as an adjunct.
   d).  Antidote of drug must be made available
   e).  Call for medical assistance immediately
   f).  Gastric lavage may be necessary in case of orally administered drugs.

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