Assisting in a Medical Emergency

Emergency preparedness in a dental office is crucial for

ensuring the safety of patients and staff.
 Responsibility for Patient Safety: The dentist and dental staff are
responsible for the safety of patients while they are in the dental
office. This includes being prepared for medical emergencies.
 Emergency First Aid Protocols: Dental offices should have
established and regularly practiced emergency first aid protocols
in place to effectively respond to medical emergencies.
 Prompt Recognition and Treatment: Successful management of
medical emergencies in the dental office requires prompt
recognition of the situation and effective treatment. Every
member of the dental team should be prepared to respond.
 Ongoing Patient Observation: Continuous monitoring of patients
is a crucial part of emergency preparedness to identify any issues
as early as possible.
 Maintaining a Calm Atmosphere: It is important for the dental
staff to remain calm during emergencies to avoid frightening the
patient, which could exacerbate the situation.
 Assigned Roles: Each team member should have a specific
assigned role in the event of an emergency. These roles should be
defined by the dentist. Roles may include calling emergency
services, retrieving emergency equipment, aiding the patient, and
attending to other patients in the office.
 Routine Drills: Regular practice is essential for maintaining
preparedness. Mock emergency drills should be conducted in the
dental office monthly to allow team members to practice their
roles and refine the emergency plan.
 Emergency Telephone Numbers: Emergency phone numbers
should be posted next to each telephone in the office. It's crucial
to keep this list of numbers up to date. By following these
guidelines and having a well-prepared and trained dental team, a
dental office can better handle medical emergencies and ensure
the safety of its patients.
 Emergency Services Contacts: In the United States and Canada,
you can reach emergency services such as EMS (Emergency
Medical Services), local police, and firefighters by dialing 9-1-1.
This is a universal emergency number that connects you to the
appropriate agency based on the situation.
 Response Time Variation: The availability of and response times
for these emergency services can vary significantly depending on
the geographic area and the population they serve. It's important
to be aware of the typical response times in your specific location.
 Life Support Capabilities: Not all EMS personnel carry the same
equipment or provide the same level of lifesaving care.
Understanding the capabilities of the responding EMS staff is
important in assessing what support can be expected.
 Additional Contacts: Apart from 9-1-1, it's advisable to have a list
of other important emergency contacts readily available. This
should include the telephone numbers of the nearest hospital,
physicians, and oral surgeons. These professionals can provide life
support while waiting for EMS personnel or another emergency
response.
 Being well-informed about response times, available services, and
having the contact information for additional medical
professionals ensures that the dental office can respond
effectively.

Recognizing a Medical Emergency

Recognizing a medical emergency and responding appropriately in a
dental office is of utmost importance.
1. Ongoing Observation: Dental staff should be vigilant and
continuously observe the patient's condition, whether in the
reception area, dental chair, or when leaving the office. The team
should pay attention to the patient's general appearance, gait, and
responses to routine questions. Changes in speech patterns or
slow responses should be noted for further evaluation by the
dentist.
2. Signs and Symptoms: It's crucial to distinguish between signs and
symptoms when a medical emergency occurs. Symptoms are what
the patient reports, such as feelings of dizziness, difficulty
breathing, or pain in a specific area. Signs are observations made
by the dental team, such as changes in skin color or an increased
respiratory rate. Signs are generally considered more reliable as
they are directly observed.

Emergency Care Standards

Each member of the dental team should possess specific

credentials and skills for handling medical emergencies. These
include:
 Ability to assess and accurately record vital signs (as
discussed in Chapter 27).
 Proficiency in basic life support for healthcare providers,
including cardiopulmonary resuscitation (CPR).
 Knowledge of the Heimlich maneuver (abdominal thrusts)
for choking incidents.
 Competence in operating automated external
defibrillators (AEDs) for cases where
defibrillation is required.
 Basic Life Support

Basic life support involves several key steps:

 Immediate recognition of an emergency.
 Activation of the emergency response system.
 Early initiation of high-quality CPR.
 Rapid defibrillation if necessary.
Understanding and being prepared to carry out these steps can
significantly improve the chances of a successful response to a medical
emergency in a dental office.
Cardiopulmonary Resuscitation

Cardiopulmonary Resuscitation (CPR) is a critical life-saving technique,

and the information provided highlights key points about its practice:
1. Immediate Initiation: In cases where the patient is not breathing
and their heart is not beating, CPR must be started immediately.
Immediate activation of the emergency response system and
commencing chest compressions for unresponsive individuals
with no breathing or abnormal breathing significantly improves
the effectiveness of CPR.
2. 2010 American Heart Association Guidelines: The 2010 American
Heart Association guidelines for CPR emphasize that chest
compressions should be initiated first for any victim who is
unresponsive and not breathing normally. This change in CPR
protocol is a departure from the old "A-B-C" sequence (Airway,
Breathing, Chest compressions) to the new "C-A-B" sequence
(Chest compressions, Airway, Breathing) for adults and pediatric
patients. This sequence change prioritizes early chest
compressions and minimizes delay in ventilation until after the
first cycle of chest compressions.
 3. Purpose of CPR: CPR combines external cardiac compressions to
stimulate the heart and rescue breathing to ensure that adequate
air enters the lungs. This combination is essential for maintaining
oxygen-carrying blood flow to the brain. Brain cells are particularly
sensitive, and irreversible damage can occur after 4 to 6 minutes
without oxygen. Therefore, quick initiation of CPR is crucial.
4. CPR for Children and Infants: CPR for children and infants follows a
similar approach to that for adults, but adjustments are necessary
to account for the anatomical and size differences in children's
bodies. Pediatric and infant CPR techniques are adapted to
provide effective chest compressions and rescue breathing for
these age groups.
Overall, CPR is a life-saving skill, and understanding the latest guidelines
and techniques is essential for providing timely and effective assistance
during medical emergencies.

Automated External Defibrillator (AED)

It is a crucial device for responding to sudden cardiac arrest, and the

provided information offers valuable insights:
1. Ventricular Fibrillation (VF): Most sudden cardiac arrest cases are
associated with ventricular fibrillation (VF), an erratic and
abnormal heart rhythm that disrupts blood circulation. VF is
responsible for approximately 80-90% of cardiac arrest cases.
2. Immediate Defibrillation: To address VF and restore a normal
heart rhythm, immediate defibrillation is essential. The sooner
defibrillation is initiated, the higher the chances of survival for the
victim. Defibrillation within the first 5 minutes of cardiac arrest
offers a roughly 50% chance of saving the victim's life. However,
for each passing minute during a cardiac arrest, the chances of
successful resuscitation decrease by 7 to 10 percent. After 10
minutes, the chances of successful rescue are minimal.
 3. AED Functionality: Many locations are now equipped with AEDs.
These devices are user-friendly and can be operated by non-
medical personnel. When an AED is applied to the patient, it's
turned on, and the device autonomously analyzes the patient's
heart rhythm. If VF or another shockable rhythm is detected, the
AED delivers a controlled electric shock to the heart muscle to
restore a proper rhythm.
4. AED Features: AEDs are powered by standard 110-volt current or
batteries, making them portable and accessible in various settings.
They often have a monitor with a display, which can show the
patient's heart rate and rhythm. Additionally, some AEDs are
equipped with the capability to print a report of the victim's heart
rhythm.
5. Automated Assessment and Defibrillation: AEDs are essentially
advanced computer microprocessors. They perform a series of
functions:
 Monitor the patient's heart rhythm in real-time.
 Distinguish VF from other abnormal heart rhythms through
computed analysis.
 Automatically defibrillate (shock) the patient if needed,
without further input from the operator.
AEDs play a critical role in increasing the chances of survival for
individuals experiencing sudden cardiac arrest by rapidly and effectively
addressing VF and other shockable rhythms.

Airway Obstruction

Concise notes based on the provided information about the accidental

aspiration of foreign objects during dental procedures and measures to
prevent airway obstruction:
 Accidental Aspiration Risk: During dental procedures, a sudden
coughing spasm or patient movement can lead to the accidental
 aspiration of foreign objects. This can result in immediate
discomfort, coughing, and choking.
 Severity Factors: The severity of the situation depends on two key
factors:
1. Lodging of the Object: The extent to which the foreign object
is lodged in the patient's throat.
2. Airway Blockage: The degree to which the patient's airway is
blocked.
 Causes of Blockage: The airway can become partially or fully
blocked if the patient inhales a small object like a crown, debris, or
a tooth fragment.
 Preventive Measures:
1. High-Velocity Suction: This equipment is used to quickly
remove fluids and debris from the patient's mouth, reducing
the risk of aspiration.
2. Use of Dental Dam: Dental dams are employed during
routine procedures to isolate the treatment area, preventing
debris from entering the patient's airway.
3. Placement of Throat Pack: A throat pack, typically made of
gauze, is positioned at the base of the patient's throat to
further prevent foreign objects from moving into the airway.
These preventive measures are essential in reducing the risk of airway
obstruction during dental treatments and ensuring patient safety.

Emergency Equipment and Supplies

 Standardized Emergency Kit: Most dental offices have a

standardized emergency kit that contains essential emergency
supplies. A clinical assistant or hygienist is typically responsible for
maintaining and updating these supplies.
 Compliance and Preparedness: The emergency medical kit must
comply with regulations and be well-prepared to address medical
 emergencies. Its contents should meet basic standards of care,
align with state, province, or territory regulations, and be
consistent with recommendations from the American Dental
Association (ADA).
 Common Lifesaving Drugs: provides a list of the most common
lifesaving drugs included in a basic emergency kit. It includes
information on brand names, uses, routes of administration, and
precautions for each drug.
 Maintenance of Drug Kit involves the following steps:
 Routine Supply Check: Periodic checks should be conducted
to ensure the quality and working condition of supplies,
including rubber tubing, oxygen masks, tourniquets,
intravenous lines, ventilation masks, and blood pressure
equipment.
 Expiry Date Examination: A weekly examination is necessary
to identify any drugs within the emergency kit that have
expired. Expired drugs should be replaced immediately.
 Oxygen Tank Check: Daily checks should be performed to
ensure that the oxygen tank or tanks are in good working
condition and adequately filled.
Maintaining the emergency medical kit is vital to ensure that it is always
ready for use during a medical emergency in the dental office, and that
all supplies and drugs are in optimal condition.
Oxygen
 Oxygen in Emergencies: Oxygen is a crucial resource in medical
emergencies, frequently used for resuscitation and life support.
 100 Percent Oxygen for Unconscious Patients: In cases where the
patient is unconscious but still breathing, the ideal agent for
resuscitation is 100 percent oxygen, ensuring a high oxygen
concentration.
 Forcing Air into Lungs for Unresponsive Patients: When patients
are not breathing, it's necessary to introduce air into their lungs
 using rescue breathing or similar methods to maintain oxygen
supply to vital organs.
 Portable Oxygen Unit: Dental offices often have portable units
with oxygen tanks that can be easily moved to a treatment room
when emergencies occur.
 Reserve Oxygen Tank: Keeping a reserve oxygen tank on hand is
important to ensure a continuous oxygen supply for emergency
treatment.
 Oxygen Cylinder Color Code: Oxygen cylinders are typically color-
coded green, making them easily distinguishable from other gas
cylinders.
Having oxygen readily available in the dental office is vital for immediate
and effective response to medical emergencies, especially those related
to respiration and resuscitation.
Emergency Responses

 Dental Assistant's Role: The dental assistant's primary role during

a medical emergency is not to diagnose a specific medical
condition. Instead, their responsibilities include:
1. Recognizing Signs and Symptoms: Identifying signs and
symptoms of a significant medical complaint.
2. Providing Support to the Dentist: Assisting the dentist in
implementing emergency procedures.
 Factors for Treatment: During the assessment of a medical
emergency, the primary factor for determining treatment is the
physical change observed in the patient.
 Common Physical Changes in Emergencies:
 Unconsciousness: Complete unresponsiveness to sensory
stimuli.
 Altered Consciousness: The patient is conscious but behaves
strangely.
  Respiratory Distress: Difficulty in breathing, even in
conscious patients.
 Convulsions: Uncontrolled contractions of skeletal muscles.
 Chest Pain: Occurs in conscious patients.
 Timing of Dental Emergencies: Most dental emergencies occur
during or immediately after the administration of local anesthesia
or at the start of a dental procedure. Tooth extractions and
endodontic treatment are procedures with a higher likelihood of
medical emergencies. These situations can be challenging due to
difficulties in achieving adequate pain control and patient anxiety.
The dental assistant's role in recognizing and responding to medical
emergencies is critical for ensuring the patient's safety and assisting the
dentist in delivering appropriate care.

Common Medical Emergencies observed in the

Dental Office
Syncope (Fainting):
 One of the most common dental office medical emergencies.
 Caused by an imbalance in blood distribution to the brain and
larger vessels in the body.
 Can be triggered by psychological factors like stress, fear, or the
sight of certain stimuli.
 Physiologic factors include prolonged sitting, fasting, fatigue, and
confinement.
 Symptoms and signs may precede actual fainting.
 Fainting is not harmful if the patient is protected during
unconsciousness.
 Close observation can help prevent syncope.
Postural Hypotension (Orthostatic Hypotension):
 Occurs when a patient quickly assumes an upright position.
 Results from insufficient blood flow to the brain.
  Common in patients receiving nitrous oxide-oxygen or intravenous
sedation.
 Brief duration of unconsciousness.
 Prolonged unconsciousness may indicate other causes.
 Pregnant patients may experience dizziness due to pressure on
abdominal veins.
 Turning to the left side or moving to an upright sitting position can
relieve symptoms.
Cardiac Emergencies:
 Angina:
 Severe chest pain due to inadequate oxygen supply to the
heart muscle.
 Usually lasts 3 to 8 minutes.
 Can be relieved with nitroglycerin.
 Patients with angina should specify this condition in their
medical history.
 These patients often carry nitroglycerin for symptom relief.
 Must be differentiated from a heart attack due to similar
symptoms.
 Acute Myocardial Infarction (Heart Attack):
 Heart muscle damage due to insufficient oxygen supply.
 Time is critical in responding to chest pain.
 Dental team's response must be swift and prudent.
 Unexplained chest pain should be treated as a potential
heart attack.
 Cerebrovascular Accident (Stroke):
 Interruption of blood flow to the brain.
 Can result in brain damage and loss of function.
 Most common in older individuals with predisposing
conditions.
 Prompt medical treatment is crucial in limiting damage.
Hyperventilation:
 Caused by stress and anxiety.
  Increased respiration depth and frequency.
 Patients typically remain conscious.
 Can result from extreme anxiety before dental treatment.
 Dental team should be prepared to help anxious patients
positively.
Asthma Attack:
 Sudden onset airway narrowing, causing breathing difficulties,
coughing, and wheezing.
 Triggers include allergies, emotional stress, and infections.
 Patients often carry bronchodilator inhalers.
 Important to note asthma in patient's medical history and ensure
the inhaler is brought to appointments.
Allergic Reaction:
 Altered reactivity to allergens (specific antigens).
 Patient's health history is crucial in assessing allergy risk.
 Increasing incidence of latex allergies (used in gloves and dental
dams).
 Speed and severity of reaction are key considerations.
 Symptoms can range from localized (slow onset, itching,
erythema, hives) to systemic anaphylaxis (life-threatening, rapid
onset).
Epileptic Seizure:
 Epilepsy involves recurrent seizures.
 Seizures may be managed with medication but can occur under
stress.
 Two seizure categories: generalized and partial.
Diabetes Mellitus:
 Metabolic disorder with Type 1 (insulin-dependent) and Type 2
(non-insulin dependent) categories.
 Imbalance can lead to hyperglycemia (excess blood sugar) or
hypoglycemia (low blood sugar).
Hyperglycemia:
 Abnormal increase in blood glucose.
  May progress to diabetic ketoacidosis and a life-threatening
diabetic coma if untreated.
Hypoglycemia:
 Abnormal decrease in blood glucose.
 Can manifest quickly.
 Common causes include skipping meals, excessive insulin without
adequate food, or excessive exercise without insulin and food
adjustment.
Each medical emergency requires specific responses and, in some cases,
rapid intervention by the dental team to ensure patient safety and well-
being.