Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 23Chapter 23

Emergency DrugsEmergency Drugs

Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Medical EmergenciesMedical Emergencies

The vast majority of medical emergencies that occur The vast majority of medical emergencies that occur in a dental office occur in the waiting room.in a dental office occur in the waiting room.

More often than not, the patient has a preexisting More often than not, the patient has a preexisting medical condition.medical condition.

Several factors have increased the incidence of Several factors have increased the incidence of medical emergencies in the dental office.medical emergencies in the dental office.

An increasing number of older patients taking multiple An increasing number of older patients taking multiple medications are seeking dental treatment.medications are seeking dental treatment.

Advances in science, medications that allow for longer Advances in science, medications that allow for longer dental appointments, and the increased use of dental appointments, and the increased use of medication in dental practice have also contributed to medication in dental practice have also contributed to older and sicker patients seeking dental treatment.older and sicker patients seeking dental treatment.

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Methods of Minimizing Medical Methods of Minimizing Medical Emergencies in the Dental OfficeEmergencies in the Dental Office

Observe the patient's stature, build, gait, coloring, Observe the patient's stature, build, gait, coloring, age, facies, and respiration.age, facies, and respiration.

Observe and record the amount of anxiety; use active Observe and record the amount of anxiety; use active listening to determine hidden nervousness.listening to determine hidden nervousness.

Take the patient's blood pressure and pulse rate, and Take the patient's blood pressure and pulse rate, and perform any necessary laboratory examination.perform any necessary laboratory examination.

Take a complete patient history, including medication Take a complete patient history, including medication history, past dental and anesthetic experiences, history, past dental and anesthetic experiences, restrictions on physical activity, diseases, and present restrictions on physical activity, diseases, and present condition.condition.

Request medical consultations as needed.Request medical consultations as needed. Prescribe premedication, if appropriate, and avoid Prescribe premedication, if appropriate, and avoid

drug interactions. drug interactions.

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

General Measures for Preparing Dental General Measures for Preparing Dental Office Staff for a Medical EmergencyOffice Staff for a Medical Emergency TrainingTraining

All office personnel should be trained in All office personnel should be trained in emergency procedures to include CPR and emergency procedures to include CPR and basic first aid.basic first aid.

Each person should have a specific role in Each person should have a specific role in treating a medical emergency.treating a medical emergency.

Dental offices should have emergency practice Dental offices should have emergency practice drills.drills.

The phone number for outside emergency The phone number for outside emergency assistance should be posted by the phone.assistance should be posted by the phone.

911 should be programmed into the speed dial 911 should be programmed into the speed dial function of the office phones.function of the office phones.

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

General Measures for Preparing Dental General Measures for Preparing Dental Office Staff for a Medical EmergencyOffice Staff for a Medical Emergency Emergency Medical KitsEmergency Medical Kits

The choice of drugs and devices kept in an The choice of drugs and devices kept in an emergency medical kit usually depends on emergency medical kit usually depends on individual circumstances, professional individual circumstances, professional experience, and personal experience.experience, and personal experience.

The kits can be homemade or purchased as a The kits can be homemade or purchased as a set through a company.set through a company.

Kits should be checked every 3 months for Kits should be checked every 3 months for outdated medications.outdated medications.

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Emergency DrugsEmergency Drugs

Level 1 (Critical Drugs)Level 1 (Critical Drugs) Albuterol inhalerAlbuterol inhaler DiphenhydramineDiphenhydramine EpinephrineEpinephrine Glucose, oral, cake frosting or orange juiceGlucose, oral, cake frosting or orange juice NitroglycerinNitroglycerin OxygenOxygen

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Emergency DrugsEmergency Drugs

Level 2 (Secondary Drugs) Level 2 (Secondary Drugs) Beta blockersBeta blockers Dextrose 50% Dextrose 50%  Diazepam/alprazolam  Diazepam/alprazolam   Hydrocortisone  Hydrocortisone   Morphine Morphine  Spirits of ammonia Spirits of ammonia  Lidocaine Lidocaine  NaloxoneNaloxone

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

EquipmentEquipment

An oxygen mask, manual resuscitation An oxygen mask, manual resuscitation bag, and oxygen tank with flow gauge are bag, and oxygen tank with flow gauge are necessary to administer positive oxygen necessary to administer positive oxygen pressure.pressure. A blood pressure cuff and stethoscope are also A blood pressure cuff and stethoscope are also

necessary.necessary. Dental practices should also be equipped with Dental practices should also be equipped with

automated external defibrillators.automated external defibrillators.

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Emergency DevicesEmergency Devices

Level 1 (Critical Devices)Level 1 (Critical Devices) Syringes/needlesSyringes/needles TourniquetsTourniquets System to give oxygenSystem to give oxygen Automated external defibrillatorAutomated external defibrillator

Level 2 (Secondary Devices)Level 2 (Secondary Devices) Cricothyrotomy deviceCricothyrotomy device Endotracheal tubeEndotracheal tube LaryngoscopeLaryngoscope System to give IV infusions System to give IV infusions

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Medical EmergenciesMedical Emergencies

Many different emergencies can occur.Many different emergencies can occur. There are several steps that can be taken There are several steps that can be taken

to treat any type of medical emergency.to treat any type of medical emergency. The most common types of emergencies The most common types of emergencies

include cardiac, respiratory, changing include cardiac, respiratory, changing consciousness, other emergencies, and consciousness, other emergencies, and drug-related.drug-related.

The dental practitioner should know the The dental practitioner should know the signs and symptoms of these emergencies signs and symptoms of these emergencies and how to respond to them.and how to respond to them.

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Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

General Treatment of General Treatment of Medical EmergenciesMedical Emergencies

Recognize the abnormal occurrence.Recognize the abnormal occurrence. Make a proper diagnosis.Make a proper diagnosis. Call 911 (or appropriate emergency number).Call 911 (or appropriate emergency number). Note the time.Note the time. Position the patient properly.Position the patient properly. Maintain an airway.Maintain an airway. Administer oxygen.Administer oxygen. Monitor vital signs.Monitor vital signs. Provide symptomatic treatment.Provide symptomatic treatment. Administer cardiopulmonary resuscitation (CPR) Administer cardiopulmonary resuscitation (CPR)

if there is no pulseif there is no pulse. .

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