Advances in dentistry and medicine have increased the number of patients with complicated medical histories who present to the dental office for treatment. Older adults and patients with special needs, in particular, are at increased risk for adverse drug reactions and medical emergencies in the dental office. Preparing for a medical emergency in the dental office requires organization, preparation, and continual training and review for all clinical office staff.
A team approach to treating medical emergencies in the office is the foundation of successful care. Epinephrine is the single most important injectable drug in the emergency kit and is the drug of choice in managing cardiovascular and respiratory manifestations of acute anaphylaxis and treating acute asthma attacks that are nonresponsive to inhalers. If the patient loses consciousness due to an evolving MI and experiences cardiac arrest, BLS-HCP protocol should immediately begin until help arrives.
A detailed history of preexisting seizure disorder is important, as it provides information regarding type, severity, duration, and medication effectiveness in controlling seizure disorders.
Anticipation of medical emergencies is an important aspect of practicing safe dentistry, and clinical dental team members should be trained to immediately diagnose and assist in managing medical emergencies. Public Health and Community Service at Tufts University School of Dental Medicine in Boston.
Incidents and emergencies can occur at any time, they can arise from a number of causes, and can have a significant impact on the University's operations. Response to incidents, which can be managed relatively quickly using local resources, possibly with the assistance of the Emergency Services. Management of emergencies that usually involve intervention by the Emergency Services and require a greater level of coordination to address the wider implications.


The procedures relating to each level of emergency response are documented in three different plans.Incident Response Plan (IRP)The IRP details the procedures for coordination between Security Services, Building Emergency Control Organisations (ECO) and the attending emergency services, and protocols for escalation to Emergency response. The EMC meets monthly and provides reports to the Senior Executive Group, the Safety and Risk Management Committee of Senate and the Central OHS Committee.Building Emergency ProceduresLocal Heads of Department are responsible for ensuring that building emergency procedures are implemented in accordance with the performance standards outlined in the Guidelines for Building Emergency Procedures. The IRP will be tested regularly in accordance with the requirements of the Building Emergency Procedures.
Although keeping the appropriate emergency equipment and drugs on hand is important, it is the training and expertise of the dental team that makes the difference when responding to a medical emergency. Creating planned protocols and reviewing medical emergency scenarios as an office are the key for preparedness.5–7 Table 1 provides drug suggestions for the most common medical emergencies experienced in the dental office. Management of medical emergencies in the dental office: conditions in each country, the extent of treatment by the dentist.
Emergencies may arise due to local anesthesia injections, adverse drug interactions, and dental anxiety, as well as other possibilities. An organized response and a designated role for each caregiver are mandatory to ensure a proper response and management. For emergency use, nitroglycerin comes in sublingual tablets and as an aerosol in a liquid pump spray. Additional drugs may be added to emergency kits, but these should dictated by the training and educational qualifications of the dental team.
Dosage is usually two puffs of either the patient's own inhaler or an albuterol inhaler from the emergency kit. Dentists and dental hygienists should always actively monitor their patients for acute changes in their medical conditions, especially patients with complex medical histories.


In addition, patients with preexisting medical conditions may be prone to acute exacerbations of these conditions, which could result in life-threatening medical emergencies. Conducting mock drills and rehearsing emergency situations regularly, in addition to certification in Basic Life Support for Healthcare Providers (BLS-HCP), will hone the skills of the entire team.
Taking a thorough medical history that specifies whether the asthma is allergic is helpful in predicting its occurrence. An emergency preparedness plan should be present in each office where the roles of the dentist, dental hygienists, dental assistants, chairside assistants, and front office staff are continually reviewed and updated.
Patients with underlying medical conditions, such as angina pectoris, hypertension, bronchospastic disease, seizure disorders, and glycemic issues, should be closely watched. In severe asthmatic reactions not alleviated by inhalers, emergency medical services (EMS) should be immediately contacted. Routinely rehearsing medical emergency scenarios and incorporating a team approach into their management will increase the effectiveness of treatment and the safety of patients. For patients taking erectile dysfunction medications, nitroglycerin should be administered cautiously due to the possibility of hypotension. No matter what their etiology, seizures lasting more than 5 minutes are dangerous and require activation of emergency response.



Crisis communications strategic planning
Grab and go emergency bag


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