Walsall Medical Poster:Layout 1

15/11/11

11:51

Page 1

Walsall Healthcare
NHS Trust

MEDICAL EMERGENCIES IN THE DENTAL PRACTICE

MEDICAL EMERGENCY
Anaphylaxis

Asthma

SIGNS & SYMPTOMS

Signs & symptoms may include:
Sudden onset
Urticaria
Angioedema
Flushing & pallor
Respiratory distress
Stridor, wheeze &/or hoarse voice
Hypotension
Tachycardia

Breathlessness & expiratory wheeze

Severe: inability to complete sentences in one breath,
RR>25/min, pulse>110/min
Life threatening: cyanosis or RR<8/min, pulse < 50/min,
exhaustion, confusion, decreased level of
consciousness

Cardiac emergencies

Heart attack (myocardial infarction)

Severe, crushing central chest pain (may radiate to
neck, jaw shoulders, left arm & back)
Pallor, sweating
Nausea/vomiting
Breathlessness

Epileptic seizure

Sudden collapse & loss of consciousness

Tonic phase (approx 30 secs)
Rigidity & cyanosis
Clonic phase (few mins)
Jerking movements of limbs, tongue may be bitten;
frothing at mouth & incontinence may occur
Following seizure
Patient flaccid and remains unconscious (variable
period); gradually regains consciousness, may be
confused

Hypoglycaemia

Shaking/trembling
Slurred speech
Vagueness
Sweating
Double vision
Confusion
Unconsciousness
Children may just appear lethargic

Stroke

Syncope

Facial weakness: smile? mouth or an eye lid

drooped?
Arm weakness: raise both arms?
Speech problems: speak clearly and understand
what is being said?
Test all three symptoms
(FAST: Stroke Association)
Feels faint/dizzy/light headed
Collapse & loss of consciousness
Pallor, sweating, slow pulse, low BP
Nausea/vomiting

TREATMENT
ABCDE approach; call 999
Lie flat, elevate legs (if breathing not impaired)
Administer oxygen 15 litres/min
Administer adrenaline 500 micrograms IM
(0.5ml of 1:1000 solution)
If necessary, repeat adrenaline at 5 minute intervals according to blood pressure,
pulse respiratory function
Paediatric doses for adrenaline:
< 6 years - 150 micrograms (0.15mls of 1:1000)
6-12 years - 300 micrograms (0.3mls of 1:1000)
> 12 years -500 micrograms (0.5mls of 1:1000)
ABCDE Approach
Sit upright
Administer 2 puffs (100 micrograms/puff) of short acting bronchodilator inhaler e.g.
salbutamol; repeat doses may be necessary
If patient unable to effectively use inhaler, administer additional doses through
spacer device
Call 999 if no response or if severe or life threatening
While awaiting ambulance: administer oxygen 15 litres per minute; up to 10
activations of salbutamol inhaler using a spacer device should also given (repeated
every 10 minutes if necessary)
Reassure patient
Call 999
ABCDE approach
Comfortable position
Administer GTN e.g. 2 activations of GTN spray
If no known allergy, administer aspirin 300mg orally (crushed or chewed)
Cyanosis (blue lips) or if deterioration in level of consciousness: administer oxygen
15 litres/min
NB If history of angina, encourage patient to take own medication e.g. GTN, & rest; where
symptoms are mild and respond rapidly with medication, calling 999 usually not necessary
ABCDE approach
Ensure safe environment: prevent injury, do not put anything into mouth, do not
restrain
Administer oxygen 15 litres/min
Once jerking movements cease: recovery position
Check for slow heart rate (can cause seizure)
Check blood glucose (hypoglycaemia can cause seizure): if < 3mmols/litre, treat for
hypoglycaemia (see below)
Following seizure, place in recovery position
Prolonged seizures (lasting 5 mins or longer) or seizures recurring in quick
succession: call 999 & administer midazolam 10mg via buccal route
Refer to hospital if status epilepticus, high risk of recurrence, first episode, difficulty
monitoring patients condition (NICE)
Paediatric doses of buccal midazolam:
1-5 years - 5mg
5-10 years - 7.5mg
> 10 years 10mg
Measure blood glucose to confirm diagnosis
Call 999 if any difficulty experienced or patient does not respond
Co-operative, conscious & able to swallow safely:
Offer 10-20g glucose e.g. orange juice, non-diet fizzy drink, 4 x glucose tablets or gel
Impaired consciousness & unable to swallow safely:
Administer buccal glucose gel &/or glucagon 1mg IM
Once consciousness returns, offer oral glucose
Paediatric dose of glucagon
< 8 years of age or < 25kg: 0.5mg
ABCDE approach
Call 999
Ensure airway patent may be necessary to place in recovery position
Administer oxygen 15 litres/min
Do not offer anything to eat or drink

Lie flat & elevate legs

Loosen tight clothing
Administer oxygen 15 litres/min
If becomes unresponsive, check for signs of life

References
British Medical Association & the Royal Pharmaceutical Society of Great Britain (2010) British National Formulary 56 Royal Pharmaceutical Society, London
Jevon P (2009) Medical Emergencies in the Dental Practice Wiley Blackwell, Oxford
Resuscitation Council UK (2011) Medical emergencies and resuscitation standards for clinical practice and training for dental practitioners and dental care professionals in general
dental practice Resuscitation Council UK, London
Acknowledgements
Poster, designed as an aid memoir by Phil Jevon, Resuscitation Officer/Clinical Lead, Manor Hospital, Walsall,
Text proof read by Mr N Rashid & Miss R Joshi, A & E Consultants and Mrs S Church, Consultant Orthodontist, Walsall Healthcare NHS Trust, Manor Hospital Walsall, UK
WALSALL H EAL TH C AR E N H S TR U ST N OVEMBER 2 011