All Emergencies - Basic life support principles:

  1. Maintain an airway
  2. Assess breathing
  3. Monitor circulation
Monitor and record all vital signs.
Hypertensive Crisis


Hypertension is only an emergency if it is symptomatic - headache, pain, CVA risk or signs

  1. Systolic BP 250 mm Hg greater or Diastolic BP 130 mm Hg or greater
  2. Most likely to occur with chronic stable hypertensive patients
  3. Possible causes: MI, aortic aneurysm, recreational drug use, MAO inhibitor use, thyroid crisis
  4. Hypertension is only an emergency if it is symptomatic (headache, pain, CVA risk or signs)
    • Malamed states that acute hypertension is extremely uncommon. Nitroglycerin or nifedipine (Procardia) can be used to lower BP.


  1. Terminate dental procedure.
  2. Position patient.
  3. A-B-C Airway, Breathing, Circulation - Basic life support.
  4. Definitive Care:
    1. Administer oxygen.
    2. Monitor BP & heart rate/rhythm q5 min.
    3. If IV not available or cannot be started:
      1. Call 911
      2. Administer nitroglyerin sublingual
      3. Emergency medical personnel can establish IV
    4. If IV can be started:
      1. Establish IV infusion
      2. Titrate nitroprusside (Nipride) @ 5 mg/kg/min infusion rate until BP lowered to desired point
      3. If myocardial infarction or congestive heart failure is present:
        • IV nitroglycerin or nitroprusside (50 microgram bolus, followed by 10-20 microgram/minute
        • IV Diazoxide (Hyperstat) - administer 1-3 mg/ky, up to 150 mg. May repeat q5-10 min. up to 600 mg.
        • When anxiety is a major component of the hypertension - midazolam or diazepam can be titrated

Source: Sedation, A Guide to Patient Management by Stanley F. Malamed