All Emergencies - Basic life support principles:

1. Maintain an airway
2. Assess breathing
3. Monitor circulation

Differential diagnosis:

1. Syncope - from anxiety or vasodepressor
2. Orthostatic hypotension
3. Hypoglycemia - medical history often will indicate diabetes
4. Adrenal insufficiency - check medical history for Addison's disease, steroid therapy

Syncope: Transient loss of consciousness, the most common medical emergency seen in the dental office.

1. Initiate basic life support
2. Place the patient in a supine position (fully reclined) with feet slightly elevated.
3. Loosen restrictive clothing
4. Administer oxygen
5. Contact EMS only if unconsciousness persists for more than 10-15 seconds after proper positioning & establishing airway.
6. Recovery may be speeded by holding a crushed aromatic ammonia capsule under the patient's nose.
7. Postpone dental care - complete recovery from syncope, however brief, requires up to 24 hours.
8. Do not permit the patient to drive a car or leave the office unescorted.

Orthostatic hypotension: Sudden drop in blood pressure from sitting up on standing too quickly. Side effect of some medications, more common in tall individuals.

1. Initiate basic life support
2. Place the patient in a supine position (fully reclined) with feet slightly elevated.
3. Loosen restrictive clothing
4. Administer oxygen

Hypoglycemia - Diagnostic Clues:

1. Weakness, dizziness
2. Pale, moist skin
3. Shallow respirations
4. Headache
5. Altered level of consciousness

Hypoglycemia - Treatment

1. Make the patient comfortable. Patient usually will prefer to sit upright or semi-reclined.
2. Begin basic life support.
3. Expect a rapid heart beat. Blood pressure should not be affected.
4. Check the medical history or medic alert bracelet to determine if diabetes is present.
5. If hypoglycemia is suspected, give the patient fruit juice, soft drink or candy bar to raise their blood sugar level.
6. Dental treatment may resume once the symptoms resolve. Patient may leave the dental office unescorted, provided the episode has fully resolved.
7. If the patient loses consciousness, treat the unconsciousness first, then manage the hypoglycemia. No need to contact EMS is patient regains consciousness within 10 seconds.
8. If the patient begins to convulse, treat the seizures first, then the hypoglycemia.

Adrenal Insufficiency

1. Terminate dental treatment.
2. Activate EMS.
3. Place patient in supine position.
4. Administer Oxygen.
5. Give 100mg Solu-cortef IM or 4mg Decadron
6. If hypotension is severe, give Ephedrine or Phenylephrine.