Table 1.

Twenty medical emergency cases that frequently take place in the dental chair.

Medical Emergency Scenario	Proposed Management
1-First-line treatment of fainting patient in dental chair	Lay flat +/− give oxygen→expect prompt recovery
2-First-line treatment of patient with hyperventilation	Ask patient to re-breath from cupped hands or reservoir bag
3-First-line treatment of patient with postural hypotension in dental chair	Lay flat, give oxygen, and sit up very slowly
4-First-line treatment of conscious patient with hypoglycemia	Give glucose with a little water or glucose oral gel
5-First-line treatment of unconscious patient with hypoglycemia	1 mg Glucagon injection
6-First-line treatment of patient with epileptic seizure	Place the patient in recovery position and check airway after convulsive movements have subsided
7-First-line treatment of patient has a crisis of hypoadrenalism (Addison’s disease or long-term steroids) in dental chair	Lay flat + give oxygen + 200 mg hydrocortisone IV
8-First-line treatment of patient has acute asthmatic attack in dental chair	Sit up + give oxygen + salbutamol
9-First-line treatment of patient has anaphylactic shock	1 mL adrenaline (1 mg/mL) for IM
10-First-line treatment of patient has been deeply sedated with benzodiazepine overdose and suffered from severe respiratory depression in dental chair	Reverse of conscious sedation by giving 0.2 mg Flumazenil IV over 15 s
11-First-line treatment of patient has sudden onset of brain stroke (hemiplegia or quadriplegia) in dental chair	Reassure the patient and transfer to hospital
12-First-line treatment of psychiatric patient has unusual/bizarre/agitated/violent behaviour in dental chair	Transfer to hospital
13-First-line treatment of patient has crushed chest pain in dental chair	400 mcg nitroglycerin spray + 300 mg aspirin chewable tablets + 50% oxygen with 50% nitrous oxide
14-Further management of patient who has episode of chest pain relieved by rest and nitrates	Give oxygen and allow home if mild and rapidly recovered
15-Further management of patient who has severe chest pain (severe angina or myocardial infarction) not relieved by rest and nitrates	Hospital for giving: IV diamorphine + thrombolytic therapy (heparin)
16-First-line treatment of patient who has sudden heart arrest in dental chair	Immediate cardiopulmonary resuscitation (CPR)
17-Cardiopulmonary resuscitation (CRP) consists of:	After 30 chest compression, give 2 breaths (the 30:2 cycle of CPR)
18-First-line management of patient with chronic liver disease needs dental extraction under LA	Arrangement for a coagulation screen and liver function tests prior to surgery
19-First-line treatment of patient with known diabetes who becomes sweaty, with nausea and tachycardia in dental chair	Check if patient has eaten and give him some glucose
20-First-line management of patient with renal failure, needs dental extraction under LA	Dental extraction must be done the day following dialysis because there is no active heparin in circulation