Vasovagal Syncope Anxiety (Common
risk factor in dental
practice) 24
Dizziness, pallor, cold sweat, slowing
of pulse, nausea, vomiting, loss of
conscioussness24
Place aromatic ammonia
under the patient’s nose25
Dosage: one to 2
vaporules25
Deliver 100% oxygen24
Place patient in a
supine position; 20, 24
if consciousness is
not regained in 30-60
seconds, consider
a more complete
differential diagnosis20
Angina Pectoris Reported history
of coronary artery
disease29
Stable angina can be
triggered by stress,
exposure to very cold or
very hot temperatures,
heavy meals, smoking29
Chest Pain that is significant but not
severe20, 26 (can last up to 20 minutes) 26
Chest fullness, burning, tightness,
dyspnea diaphoresis 26
Typically not the patient’s first time
experiencing this type of pain20
One sublingual (0.4 mg)
tablet or one spray (0.4
mg) from nitroglycerin
spray atomizer
administered every 5
minutes ( 3 doses) 26
***Do not administer
nitroglycerin to patients
who have taken an
erectile dysfunction
drug in the previous 24
hours20, 25
Stop the procedure26
Allow the patient to
rest26
Continuously monitor
vital signs26
Place patient in a semi
reclined position26
Provide supplemental
oxygen if necessary26
Mild Allergic
Reaction
Itching, hives, rash20
Patient is conscious with a verified airway
that is patent20
Administer a histamine
blocker such as
diphenhydramine
(Benadryl) 20
Assist the patient
into a comfortable
position20
Seizure Previous diagnosis of
epilepsy20
Stress can be a trigger34
Light can be a trigger-
(offer patients dark
colored safety glasses
and do not direct the
operator light into the
patient’s eyes) 34
Signs and Symptoms vary depending on
the type of seizure34
Simple seizures- consciousness is not
impaired34
Complex seizures- consciousness is
impaired34
Motor Seizure: the body stiffens and
muscles will jerk34
Sensory Seizure: affects the senses (i.e,
tingling, smell a bad odor, taste things
not present in the mouth, ringing in the
eyes, spinning feeling) 34
Autonomic Seizure: affects the nervous
system (i.e., sweating, change in heart
rate) 34
Psychic Seizure: manifests as strong,
sudden emotions (i.e, anxiety, happiness) 34
Tonic-Clonic (Grand mal)- Monotonous
epileptic cry at onset;
Convulsions that start as fast small
amplitude movements and progress to
slower larger movements34
Atonic Seizure: manifests as a sudden loss
in muscle strength34
Patients typically have a strong pulse
when having a seizure20
Oxygen at a rate of 6-8L/
minute28
Remove foreign
materials from the
patient’s mouth20
Place the patient on
his side to minimize
aspiration28
Use passive restraint
to minimize the
chance of injury34
Call 911 if
1. the patient is
unconscious for more
than 5 minutes34
2. the patient
becomes cyanotic28
3. it is the patient’s
first seizure34
Box 1: Overview and Management of Common Medical Emergencies in Dental Practice
