Emergency Medicine - IneedCE.com

Earn 

2 CE credits 

This course was 

written for dentists, 

dental hygienists, 

and assistants. 

Emergency 

Medicine 

A Peer-Reviewed Publication 

Written by Dr. Stanley Malamed 

PennWell designates this activity for 2 Continuing Educational Credits 

Publication date: October 2007 

Go Green, Go Online to take your course 

Review date: March 2011 

Expiry date: February 2014 

This course has been made possible through an unrestricted educational grant. The cost of this CE course is $49.00 for 2 CE credits. 

Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.

Educational Objectives 

Upon completion of this course, the clinician will be able 

to do the following: 

1. Describe the completeness of the office’s current 

emergency medicine kit 

2. List and describe questions to ask patients in review 

of their health history to evaluate the potential for an 

emergency situation before it arises 

3. List and describe the signs and symptoms of separate 

categories of medical emergencies 

4. Describe the basic protocol for treating all medical 

emergencies and be able to apply the PABCD protocol 

to manage different emergency situations 

Abstract 

Medical emergencies can and do occur, not only in your 

dental office but any place and at any time. The entire staff 

and designated in-office emergency team must be trained, 

and emergency equipment and drugs must be available and 

current. The best way to handle an emergency is to start by 

being prepared. 

Introduction 

A heart attack occurs every 20 

seconds. About 25% of those who 

have heart attacks do not realize 

they are having them. 

Imagine you are treating a patient, stop treatment to ask her 

a question, and find that she is unresponsive. You quickly ask 

someone to tell the receptionist to call 911 and to bring you the 

oxygen tank. The oxygen tank finally arrives about 10 minutes 

later, but it is almost empty. You eventually get another oxygen 

tank from an assistant, but it has no tubing, so there is another 

delay in getting the patient oxygen. The paramedics finally arrive, 

but it is too late – the patient is dead. 

Were you prepared? You had the oxygen tank, the emergency 

kit, and CPR training. You may have thought you 

were prepared — until the patient died. Emergencies are 

rare in dental offices. Nonetheless, we must be prepared 

to manage medical emergencies when they do occur. 

Preparation 

Your office must be prepared to deal with medical emergencies. 

You must find out from patients any medical 

conditions or medications they are or have been taking. 

The entire staff must be trained, a designated in-office 

emergency team must also be trained, and emergency 

equipment and drugs must be available and current. 

Without all these, you will not be prepared to handle 

medical emergencies. 

Training the Entire Staff – Basic Life Support 

(CPR) Training 

Every single person who works in the dental office should 

receive CPR training. This is the most important step in 

preparing for or managing a medical emergency. Most 

states that require dentists and hygienists be trained in 

CPR for licensure mandate CPR recertification every two 

years — this is not adequate to be able to properly perform 

CPR. It is recommended that basic life support training be 

provided in the dental office annually. 

The In-Office Emergency Team 

The emergency team should ideally consist of at least three 

people, at a minimum two. The dentist is the team leader as soon 

as he or she arrives on the scene. Do not leave the patient alone 

during a medical emergency unless absolutely necessary. The 

duties of team members are found in Table 1. 

Table 1. The In-Office Emergency Team 

Team member 1: The person who first observes the emergency 

– could be any staff member. Responsible for staying with 

the patient, performing CPR as needed. 

Team member 2: The person who will get the emergency 

oxygen cylinder and emergency drug kit as soon as the person 

hears of the emergency and bring it to the location of the 

patient in distress. 

Team member 3: 

All other staff members. Handle other tasks as assigned by the 

dentist during the emergency. Call 911 if assigned to do so. A 

staff member should go to the lobby of the building and wait 

for the ambulance to arrive and also have the elevator waiting 

in the lobby to save time if in a multistory building. If another 

staff member is available, this person stands in the background 

and records the patient’s vital signs or what is happening. 

Calling for Help 

Knowing when to seek medical assistance and not hesitating 

to do so are crucial. Never hesitate – it is better to call 

than to attempt to handle the emergency yourself only to 

discover you cannot and it is too late. If you think that you 

need help, get it. If you do not know what is going on or 

are concerned about the situation, call for help. When in 

doubt, call for help. 

The most logical thing to do is to call 911, Emergency Medical 

Services (EMS). Their job is to save lives. The dentist is legally 

responsible during a medical emergency to keep the patient alive 

until he or she gets better or until someone who is better trained 

arrives on the scene to take over. If a team member calls 911 and 

EMS takes six minutes to arrive, then the dentist is responsible 

for keeping the person alive for those six minutes. If your office 

is in an isolated area, you may be responsible for the patient for 

a longer period of time. If so, basic training will be important for 

you; however, more advanced training may be necessary. 

Do not assume if you work in a medical–dental building 

that you can call one of the physicians down the hallway for 

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help – usually that is not the case, as they are not specialists 

in emergency medicine. Therefore, the recommendation is 

to always call 911. 

Emergency Equipment 

Oxygen Tank 

The oxygen tank is important – oxygen is the second-mostimportant 

drug in emergency medicine. Oxygen must be 

available in an “E” cylinder, which is about three feet high 

and contains enough oxygen to ventilate a nonbreathing 

adult for approximately 30 minutes. Ensure that all staff 

members know where the oxygen cylinder and emergency 

kit are kept and that they are readily accessible. The oxygen 

cylinder should be checked regularly to make sure there is 

sufficient oxygen in the tank and that all tubing and equipment 

is present and functioning. 

Pocket Mask 

This full-face mask is stored folded in on itself. When 

pressed, it becomes the same type of face mask used in 

general anesthesia to maintain the airway of an unconscious 

person. By holding the mask on properly and 

putting your mouth onto the mask, you can ventilate a 

person with 16% oxygen. 

Automated External Defibrillator (AED) 

The AED is a small lightweight device that monitors a 

person’s heart rhythm and talks a first responder through 

very simple steps to defibrillate the patient. Defibrillation 

is very important and is carried out by placing special 

pads on the torso that recognize a sudden cardiac arrest. 

For every minute that elapses until the time a heart attack 

patient is successfully defibrillated together with basic life 

support (BLS), the survival rate has been estimated to go 

down 10%. At one minute the survival rate is 90%, and by 

10 minutes, 0%. 

Drug Kit 

Except for drugs used for anaphylaxis, drug therapy will 

always be secondary to basic life support (BLS). Apart from 

oxygen used in BLS, there are six drugs in a bare-bones basic 

emergency kit, two injectable and four noninjectable. 

Injectable Drugs 

Epinephrine 

Epinephrine is the single most important drug in emergency 

medicine and is used when an anaphylactic reaction 

occurs. Anaphylaxis is life-threatening. Epinephrine 

is dosed in a 1:1000 (0.3 mg) concentration and must be 

available in a preloaded syringe. The faster the patient 

receives epinephrine, the greater the chance of survival. It 

is very common to need more than one dose. Therefore, in 

addition to the preloaded syringe, the emergency kit should 

contain a minimum of two or three 1 ml glass ampoules of 

epinephrine 1:1000. There is no medical contraindication 

to the use of epinephrine in an anaphylactic reaction. 

Diphenhydramine (or Benadryl) 

Histamine blockers are used in the management of primarily 

non-life-threatening allergic reactions as well as 

in anaphylactic reactions after epinephrine has saved the 

person’s life. Diphenhydramine (or Benadryl) is the histamine 

blocker most commonly used in emergency drug 

kits. There are no contraindications to the administration 

of a histamine blocker during a medical emergency. As 

there is no urgency in giving the histamine blocker, it is 

not recommended to preload a syringe. 

Noninjectable Drugs 

Nitroglycerin 

Nitroglycerin, a vasodilator, must be included in the drug 

kit. Patients who have angina will bring their nitroglycerin 

with them, usually in tablet form. It is strongly recommended 

that the emergency drug kit contain Nitrolingual 

Spray. This is sprayed on the patient’s tongue for the 

translingual application of nitroglycerin, is as effective as 

tablets, and has a much longer shelf life. One spray equals 

one sublingual tablet. There are two contraindications to 

the administration of nitroglycerin: 

• A patient suffering from chest pain who is exhibiting signs of 

a drop in blood pressure (e.g., feels faint or dizzy). 

• A patient who has chest pain and has taken Viagra within 

the previous 24 hours. Viagra and nitroglycerin both lower 

blood pressure; if a patient takes both drugs within a 

24-hour period, it can lead to unconsciousness 

Bronchodilator 

A bronchodilator is used to treat an acute asthmatic attack. 

Patients with asthma will bring their own medication to 

the office and should use their own inhalers if necessary. 

The office needs a bronchodilator in the emergency kit in 

case an asthmatic does not bring medication or a patient 

with no history of asthma goes into bronchospasm. The 

most commonly used drug in the U.S. is albuterol (Ventolin; 

Proventil), in an inhaler. The patient places the inhaler 

into the mouth and compresses the spray vial to express 

the bronchodilator while inhaling, then slowly exhales to 

disperse it in the bronchii. The bronchospasm will subside 

and go away within 30 seconds to one minute. 

Glucose (Sugar) 

Hypoglycemia, or low blood sugar, is a very common emergency 

in the dental office and is easily managed with sugar, 

which can be made available either in a tube (InstaGlucose) 

or as a bottle of orange juice or a nondiet soft drink. 

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Aspirin 

Aspirin is part of the prehospital treatment for suspected 

heart attack victims. One aspirin tablet (325 mg) chewed, 

not swallowed, is recommended in any patient who is suffering 

chest pain for the first time. There are three contraindications 

to the administration of aspirin: 

• A patient with an allergy to aspirin 

• A patient with a bleeding disorder of any type 

• A patient with a gastric or peptic ulcer 

There are no substitutes for aspirin in this situation. 

Secondary Drugs 

Aromatic Ammonia 

Aromatic ammonia is used to manage a patient who is 

fainting or has fainted. Ammonia vaporil is crushed between 

your fingers and held under the patient’s nose. The 

noxious odors stimulate movement, which increases blood 

flow to the patient’s brain if the person is in a supine position. 

In addition to ammonia being in the emergency kit, 

one or two vaporils should be taped to a wall or cabinet 

within arm’s reach in every treatment room. 

Management of Medical Emergencies 

All medical emergencies are managed in basically the same 

way, using the PABCD protocol. 

Conscious Patients 

Whichever position is most comfortable for the patient 

is the position of choice (P). If the person is breathing or 

talking to you, then the airway is open. Since the patient is 

conscious, his or her heart is beating. When the conscious 

patient speaks, you have assessed the person’s airway (A), 

breathing (B), and circulation (C) just by listening to them. 

You do not have to do anything for A, B, or C. 

P. Positioning patient 

A. Airway 

B. Breathing 

C. Circulation 

D. Definitive care 

Unconscious Patients 

Unconsciousness patients should be in the supine position 

– lying face up with the feet elevated slightly. The most 

common reason for loss of consciousness is low blood pressure. 

In the supine position, the patient’s head and heart 

are parallel to the floor, increasing blood flow to the brain, 

and the patient can still breathe adequately. Do not put an 

unconscious patient in a head-lower-than-heart position 

– this has the opposite effect. 

Airway management, the next step, is critically important. 

In unconscious patients the muscles relax, including the 

tongue, which falls backward into the airway due to gravity and 

either totally or partially obstructs the airway. The Head Tilt/ 

Chin Lift is used to maintain the airway and is very simple to 

accomplish – place one hand on the patient’s forehead, place 

two fingers under the jaw, and rotate the head back; since the 

tongue is attached to the mandible, it is lifted from the airway 

when you lift the mandible. 

Next, check whether the patient is breathing (B) (air 

going in and out). While maintaining Head Tilt/Chin 

Lift, place your ear one inch away from the patient’s mouth 

and nose, while looking at the patient’s chest to see if the 

patient is trying to breathe. This is a very important concept: 

the airway could be obstructed, but the patient would 

still automatically attempt to breathe and move their chest. 

You need to physically feel and hear the patient’s breath. If 

you feel or hear air coming out of the patient’s mouth and 

nose, the airway is open and the person is breathing. If the 

patient is not breathing, the rescuer must deliver two complete 

full ventilations to get oxygen to the patient’s lungs 

and blood. 

Checking circulation (C) is the next step. You need to 

know if the blood that now contains oxygen is circulating 

through the body and going to the patient’s brain. Maintain 

the Head Tilt/ Chin Lift and check the carotid artery 

for a pulse. It is vitally important to know how to locate 

the carotid artery. Missing and misdiagnosing the carotid 

artery is a life-and-death mistake. To locate the carotid artery, 

maintain the Head Tilt with one hand, place the index 

and middle fingers of the opposite hand on the patient’s 

Adam’s apple (thyroid cartridge), and slide them down 

along the neck (towards the rescuer) until the fingers fall 

into the groove formed by the sternocleidomastoid muscle. 

The carotid artery is located in that groove. Palpate the carotid 

pulse for no more than 10 seconds. If the pulse is not 

present, start doing chest compressions to circulate blood, 

which contains oxygen, to the patient ’s brain to keep the 

patient alive. 

The last step is definitive care (D). P, A, B, and C are 

basic life support. Definitive care is the stage where you 

will diagnose the problem. If a diagnosis can be made and 

the office has the appropriate drugs and equipment, you 

can treat it. If you cannot diagnose the problem, or do not 

feel comfortable treating it, call 911. 

Specific Medical Emergencies 

We will now look at some of the emergencies you may encounter 

in the office and their management using PABCD. 

Hypoglycemia 

Hypoglycemia, or low blood sugar, is most likely in a diabetic, 

particularly the type 1 insulin-dependent diabetic. 

The classic signs and symptoms are that the patient is cold, 


sweaty, shaking, and mentally disoriented. Many patients, 

however, do not exhibit these. Therefore, when reviewing 

the patient’s medical history, it is important to ask diabetic 

patients to list their signs and symptoms. 

Before you start dental treatment, ask your patients 

these questions: “When did you last take your insulin?” and 

“When did you last eat?” If the patient took insulin and 

hasn’t eaten recently, give the patient some orange juice 

before you start your treatment. 

Mental confusion or mental disorientation is often 

the first sign of hypoglycemia. If a diabetic patient shows 

either of these signs, stop treatment and apply the PABCD 

protocol as follows: 

Conscious diabetic – position comfortably. A, B, and 

C are not required, because the person is talking to you. 

Definitive care is simply the administration of sugar. 

If you have orange juice or a soft drink, give the patient 

four ounces, wait about five minutes, give the person four 

ounces more, wait five minutes more, and then give the 

patient the last four ounces. Within that 15-minute period, 

the person’s mental clarity will return and the signs of hypoglycemia 

will subside. The problem will be resolved. 

Under a different scenario, a patient could collapse. 

Team member 1 should determine loss of consciousness 

by “shake and shout,” and call for help. Begin the PABCD 

protocol as follows: 

Unconscious diabetic — Place in the supine position. A, 

B, C – check the airway by performing a Head Tilt/Chin 

Lift, check for breathing (look, listen, feel), and check for 

a carotid pulse. The emergency team should come to the 

scene with the emergency kit and oxygen. No drugs should 

be administered, because at that moment you do not know 

what the problem is. You have a known diabetic, probably 

hypoglycemic, who is unconscious, is breathing, and has 

a pulse. The most prudent treatment is to maintain BLS, 

notify EMS, and allow them to make a definitive diagnosis 

and treat the patient. 

Epilepsy 

Epilepsy occurs when the signals in the brain are disrupted, 

leading to a seizure. 

It is important to ask epileptic patients the following 

questions when reviewing their medical history: What 

type of seizure do you have? The most common type of 

seizure is the grand mal seizure. This lasts in total from 

two to three minutes, during which the body will alternate 

between phases of full body rigidity and relaxation. After 

this the patient remains unconscious for a while and will 

awaken experiencing confusion and extreme fatigue. What 

medication(s) are you taking to control your seizures and how 

effective are they? What is your aura? Some patients have 

an aura – this could be visual such as seeing rainbows, or 

a sound or smell, but it is always the same. If you know 

what the patient’s aura is, you may recognize a seizure as it 

begins. Have you ever had a seizure that did not stop? Have 

you ever been hospitalized for your seizures? A seizure that 

lasts for five minutes or longer is called status epilepticus 

and is life-threatening. 

You may be in the middle of treatment when a patient’s 

seizure starts. If the patient is a minor, call the parent into 

the room. 

The PABCD protocol for epileptic patients is as follows: 

If possible, remove the doughnut or pillow from the 

dental chair. Position the patient so that he or she cannot 

hit any sharp objects. One rescuer can stand by the 

patient’s arms and one by the patient’s legs, gently holding 

and protecting the patient from injury. 

Maintain the patient’s airway by performing a Head 

Lift/Chin Tilt. Check for breathing (look, listen, feel), 

and check for the carotid pulse. When the patient awakes 

tell the person where he or she is, what happened, and that 

everything is under control. 

If the parent of a minor patient notices that something 

about the seizure is different and tells you to call 911, immediately 

do so. Once the seizure has stopped, the paramedics 

who arrive on the scene will stabilize the patient and transport 

the patient to the hospital for definitive care. 

In any situation in which you are uncomfortable, call 911 

immediately. 

Asthma 

Asthma, or bronchospasm, occurs when the smooth muscles 

surrounding the bronchii go into spasm. The airway 

is narrowed, and breathing becomes extremely difficult. 

An acute asthma attack that is not treated promptly can 

be fatal. 

When an asthmatic patient comes to the dental office 

for the first time, you must ask the following questions: 

What type of asthma do you have? How often do you have 

asthmatic attacks? What triggers your asthmatic attacks? 

Asthmatics can have either allergic asthma or nonallergic 

asthma. Nonallergic asthma is very often induced by fear 

and anxiety – be aware: if such a patient fears going to the 

dentist, he or she will likely have an asthmatic attack in the 

dental chair. What are you allergic to? What medications 

do you take for your asthma? Asthmatics usually take two 

medications: an inhaler such as albuterol used to manage 

acute episodes as well as preventive medication taken once 

daily. When you call to confirm patients’ appointments, remind 

them to bring their inhalers with them. Have you ever 

had an asthmatic attack that didn’t stop and that required 

hospitalization? That question will help you determine 

whether to notify 911. 

The PABCD protocol is started when the patient is positioned 

comfortably. The first thing that a patient having 

an acute asthma attack will do is sit up. A, B, and C need 


not be done, because the patient is breathing (albeit with 

difficulty) and is conscious. Definitive care is simply to 

give the patient his or her own bronchodilator. The usual 

dose is two puffs of the medication, and within 15 to 30 

seconds the bronchospasm is broken, with a second dose 

five minutes after the first if the bronchospasm did not 

stop. Once the asthmatic attack is over, it is OK to continue 

with the planned dental treatment if both the clinician and 

the patient are comfortable doing so. Find out first why the 

asthma attack happened – if it was fear, treat the fear first. 

Allergic Response: Anaphylaxis 

Common allergens include penicillin, latex, aspirin, strawberries, 

shellfish, and peanuts. Histamine, released by mast 

cells, produces virtually all the clinical signs and symptoms 

associated with allergic reactions, including rash, bronchospasm, 

and vasodilation. The severity of the allergic reaction 

depends upon how rapidly and where these chemicals are 

released. Delayed-onset allergies most commonly involve 

only the skin and are not life-threatening. Immediate-Onset 

Allergies (Anaphylaxis) develop in seconds or minutes 

following allergen exposure. Immediate-onset allergies 

are life-threatening, usually involving the respiratory and 

cardiovascular systems and producing bronchospasm and a 

drop in blood pressure. This requires immediate emergency 

management to keep the person alive. 

The PABCD protocol to manage anaphylaxis is as 

follows: 

All patients will initially be conscious, allowing you to 

position them comfortably and move to definitive care. If 

patients are unconscious, place them in the supine position. 

Assess airway and breathing, and take any necessary action. 

Have one of your staff call 911. Immediately get the preloaded 

epinephrine syringe and give the injection in the deltoid, 

tongue, or lateral thigh. Be prepared to monitor A, B, and C 

until help is on the scene and to readminister epinephrine 

in approximately five minutes, if necessary. Epinephrine is 

the drug of choice – it acts as a bronchodilator and elevates 

blood pressure. 

Chest Pain 

A patient may complain of a vague pain in the area of the 

chest. This could be cardiac or noncardiac in origin. Two 

common cardiac syndromes are angina pectoris and acute 

myocardial infarction (heart attack). 

Angina Pectoris 

The patient will usually describe an angina attack as 

tightness, heaviness, or a constricting feeling in the chest 

and will often make a fist and hold it against the chest to 

describe this. The patient will know that it is an angina 

attack. Use the PABCD protocol to manage this patient. 

Position the patient comfortably. A, B, and C need not 

be done, because the patient is conscious and talking. 

Definitive treatment is to simply give patients their 

nitroglycerin and let them medicate themselves. The 

average dose is two tablets placed under the tongue. The 

tablets dissolve, and within one to two minutes the attack 

is over. The nitroglycerin spray from the emergency drug 

kit should be used if the patient forgot his or her medicine 

or it doesn’t work (e.g., it has expired). The usual dose 

is two sprays within two minutes to resolve the attack. 

Oxygen can be given any time during the attack. Planned 

dental treatment can continue if both the clinician and 

patient are comfortable. 

In the following four situations, the first thing to do is to 

call EMS because the patient is probably having a myocardial 

infarction and not an angina attack: 

• A patient tells you that the pain is getting worse. 

• The patient takes three doses of nitroglycerin at fiveminute 

intervals and the pain doesn’t go away. 

• The patient takes nitroglycerin and the pain goes away 

but comes back. 

• A patient with no prior history of cardiovascular 

disease has chest pains for the first time. 

Myocardial Infarction (MI) 

A myocardial infarction occurs when muscle distal to a 

blood clot in the coronary artery no longer receives any 

blood and the heart muscle in that area begins to die. Heart 

muscle takes approximately six hours to die; until then it 

is considered injured. Injured heart muscle can trigger irregular 

heartbeats, which may stop the heart from beating 

or from beating enough to keep the body alive. This is a 

cardiac arrest. It is possible to survive a heart attack with 

little to no permanent damage if the patient gets hospital 

treatment within the first six hours of onset. 

The patient experiencing acute myocardial infarction 

is conscious and feels crushing, intense, radiating pain. 

Classic myocardial pain radiates from the chest into the 

stomach, giving a bloated feeling. The pain radiates down 

the left arm, usually as a tingling sensation in the arm and 

pinkie finger, and may radiate to the left side of the patient’s 

neck and mandible. The patient’s skin is normally an ashen 

gray color. The mucus membranes may be cyanotic, and 

the patient may be sweating profusely. 

If you suspect a patient is having a myocardial infarction, 

start to position the patient comfortably. A, B, and C 

need not be done, because the patient is breathing and can 

speak to you. You need to call EMS immediately and move 

on to definitive care. 

There are four things that can be done to manage this 

victim: morphine, oxygen, nitroglycerin, and aspirin 

(MONA). 

Morphine is not available in a dental office. However, 

the combination of 50% nitrous oxide and 50% oxygen is 

as effective as IV morphone in treating the pain of acute 

myocardial infarction. 


Oxygen must be administered. A five-liter flow of 

oxygen will help deliver more oxygen to the muscles and 

brain. This will also help the patient feel and look a little 

bit better. 

Nitroglycerin should be administered if it hasn’t 

already been. A dose of two sprays or two tablets is 

recommended. 

One adult-dose aspirin tablet (325 mg) is administered; 

it should be chewed and dissolved in the mouth, 

not swallowed whole. Aspirin has thrombolytic properties, 

so it prevents the blood clot from getting any larger. 

Aspirin should not be administered to patients with 

contraindications. 

Once the paramedics arrive, they will start an IV, monitor 

the victim’s heart with an electrocardiogram, deliver 

appropriate medications, and transport the patient to the 

hospital for further care. 

Cardiac Arrest 

If the patient becomes unconscious before the arrival of 

EMS, the PABCD protocol is followed, according to the 

BLS protocol. 

Successful management of this event might look as 

follows: 

Position the patient supine and perform “shake and 

shout.” The patient is unconscious. The airway is checked 

by using a Head Lift/ Chin Tilt. Breathing is assessed. In 

this particular patient, when the carotid pulse is checked, 

but there is none. The dentist tells the assistant to notify 

EMS, “We have a cardiac arrest.” The dentist begins performing 

one-rescuer CPR at a ratio of 15:2 (compressions: 

ventilations) while the other assistant gets the emergency 

drugs and equipment. Once EMS has been notified, the 

assistant and the doctor work as a two-person rescue team, 

continuing to perform CPR at a ratio of 15:2. The other 

assistant returns with the emergency drug kit, the oxygen 

cylinder, and the AED. The oxygen cylinder is turned on, 

and the patient is ventilated with positive pressure oxygen. 

The AED is placed by the patient’s left shoulder and turned 

on. At this point CPR is discontinued and instructions 

from the AED are followed. Paramedics should transport 

the patient to the hospital for further treatment. 

Conclusion 

Medical emergencies can and do occur, not only in your 

dental office, but also at any place and at any time. The best 

way to handle an emergency is to start by being prepared. 

This course covers the most common medical emergencies 

that the dental practitioner, or anyone else, for that matter, 

may have to face. The main purpose of this course is to provide 

you with the necessary information to save the life of 

someone experiencing a medical emergency. Be prepared, 

and make sure the entire staff is ready to work together to 

manage these situations should the need ever arise. 

Author Profile 

Dr. Stanley Malamed 

Dr. Malamed was born and raised in the Bronx, New York, 

graduating from the New York University College of Dentistry 

in 1969. He then completed a dental internship and 

residency in anesthesiology at Montefiore Hospital and 

Medical Center in the Bronx, New York, before serving for 

two years in the U.S. Army Dental Corps at Fort Knox, 

Kentucky. In 1973, Dr. Malamed joined the faculty at the 

University of Southern California School of Dentistry in 

Los Angeles, where today he is professor and chair of the 

Section of Anesthesia and Medicine. Dr. Malamed is also 

a diplomate of the American Dental Board of Anesthesiology, 

as well as a recipient of the Heidebrink Award (1996) 

from the American Dental Society of Anesthesiology and 

the Horace Wells Award from the International Federation 

of Dental Anesthesia Societies, 1997 (IFDAS). 

Dr. Malamed has authored more than 85 scientific papers 

and 16 chapters in various medical and dental journals and 

textbooks in the areas of physical evaluation, emergency 

medicine, local anesthesia, sedation, and general anesthesia. 

In addition, Dr. Malamed is the author of three widely 

used textbooks, published by CV Mosby Inc: Handbook of 

Local Anesthesia (4th edition, 1997) and Sedation: A Guide 

to Patient Management (3rd edition, 1995). 

In his spare time, Dr. Malamed is an avid runner and 

exercise enthusiast, and admits an addiction to the New 

York Times crossword puzzle, which he has done daily 

since his freshman year in dental school. 

References 

ACLS Provider Manual, American Heart Association. 

Cumming RO editor 2001. 

American Academy of Pediatric Dentistry: Guidelines for the 

elective use of conscious sedation, deep sedation, and 

general anesthesia in patients, Pediatr Dent 18 (6):30-81m 

1996. 

American Association of Oral and Maxillofacial Surgeons: 

Parameter of care for oral and maxillofacial surgery: a 

guide for practice, monitoring and evaluation, Rosemont, 

Ill, 1995. American Dental Association House of 

Delegates: The use of conscious sedation, deep sedation, 

and general anesthesia in dentistry, Chicago, November, 

1985, The Association. 

American Dental Association: Guidelines for teaching the 

comprehensive control of pain and anxiety in dental 

education, Chicago, 1989, The Association. 

American Dental Association Council on Dental Therapeutics: 

Emergency kits, J Am Dent Assoc 87:909, 1973. 

American Dental Association: ADA guide to dental 

therapeutics, Chicago, 1998, The Association. 

Academy of General Dentistry: Medical emergencies : video 

journal of dentistry 3:3, Chicago, 1994, The Academy 

(videotape). 

American Heart Association Emergency Cardiac Care 

Committee and Subcommittee: Guidelines for 

cardiopulmonary resuscitation and emergency cardiac 

care, JAMA 268(16):2171-2302, 1992. 

Anderson KN, editor: Mosby’s medical, nursing & allied 


health dictionary, ed 5, St. Louis, 1998, Mosby. 

Angst DM, Bensinger DA: Angina. In Cardiopulmonary 

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Disclaimer 

The author of this course has no commercial ties with the 

sponsors or the providers of the unrestricted educational 

grant for this course. 

Reader Feedback 

We encourage your comments on this or any PennWell course. 

For your convenience, an online feedback form is available at 

www.ineedce.com. 


1. People _________ realize when 

they are having a heart attack. 

a. never 

b. sometimes 

c. always 

d. intermittently 

2. Basic life support should be 

learned by _________. 

a. the dentist every three years 

b. only the receptionist 

c. the entire staff annually 

d. only those treating patients 

3. The first person of an in-office 

emergency team_________. 

a. is the first person to arrive on the scene 

b. may or may not be the doctor 

c. may need to administer basic life support 

d. all of the above 

4. In a medical emergency, only 

call Emergency Medical Services 

(911) when you _________ that 

you need them. 

a. are absolutely sure 

b. are fairly sure 

c. think 

d. none of the above 

5. Anaphylaxis is_________. 

a. an immediateonset allergic reaction of 

b. life threatening 

c. treated in a medical emergency with a 

preloaded syringe of epinephrine 


6. Your emergency drug kit should 

contain _________ ampoule(s) of 

epinephrine. 

a. one 

b. two 

c. three or four 

d. no 

7. Diphenhydramine, commonly 

known as Benadryl ® , _________. 

a. is used to treat allergic reactions 

b. is a histamine blocker 

c. does not need to be available in a preloaded 

syringe 


8. Which of the following applies to 

nitroglycerin spray? 

a. It has a longer shelf life than 

nitroglycerin tablets. 

b. One spray is equivalent to one 

sublingual tablet. 

c. It is a vasodilator. 


9. Patients who are contraindicated 

to receive nitroglycerin 

are _________. 

a. those with chest pain who are exhibiting signs 

of a drop in blood pressure 

b. those with chest pain who have taken Viagra ® 

within the previous 24 hours 

c. those with chest pain 

d. a and b 

10. Bronchodilators for the acute 

treatment of asthma are available 

in_________. 

a. a liquid syrup 

b. a tablet 

c. an inhaler 


Questions 

11. Glucose can be administered in 

a medical emergency _________. 

a. as a treatment for chest pain 

b. in the form of a nondiet soft drink or orange 

juice 

c. as a treatment for hypoglycemia 

d. b and c 

12. Oxygen must be available 

in _________. 

a. a “B” cylinder 

b. a “D” cylinder 

c. an “E” cylinder 

d. an “F” cylinder 

13. It is recommended that aromatic 

ammonia be _________. 

a. in the emergency kit 

b. in the sterilization area 

c. within arm’s reach in every treatment room 

d. a and c 

14. An AED is _________ in 

managing a cardiac emergency. 

a. surplus to requirements 

b. unnecessary 

c. necessary 


15. The acronym for managing 

medical emergencies is_________. 

a. ABCD 

b. PACD 

c. DCBA 

d. PABCD 

16. If you place your patient in 

the supine position, they are 

positioned _________. 

a. vertically 

b. lying down with their feet slightly elevated 

c. horizontally with their head slightly higher 

than their feet 


17. By listening to a conscious 

patient speak, you assess 

their _________. 

a. airway 

b. breathing 

c. circulation 


18. To open a patient’s airway you 

must perform _________. 

a. Chin Lift/ Head Tilt 

b. Chin Tilt/Head Lift 

c. Head Tilt/Chin Lift 

d. Any of the above 

19. A person’s chest movement is 

an automatic sign that he or she is 

_________. 

a. swallowing 

b. breathing 

c. listening 


20. The carotid pulse is palpated for 

no more than _________. 

a. 10 minutes 

b. 10 seconds 

c. 5 minutes 

d. 5 seconds 

21. Chest compression _________. 

a. circulates blood 

b. causes pain 

c. causes lazy breathing 


22. To locate the carotid 

artery, _________. 

a. maintain Head Tilt with one hand 

b. place the index and middle fingers of the 

opposite hand on the patient’s Adam’s apple 

c. slide fingers down into the groove formed by 

the sternocleidomastoid muscle 


23. If you are uncomfortable treating 

the medical emergency you 

should _________. 

a. call the doctor down the hall 

b. call the patient’s family 

c. call 911 


24. The most common treatment 

for someone with low blood sugar 

(hypoglycemia) is _________. 

a. oxygen 

b. epinephrine 

c. sugar 

d. aspirin 

25. It is important to ask your 

patients about their seizures so 

you will know _________. 

a. how they start 

b. how long they last 

c. whether you need to call 911 


26. An asthma sufferer should have 

relief from a bronchospasm within 

________ seconds of taking _____ 

puffs of an inhaler. 

a. 15–30, 2 

b. 30–45, 2 

c. 45–32, 3 

d. 15–30, 3 

27. The average dose of sublingual 

nitroglycerin is _______. 

a. 1 tablet 

b. 2 tablets 

c. 3 tablets 

d. 4 tablets 

28. If an angina attack does not go 

away, or if the pain gets worse or 

comes back, you should suspect 

that the patient is having a 

_________. 

a. diabetic attack 

b. myocardial infarction 

c. stroke 


29. A combination of 50% nitrous 

oxide and 50% oxygen is as effective 

in treating pain as _________. 

a. morphine 

b. nitroglycerin 

c. aspirin 

d. epinephrine 

30. Epinephrine is the drug of 

choice in the treatment of 

anaphylaxis because it _________. 

a. acts like a bronchodilator 

b. elevates blood pressure 

c. lowers blood pressure 

d. a and b 


ANSWER SHEET 

Emergency Medicine 

Name: Title: Specialty: 

Address: 

E-mail: 

City: State: ZIP: 

Telephone: Home ( ) Office ( ) 

Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all 

information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will earn 

you 2 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. 

Educational Objectives 

1. Describe the completeness of the office’s current emergency medicine kit 

2. List and describe questions to ask in review of their health history to evaluate 

the potential for an emergency situation before it arises 

3. List and describe the signs and symptoms of separate categories of medical emergencies 

4. Describe the basic protocol for treating all medical emergencies and be able to apply 

the PABCD protocol to manage different emergency situations 

Course Evaluation 

Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0. 

1. Were the individual course objectives met? Objective #1: Yes No Objective #3: Yes No 

Objective #2: Yes No Objective #4: Yes No 

2. To what extent were the course objectives accomplished overall? 5 4 3 2 1 0 

Mail completed answer sheet to 

Academy of Dental Therapeutics and Stomatology, 

A Division of PennWell Corp. 

P.O. Box 116, Chesterland, OH 44026 

or fax to: (440) 845-3447 

For immediate results, go to www.ineedce.com 

and click on the button “Take Tests Online.” Answer 

sheets can be faxed with credit card payment to 

(440) 845-3447, (216) 398-7922, or (216) 255-6619. 

Payment of $49.00 is enclosed. 

(Checks and credit cards are accepted.) 

If paying by credit card, please complete the 

following: MC Visa AmEx Discover 

Acct. Number: ______________________________ 

Exp. Date: _____________________ 

Charges on your statement will show up as PennWell 

3. Please rate your personal mastery of the course objectives. 5 4 3 2 1 0 

4. How would you rate the objectives and educational methods? 5 4 3 2 1 0 

5. How do you rate the author’s grasp of the topic? 5 4 3 2 1 0 

6. Please rate the instructor’s effectiveness. 5 4 3 2 1 0 

7. Was the overall administration of the course effective? 5 4 3 2 1 0 

8. Do you feel that the references were adequate? Yes No 

9. Would you participate in a similar program on a different topic? Yes No 

10. If any of the continuing education questions were unclear or ambiguous, please list them. 

___________________________________________________________________ 

11. Was there any subject matter you found confusing? Please describe. 

___________________________________________________________________ 

___________________________________________________________________ 

12. What additional continuing dental education topics would you like to see? 

___________________________________________________________________ 

___________________________________________________________________ 

AGD Code 142 

PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS. 

AUTHOR DISCLAIMER 

The author of this course has no commercial ties with the sponsors or the providers of 

the unrestricted educational grant for this course. 

SPONSOR/PROVIDER 

This course was made possible through an unrestricted educational grant from 

HealthFirst. No manufacturer or third party has had any input into the development of 

course content. All content has been derived from references listed, and or the opinions 

of clinicians. Please direct all questions pertaining to PennWell or the administration of 

this course to Machele Galloway, 1421 S. Sheridan Rd., Tulsa, OK 74112 or macheleg@ 

pennwell.com. 

COURSE EVALUATION and PARTICIPANT FEEDBACK 

We encourage participant feedback pertaining to all courses. Please be sure to complete the 

survey included with the course. Please e-mail all questions to: macheleg@pennwell.com. 

INSTRUCTIONS 

All questions should have only one answer. Grading of this examination is done 

manually. Participants will receive confirmation of passing by receipt of a verification 

form. Verification forms will be mailed within two weeks after taking an examination. 

EDUCATIONAL DISCLAIMER 

The opinions of efficacy or perceived value of any products or companies mentioned 

in this course and expressed herein are those of the author(s) of the course and do not 

necessarily reflect those of PennWell. 

Completing a single continuing education course does not provide enough information 

to give the participant the feeling that s/he is an expert in the field related to the course 

topic. It is a combination of many educational courses and clinical experience that 

allows the participant to develop skills and expertise. 

COURSE CREDITS/COST 

All participants scoring at least 70% (answering 21 or more questions correctly) on the 

examination will receive a verification form verifying 2 CE credits. The formal continuing 

education program of this sponsor is accepted by the AGD for Fellowship/Mastership 

credit. Please contact PennWell for current term of acceptance. Participants are urged to 

contact their state dental boards for continuing education requirements. PennWell is a 

California Provider. The California Provider number is 4527. The cost for courses ranges 

from $49.00 to $110.00. 

Many PennWell self-study courses have been approved by the Dental Assisting National 

Board, Inc. (DANB) and can be used by dental assistants who are DANB Certified to meet 

DANB’s annual continuing education requirements. To find out if this course or any other 

PennWell course has been approved by DANB, please contact DANB’s Recertification 

Department at 1-800-FOR-DANB, ext. 445. 

RECORD KEEPING 

PennWell maintains records of your successful completion of any exam. Please contact our 

offices for a copy of your continuing education credits report. This report, which will list 

all credits earned to date, will be generated and mailed to you within five business days 

of receipt. 

CANCELLATION/REFUND POLICY 

Any participant who is not 100% satisfied with this course can request a full refund by 

contacting PennWell in writing. 

© 2008 by the Academy of Dental Therapeutics and Stomatology, a division 

of PennWell

Emergency Medicine - IneedCE.com

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