“First, Do No Harm” (Hippocratic Oath)

Develop a medical emergency team (Box F). Know what to look for – be familiar with predisposing factors and signs and symptoms of medical emergencies. Be alert – monitor the patient’s physical and emotional status during treatment – look for evidence of distress or adverse reactions, particularly when drugs are being administered to the patient. Train under simulated conditions. Check regularly the status of emergency drugs and other equipment (Box F).

Box F. Being Prepared.

Emergency TeamEmergency DrugsEmergency Drugs
Team supervisor (the dentist)
  • Assesses level of consciousness
  • Performs physical examination
    • Obtains initial vital signs
  • Determines course of treatment
  • Initiates CPR and AED
Epinephrine, 1:1,000
  • Autoinjectors (adult, 0.3 mg; child, 0.15 mg)
Bronchodilator
  • Albuterol inhalor
Diphenhydramine hydrochloride
  • 25 mg oral tabs
Nitroglycerin
  • 0.4 mg sublingual tablet or aerosol spray
Glucose tablets

ASA
  • 325 mg
Aromatic ammonia
Oxygen tank
  • Portable E cylinder with regulator
  • Nasal canullae
  • Nonrebreathing masks with an oxygen reservoir
  • Nasal hood
  • Positive pressure administration capability
  • Bag-valve-mask device with oxygen reservoir
Stethoscope and sphygmomanometer
  • Adult small, medium, and large cuff sizes
Automated external defibrillator (AED)

Oropharyngeal airways
  • Adult sizes 7, 8, and 9 centimeters
Magill forceps
  • To retrieve foreign objects from the hypopharynx
Second member
  • Notifies staff
  • Gathers emergency equipment and supplies
  • Prepares therapeutic agents for administration by the dentist
  • Administers oxygen
  • Assists with CPR and AED
Third member
  • Monitors vital signs
  • Records information in the chart
  • Activate EMS
  • Assists with CPR and AED
  • Performs other tasks