![Page 1: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/1.jpg)
MEDICAL
EMERGENCIES
![Page 2: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/2.jpg)
CONTENTS
• Introduction
• Objectives
• Prevention of medical emergency
• Preparation for emergencies
• Recommended dental office emergency drugs
• Suggested dental office emergency equipment
• Basic life support
• Commonly occurring medical emergencies
• Conclusion
• Refrences
![Page 3: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/3.jpg)
• Dorland’s medical dictionary, defined medical
emergency as a sudden, urgent, usually unforeseen
occurrence requiring immediate action.
• Medical emergencies in dental practice are not an
uncommon occurrence, it invariably occurs when least
expected.
• Simple protocols that are followed will help the dentist
to be in control with situation.
INTRODUCTION
![Page 4: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/4.jpg)
OBJECTIVES
❖Recognize a medical emergency.
❖Asses and manage various life-threatening medical
emergencies.
❖Contempt in basic life support (BLS)
❖Know what equipments and medications be kept in an
emergency kit.
![Page 5: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/5.jpg)
PREVENTION OF MEDICAL
EMERGENCY
• Complete medical and dental history
• Physical examination
• Medical consultation if required
• Patient monitoring
![Page 6: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/6.jpg)
PREPARATION FOR
EMERGENCIES
• A functioning dental office emergency team.
• The ability to properly perform basic life
support.
• Access to emergency medical assistance.
• The availability of emergency drugs and
equipment.
![Page 7: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/7.jpg)
Malamed SF. Emergency Medicine in Pediatric Dentistry: Preparation and Management.
C.D.A. journal. 2003; 31.
RECOMMENDED DENTAL OFFICE EMERGENCY
DRUGS
![Page 8: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/8.jpg)
• The level of medical care which is used
for victims of life-threatening injuries until
they can be given full medical care at a
hospital.
BASIC LIFE SUPPORT
![Page 9: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/9.jpg)
Regardless of emergency, discontinue
dental procedure immediately & follow
pattern of
1. Circulation evaluation to
ensure that the vital organs
are being supplied adequately.
2. Airway patency and
maintenance.
3. Breathing assessment of the
child.
4. Definitive treatment.
1
2
4
3
![Page 10: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/10.jpg)
![Page 11: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/11.jpg)
Basic Life Support/Cardiopulmonary Resuscitation. American Academy Of
Pediatric Dentistry, 2015.
![Page 12: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/12.jpg)
Circulation
Airway
Management
Head
tilt chin
lift
Jaw
thrust
Breathing
▪ Pinch nose
▪ Take normal breath
▪ Place lips over mouth
▪ 1 breath every 6 sec
▪ Blow until chest rises
▪ Allow chest to fall
▪ Repeat
![Page 13: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/13.jpg)
CPR FOR CHILDREN
![Page 14: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/14.jpg)
COMMONLY OCCURRINGMEDICAL EMERGENCIES
1. Allergy or Allergic reaction
2. Anaphylaxis
3. Acute asthmatic attack.
4. Hypoglycemic shock
5. Airway obstruction
6. Seizures
7. Syncope
![Page 15: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/15.jpg)
1. ALLERGY / ALLERGIC REACTION
• Allergy-hypersensitive state results from exposure to allergen.
• Range from immediate-life threatening condition seen within
seconds or delayed type reaction which may manifest hours
or days after exposure.
• Urticaria-itching
• Angioedema
• bronchospasm,
• Conjuctivitis and
watering of eyes
• Hypotension
![Page 16: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/16.jpg)
2. ANAPHYLAXIS
• They pose greatest risk to the pediatric patient and is
of greatest concern to dental staff.
• Result from drug administration or reaction to an
allergen (impression material or other materials)
• Most life threatening and dramatic allergic reaction.
• Death can occur in minutes if not treated
appropriately.
• Reactions affect skin, smooth muscle, respiratory and
cardiovascular system
![Page 17: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/17.jpg)
• Anaphylactic shock occurs when consciousness lost as
result of hypotension from an anaphylactic reaction.
• Symptoms begin with skin, eyes, nose then GI system,
respiratory system, finally CVS symptoms develop.
• Prompt therapy can stop reaction
Cardiac arrest
Cardiovascular shock
Including pallor,
sycope, tachycardia,
weak pulse-syncope
Respiratory-
sneezing,
coughing,
wheezing,
Rhinitis
bronchospasm,
laryngospasm
Skin-
Urticaria-itching
Angioedema
Rash Gastrointestinal-
Nausea
Vomiting,
Abdominal cramps
![Page 18: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/18.jpg)
MANAGEMEN
T
Acute Reaction:
• Basic Life Support
• Epinephrine, injection i/m,1:1000 in 1 mg vials
• If no improvement then 0.3-0.5mg im/sc repeat every 5-10
minutes. Pediatric dose- 0.2-0.3 mg
• Oxygen is administered continuously.
• Corticosteroid-high dose is given if asthma, edema or
pruritis.
• Isotonic solutions for hypotension
• Beta-adrenergic agonist in bronchospasm
• Activate EMS (Emergency life support)
![Page 19: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/19.jpg)
3. ACUTE ASTHMATIC
ATTACK
• Generalized contraction of smooth muscles of bronchi
and bronchioles.
• Characterized- increased irritability of tracheo bronchial
tree to various stimuli including pollen, stress, cold,
upper respiratory tract infections, animal fur.
• Bronchospasm, mucosal edema and intra luminal
secretions lead to airway obstruction. Triggered by
emotional stress and anxiety during the course of
treatment.
![Page 20: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/20.jpg)
![Page 21: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/21.jpg)
Recognition➢ Attack may be very mild or present
as STATUS ASTHAMATICUS
➢Expiratory or inspiratory Wheezing
➢ Nonproductive Cough
➢ Diaphoretic
➢ Cyanosis of nail beds
➢ Chest tightness
➢ Chest congestion
➢ Fatigue
➢ Panic, Anxious, confused.
➢Thick stringy mucous at
termination of intense coughing
![Page 22: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/22.jpg)
TREATEMEN
TTreatment:
➢ Discontinue dental treatment.
➢ Sitting position is most comfortable
➢ Use of bronchodilators supplemented with oxygen
and hydration. Supplemental oxygen at 10L/min.
➢ Patient to use his own inhaler, if available with him
➢ Adrenaline 1:1000, 0.15 ml SC/IM
➢ Corticosteroids if required.
➢ If no improvement call EMS
![Page 23: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/23.jpg)
▪ Atropine and antihistaminic drugs also tend to dry
secretions.
▪ Aspirin should be avoided in asthmatics as this can make
the conditions worse in certain patients.
▪ A preoperative history of
✓Severity
✓Medicines required
✓Degree of control
✓Recent visit to emergency room to be taken.
![Page 24: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/24.jpg)
4. AIRWAY OBSTRUCTION
May be caused by-
✓ Swelling of neck owing to infection or trauma
✓ Tumors growing in the air passage
✓ Unconsciousness, causing tongue to fall posteriorly
✓ Obstruction from a foreign body
![Page 25: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/25.jpg)
Obstruction from a foreign body may occur in……..
• Waiting room owing to food or partial denture
• In the operatory room from various oral surgical
instruments, materials, tooth or vomitus.
• In a restaurant (café coronary)
More likely to occur when consciousness is reduced
![Page 26: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/26.jpg)
Recognition:
• Disappearance of foreign body from oral cavity + signs of
laryngeal and bronchial irritation. Consider to have passed into
respiratory passage until proved other wise.
Partial obstruction:
• Gag, choking, coughing or wheeze in an attempt to eject object.
Advise radiographs of chest & abdomen to confirm location.
Complete obstruction:
• No noises are made although patient is attempting to cough or
talk, showing signs of choking, suprasternal & intercostal
retraction
• If foreign body located in trachea or bronchi. Should be referred
immediately for removal by bronchoscopy or thoracotomy.
![Page 27: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/27.jpg)
SIGNS AND SYMPTOMS-
• First Phase (1-3 min) : Conscious, universal chocking,
struggling, paradoxical respirations without air movement or
voice, increased BP & Heart rate.
• Second Phase (2-5 min) : Loss of consciousness, decreased
respiration, BP, heart rate.
• Third Phase (>3-5 min) : Coma, absent vital signs, dilated
pupils.
PREVENTION
• Rubber dam
• Oral/ throat packing (used in sedation or GA)
• Ligature (small instruments secured by tying)
![Page 28: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/28.jpg)
TREATMENT-
1. Lean patient over chair & pound firmly on back try to
dislodge foreign body (small children may be held upside
down by legs & sharp blows rendered to back).
2. If unsuccessful. Keep patient supine on floor/Trendelenburg
position if in dental chair, with head to side and mouth open.
Middle and index fingers should be placed into pharynx and
swept laterally in attempt to remove object.
![Page 29: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/29.jpg)
3. Try to remove object using laryngoscope and Magill
forceps if possible
4. Consider Heimlich procedure (1975): Procedure takes
advantage of remaining air within lungs and by
forcefully compressing the lungs, increases air pressure
within trachea, thus ejecting the offending bolus out.
(like a “cork from a champagne bottle”) (avg. airflow
rate of 205 L/min and pressure 31mm Hg, expelling an
avg. volume of 0.94 L of air in approx. ¼ sec).
![Page 30: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/30.jpg)
![Page 31: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/31.jpg)
5. HYPOGLYCEMIA
• Condition of acutely decreased blood sugar. Life
threatening- more critical than hyperglycemia in emergency
situation. Must be treated rapidly.
• Children suffer from diabetes mellitus type 1.
• Blood (venous) glucose level falls to < 50mg/100ml in
adults & <40mg/100ml in children.
• CAUSES- Intake of too little food, Impaired gastric
emptying. Exercise Is attempted but no reduction in insulin
dose.
![Page 32: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/32.jpg)
Signs And Symptoms-
![Page 33: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/33.jpg)
• Terminate procedure.
• For conscious patient, glucose/ carbohydrate to be given in
3-4 ounces (1ounce= 28gms) every 5-10 min until
symptoms disappear.
• For unresponsive conscious patient, Glucagon 1mg IV/IM
or 50ml of 50% dextrose IV over 2-3 mints.
• Oral-paste or drink.
• Perform BLS.
• Activate EMS.
![Page 34: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/34.jpg)
6. SYNCOPE
• Sudden, transient loss of consciousness that usually
occurs secondary to a period of cerebral ischemia.
• Predisposing factors-
1. Psychogenic factors- Fright, anxiety, emotional stress,
pain, site of blood
2. Non- psychogenic factors- Erect sitting or standing
posture, hunger from dieting or a missed meal,
exhaustion, poor physical condition, male gender.
![Page 35: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/35.jpg)
PATHOPHYSIOLOGY-
• Dilation of blood vessels in skeletal muscle and
splanchnic region.
• A fall in peripheral resistance with decreased venous
return to the heart. This leads to fall in arterial pressure.
• Vagal reflexes are activated, causing bradycardia,
reduction in cardiac output, further reduction in BP, all
leading to decreased cerebral perfusion.
VASOVAGAL ATTACK- rare entity in children as:
• Children keep moving their extremities
continuously.
• The parasympathetic tone in a child is higher.
• Children are more expressive.
![Page 36: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/36.jpg)
Clinical manifestations-
EARLY
• Feeling of warmth
• Loss of color, pale.
• Heavy perspiration
• Reports of feeling bad
• Nausea
• BP slightly lower
• Tachycardia
LATE
Pupillary dilation
Yawning
Hyperpnea
Cold hands and feet
Hypotension
Bradycardia
Visual disturbance
Dizziness
Loss of consciousness
![Page 37: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/37.jpg)
EMERGENCY MANAGEMEMT-
First step is PREVENTION-
• Proper positioning
• Anxiety relief
• Dental therapy consideration
Second step is MANAGEMENT-
• Discontinue treatment
• Assess the level of consciousness: Patient’s lack of response to
sensory stimulation
• Activate the office emergency system: Call for help and
emergency drug kit should be available
• Position of patient: Proper supine position with feet elevated.
• Assess airway and circulation
• Provide definitive care: Give oxygen, monitor vital signs, No
drug treatment usually indicated.
• Also loosen clothing if binding & cold towel at back of neck
![Page 38: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/38.jpg)
7. SEIZURES
• Group of disorders of cerebral functions characterized by
chronic, recurrent, paroxysmal discharge of cerebral
neurones.
Primary
generalized;
➢Tonic clonic
➢Absence
➢Infantile
spasm
➢myoclonic
Partial/focal
seizures
➢Motor
➢Sensory
➢Visual
➢Versive
➢Temporal
![Page 39: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/39.jpg)
Recognition-
• A positive medical history for seizures.
• Typical pre seizure appearance or signs which differ in
different individuals, - aura, may be seen.
• Loss of consciousness.
• Generalized tonic – clonic seizure.
![Page 40: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/40.jpg)
Treatment-
• Usually self limiting , convulsions lasting 2-5 minutes.
• Place patient in supine position.
• Primary aim is to prevent injury.
• Remove all materials and instruments from mouth & vicinity.
• Gently restrain patient.
• Maintain PABC on recovery .
• If convulsion last for more than 5 minutes or reappear at short
intervals, dial EMS.
• In the meantime administer diazepam 0.3 mg/kg, IV if
trained.
![Page 41: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/41.jpg)
CONCLUSION
• Many medical emergencies can be treated without drugs.
Without ABCDs of CPR, drugs are of little value.
• All office personal should be trained to assist in the
recognition and management of emergencies, which
includes biannual renewal of BLS skills.
• The office staff should have pre-assigned specific
responsibilities so that in the event of an emergency each
person knows how to manage.
![Page 42: Medical Emergencies · CONTENTS • Introduction • Objectives • Prevention of medical emergency • Preparation for emergencies • Recommended dental office emergency drugs •](https://reader034.vdocuments.site/reader034/viewer/2022042418/5f3410b481d8136c8e751a2b/html5/thumbnails/42.jpg)
REFERENCES
• Marwah N, Nonpharmacological Behaviour Management, Textbook
of Pediatric Dentistry,3rd ed. Jaypee;2014; 219.
• Casamassimo et.al. Pain reaction control : sedation, Pediatric
Dentistry Infancy through Adolescence, 5th ed. Elsevier; 2013; 110
• Malamed SF. Emergency Medicine in Pediatric Dentistry: Preparation
and Management. C.D.A. journal. 2003; 31.
• Vranić DN et al. Medical Emergencies in Pediatric Dentistry. Acta
stomatol Croat. 2016;50(1):72-80 .
• Basic Life Support/ Cardiopulmonary Resuscitation. American
Academy Of Pediatric Dentistry, 2015.
• Management of Medical Emergencies. American Academy Of
Pediatric Dentistry , 2015 ; 37.