Managing Clinical Emergencies

Dental school focuses heavily on didactics during D1 and D2 to equip students with sufficient medical knowledge to respond to clinical emergencies. Common emergencies may include hypoglycemia, issues with hemostasis, lacerations, panic attacks, and syncope. 

I have asked a couple colleagues (who will remain anonymous for this post) to describe a clinical emergency they faced and what they learned. I am so thankful that these colleagues were willing to revisit these stressful moments with such honesty and insight. Hopefully, this post will help prepare you for potential clinical emergencies you may face!

Scenario #1: Laceration

1. What was the emergency? How did it occur? 

Laceration of the junction between the upper and lower lip (i.e., the labial commissure). It happened during a crown prep of #15.

2. How did you respond?

I stopped the procedure, asked the patient to sit up and hold gauze with pressure on the area until hemostasis was achieved. This took a loooooooong time because the patient was on Plavix. While I remained cool and collected on the outside, internally, I was freaking out!

3. What was the final outcome?

The patient received one stitch to close up the area. The patient came back after 2 weeks for a follow-up appointment to evaluate and remove the stitch. Healing was deemed sufficient.

4. What did you learn? 

Always use a dry-angle or some protection when prepping molars. Also, lacerations in the oral cavity heal pretty quickly! The patient was also very jumpy, so remind patients to raise their hands instead of moving in the chair when they need your attention.

5. Would you do anything differently next time?

Always use a dry-angle, have an assistant there to retract, maybe implement calming techniques for jumpy patients?

6. Can this be prevented in the future?

Yes, but I’ve also heard this is a very common complication for many dentists. I guess I could be more mindful next time when prepping.

Scenario #2: Panic Attack

1. How did the emergency occur? OR, How did you recognize the emergency situation/condition?

I was anesthetizing my patient for a restorative procedure. The patient did not get numb after the first IAN, so I administered a second one. Shortly after the injection, the patient had a panic attack. They seemed hyper and anxious, and complained, “I can’t breath.”

2. How did you respond?

I called over the nurse to check the patient’s oxygen levels. Although the oxygen levels appeared normal, the patient still complained they couldn’t breath. So, we eventually called 911 and the EMT took care of everything.

3. What was the final outcome?

They were taken care of at the hospital and fully recovered.

4. What did you learn? 

Everyone reacts differently to treatment. I had already treated this patient previously, so I would say that every appointment is different too! Always be vigilant. Finally, I documented everything in great detail. Documentation is essential. 

5. Would you do anything differently next time?

If your first IAN doesn’t work, ask your faculty to come help you with the second one (especially if this is early on in clinic).

6. Can this be prevented in the future?

Not really, so don’t blame yourself! Just try to remain cool and calm, and don’t be afraid to call 911 if the situation is out of your scope of care!

Scenario #3: Syncope

1. How did the emergency occur? OR, How did you recognize the emergency situation/condition?

A 30 year-old patient (non-contributory medical history) presented to the urgent care clinic with a severely decayed #31.  They opted for extraction instead of RCT.  The extraction was pretty traumatic and the patient had a lot of anxiety.  The patient seemed borderline combative! All of a sudden, they passed out after the procedure on the floor!

2. How did you respond?

I immediately had another student run and grab an oral surgery faculty member.  In the meantime, I placed the patient in the supine position.  Supine means to lay the patient flat and have the legs elevated in order to facilitate more blood flow to brain.  

3. What was the final outcome?

This was a clear case of syncope – very common in the dental chair.  It is provoked by fear and anxiety.  The final result was the patient jumped up! They had no idea what was happening, and wanted to leave ASAP.  We made the patient stay in order to monitor them for the next fifteen minutes.  

4. What did you learn? 

I learned how to manage an emergency and stay calm.  Clear and decisive thinking can occur when you stay calm.

5. Would you do anything differently next time?

No, I took the right course of action! Although, I had no clue how to take pulse when the faculty asked me. I would definitely learn that. A normal resting heart rate (pulse) for adults ranges from 60 to 100 beats per minute. 

6. Can this be prevented in the future?

No way. Fear and anxiety are always going to be involved in going to the dentist and getting an extraction performed. Performing treatment quickly and efficiently though certainly can help! Being able to manage these situations is key!

Did you experience a clinical emergency in dental school? How did you respond? Comment below!


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