38: Medical Emergencies

SECTION 4 Medical Emergencies

American Society of Anesthesiologists (ASA) Physical Status Classification System to Determine Medical Risk

Adapted from Malamed SF: Medical emergencies in the dental office, ed 6, St Louis, 2007, Mosby; Stefanac SJ, Nesbit SP: Treatment planning in dentistry, ed 2, St Louis, 2007, Mosby; and Little JW, Falace DA, Miller CS Dental mangement of the medically compromised patient, ed 7, St Louis, 2008, Mosby.

ASA I: Normal, healthy client without systemic disease.

ASA II: Client with a mild systemic disease or a significant risk factor (e.g., considerable anxiety, mild obesity, pregnancy, a smoker, well-controlled type 2 diabetes, controlled hypertension, well-controlled epilepsy, and/or well-controlled asthma). Person is able to walk up a flight of stairs or two level city blocks.

ASA III: Client with moderate or severe systemic disease that limits activity but is not incapacitating (e.g., massive obesity, symptomatic respiratory disease, stable angina, pooly controlled hypertension, exercise-induced asthma, prior myocardial infarction within 1 month or cerebrovascular accident with no residual signs and symptoms for more than 6 months before treatment).

ASA IV: Client with an incapacitating systemic disease that is a constant threat to life. Person is unable to walk up a flight of stairs or two level city blocks and is in distress at rest (e.g., unstable angina, liver failure, severe congestive heart failure, end-stage renal disease, myocardial infarction within 1 month or cerebrovascular accident within 6 months, uncontrolled epilepsy or uncontrolled diabetes).

ASA V: A moribund client not expected to survive 24 hours with or without an operation.

ASAE: Emergency operation. The E precedes the number to indicate the client’s physical status (e.g., ASAE III).

Summary of Techniques for Adult, Child, and Infant Cardiopulmonary Resuscitation

Basic Emergency Drug Kit ^∗

Drug/Route Administered	Action	Indication
Aromatic ammonia/inhaled	Chemical irritant	Syncope (fainting)
Epinephrine pen/subcutaneous	Cardiac stimulant and bronchodilator	Acute allergic reaction; acute bronchospasm (asthma)
Nitroglycerin/sublingual	Relaxes smooth muscle and dilates coronary arteries	Angina pectoris
Glucose/oral as sugar cubes, orange juice, or nondiet soft drink	Elevates blood sugar	Hypoglycemia
Bronchodilator/inhaled (albuterol, proventil, terbutaline)	Dilates bronchi	Bronchospasm; asthma
Antihistamine/oral (Benadryl)	Decreases the allergic response	Allergic reaction
Oxygen/inhaled	Increases oxygen to the brain	Respiratory distress