Two Eyes, Two Fingers, Two Minutes: Making It Easier to Recognize and Manage Medical Emergencies in Dental Practice Part 2: Algorithms to Guide Treatment using the M-DEWS2 Tool

A medical emergency may occur in any dental clinic at any time whether the patient has received treatment or not. The first paper in this series of two described the M-DEWS2 assessment tool to aid the early management of the medically deteriorating patient and to facilitate his/her subsequent acute management.¹ The eight common medical emergencies which may be seen in the dental care setting are asthma, angina, acute myocardial infarction (heart attack in layman's terms), vasovagal syncope, hypoglycaemia, anaphylaxis, cerebrovascular accident (‘stroke/brain attack’) and seizures. This present paper describes algorithms which may be used to manage and treat these common medical emergencies in conjunction with the M-DEWS2 tool. The diagnosis and management of these conditions are now discussed.

In the UK, over 8 million people, or approximately 12% of the population, have been diagnosed with asthma with approximately 160,000 people being newly diagnosed each year.² Asthma is a chronic respiratory condition associated with airway inflammation and hyper-responsiveness. An acute exacerbation may be triggered by such things as exposure to an environmental stimulant (such as cold air, warm or moist air, exercise or exertion, or emotional stress) or allergen (for example, air-freshener or pollen). The bronchi swell and narrow the airways, creating breathing difficulties that may range from mild to life-threatening. This makes breathing for the patient very difficult, especially when breathing out, and can be extremely frightening in a severe episode. The disease is heterogeneous, with different underlying disease processes and variations in severity, clinical course, and response to treatment.