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Emergency Protocols — Instant Access

Call 999 if in any doubt. These protocols are for quick reference only and do not replace clinical judgement, in-date training or emergency services.

Content last reviewed: August 2026 — verified against Resuscitation Council UK 2025 guidelines, SDCEP Medical Emergencies in the Dental Practice (Walsall/BDA poster, May 2020), and current NICE guidance.

These protocols are freely accessible without login. For the full clinical handbook, atlas and CPD modules, please sign in or register.

Cardiac Arrest

Unresponsive · no normal breathing · no pulse

  1. 1CALL 999 immediately
  2. 2Lay flat · head tilt · chin lift · check airway
  3. 330 compressions — centre of chest, 5–6 cm deep, 100–120/min · then 2 rescue breaths. Continue 30:2.
  4. 4Attach AED as soon as available — follow all voice prompts. Minimise interruptions to CPR.

Anaphylaxis

Urticaria · wheeze · angioedema · hypotension · rapid onset after allergen

  1. 1CALL 999 · stop all drugs/allergens immediately
  2. 2Lay flat + raise legs. If breathing difficulty: sit up. Unconscious: recovery position.
  3. 3Adrenaline 1:1000 IM — anterolateral thigh:
    Adult / >12 yr: 0.5 mL · 6–12 yr: 0.3 mL · <6 yr: 0.15 mL
  4. 4Oxygen 15 L/min · Repeat adrenaline every 5 min if no improvement
⚠ Use 1:1000 (1 mg/mL) adrenaline — NOT 1:10,000 cardiac concentration

Hypoglycaemia

Diabetic · sweating · pale · confused · aggressive · trembling

  1. 1If conscious: 15–20 g fast glucose orally — Glucogel (1.5 tubes) · 150 mL Lucozade · 5 Dextrosol tablets · 4 tsp sugar in water
  2. 2Recheck at 10–15 min. Repeat glucose if still symptomatic. Then give complex carbohydrate (biscuit, sandwich).
  3. 3If unconscious: Nothing in mouth · Glucagon 1 mg IM · Recovery position · Call 999

Vasovagal Syncope

Most common dental emergency · pallor · bradycardia · nausea · brief loss of consciousness

  1. 1Lay flat IMMEDIATELY + raise legs 30–45° — do NOT keep patient upright
  2. 2Loosen clothing · oxygen if available · monitor pulse. Usually rapid recovery; if recovery is not prompt and complete, reassess and consider another cause.
  3. 3Call 999 if: no pulse · seizure · no recovery within 3 min · diagnosis uncertain

Epileptic Seizure

Tonic-clonic movements · cyanosis · incontinence · post-ictal confusion

  1. 1Clear surrounding area · cushion head · do NOT restrain · nothing in the mouth
  2. 2Time the seizure from onset. Turn onto side post-ictally (recovery position).
  3. 3If > 5 minutes: Midazolam 10 mg buccal (Epistatus) · Call 999
  4. 4Call 999 regardless if: first ever seizure · injury · no recovery · repeated seizures

Acute Asthma

Wheeze · dyspnoea · unable to complete sentences · falling SpO₂

  1. 1Sit upright. Salbutamol 2 puffs initially via spacer where available
  2. 2Oxygen 15 L/min (target SpO₂ 94–98%). COPD patients: 24–28% Venturi, target 88–92%.
  3. 3Call 999 if response is unsatisfactory, deteriorating, or severe/life-threatening (e.g. silent chest) — do not wait for a fixed time or puff count
  4. 4While awaiting the ambulance, give further puffs individually according to response, approximately every 60 seconds, up to a maximum of 10 puffs in total

Choking (Adult)

Sudden inability to speak or cough · clutching throat · silent distress

  1. 1Encourage the patient to cough — an effective cough may clear the obstruction.
  2. 2If the cough becomes ineffective: up to 5 back blows (heel of hand between shoulder blades).
  3. 3If unsuccessful: up to 5 abdominal thrusts.
  4. 4If still unresolved: call 999 and continue alternating 5 back blows and 5 abdominal thrusts.
  5. 5Do NOT perform blind finger sweeps.
  6. 6If the patient becomes unresponsive: start CPR (ensure 999 has been called).
⚠ Anyone treated with abdominal thrusts or chest compressions must be assessed by a healthcare professional afterwards.

Angina / Acute Coronary Syndrome

Chest pain/tightness · may radiate to arm or jaw · sweating · nausea

  1. 1Stop procedure · sit upright · GTN spray 1–2 puffs sublingual · rest and reassure
  2. 2Relief within 3–5 min = angina. Monitor. Do not continue treatment that day.
  3. 3Not relieved after 5 min — assume MI: Call 999 · Aspirin 300 mg chewed · O₂ if SpO₂ <94% · Prepare AED

LA Systemic Toxicity (LAST)

Metallic taste · tinnitus · perioral tingling → seizure → cardiovascular collapse

  1. 1STOP injection immediately. Call 999.
  2. 2Lay flat · Oxygen 15 L/min · Establish IV access if possible
  3. 3Midazolam IV/buccal for seizures. Intralipid 20% for cardiovascular collapse (paramedics/hospital).
Prevention: always aspirate · inject slowly (<1 mL/min) · know your maximum doses

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GDC mandatory emergency kit: Oxygen · Adrenaline 1:1000 · Aspirin 300 mg · GTN spray · Glucagon 1 mg · Glucogel · Midazolam buccal 10 mg · Salbutamol + spacer · AED · Pocket mask

Restock after every use · Annual emergency training for all staff · Check expiry dates monthly

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