Hypoglycemia, or low blood sugar, is most likely in a diabetic, particularly the type 1 insulin-dependent diabetic. The classic signs and symptoms are that the patient is cold, sweaty, shaking, and mentally disorientated. Many patients, however, do not exhibit these. Therefore, when reviewing the patient's medical history, it is important to ask diabetic patients to list their signs and symptoms.

Before you start dental treatment, ask your patients these questions: "When did you last take your insulin?' and "When did you last eat?" If the patient took insulin and hasn't eaten recently, give the patient some orange juice before you start treatment. Mental confusion or disorientation is often the first signs of hypoglycemia. If a diabetic patient shows either of these signs, stop treatment and apply the PABCD protocol. P. Position Patient A. Airway B. Breathing C. Circulation D. Definitive Care

Medical emergencies can and do occur, not only in your dental office but any place at any time. The entire staff and designated in-office emergency team must be trained, and emergency equipment and drugs must be available and current. The best way to handle an emergency is to start by being prepared.

Imagine you are treating a patient, stop treatment to ask her a question, and find that she is unresponsive. You quickly ask someone to tell the receptionist to call 911 and to bring you the oxygen tank. The oxygen tank finally arrives about 10 minutes later, but is almost empty. You eventually get another oxygen tank from an assistant, but it has no tubing, so there is another delay in getting the patient oxygen. The paramedics finally arrive, but it is too late-the patient is dead. WERE YOU PREPARED? You had the oxygen tank, the emergency kit, and CPR training. You may have thought you were prepared-until the patient died. Emergencies are rare in dental offices. Nonetheless, we must be prepared to manage medical emergencies when they do occur. (Dr. Stanley Malamed)