Medical Emergencies
Assessment of the sick or unconscious patient
The whole dental team should always be on the lookout for when a patient doesn’t seem “well”. Small changes in skin colour, breathing pattern, sweating, eyes rolling or closing, muscle tone, trembling, slurring are signs that a medical emergency might be developing.
A general rule for managing any emergency is that the team must not put themselves in physical danger, and become casualties themselves.
Always assess the level of personal risk and ensure you will be safe first.
You must immediately assess the patient to diagnose the problem that may be developing.
If you prefer to view this page as didactic information, rather than as a self assessment, click the arrow below.
Didactic Information:
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If you suspect something is amiss, ask the patient “are you alright?”
If there is no response, shake them and repeat the question.
If they don’t respond normally, saying all is well, or speak only short sentences, a medical emergency may be developing.
The ABCDE approach to assessment
If you suspect an emergency is developing, (or it has developed!) you must first assess the patient using the ABCDE mnemonic.
A – AIRWAY
B – BREATHING
C – CIRCULATION
D – DISABILITY
E – EXPOSURE
If while going through the assessment, you discover a life threatening condition, you should manage that before proceeding further with the assessment.
AIRWAY
If the airway is obstructed, no oxygen can reach the tissues. Look and listen for signs of airway obstruction., such as abnormal or absent breathing, cyanosis. Hold your ear near to the mouth if you are not sure.
If the airway is obstructed, tilt the head back and remove any foreign bodies / liquid with the dental Aspirator and / or forceps.
If the patient is choking, or has aspirated, institute appropriate treatment immediately.
BREATHING
Having ensured there are no foreign body obstructions, check if the patient is breathing normally. Adult rate should be between 12 and 20 breaths per minute, children between 20 and 30.
If the patient is not breathing, or breathing inadequately, call urgently for an ambulance.
At this stage, if you suspect a life threatening problem such as an acute Asthma attack, or Anaphylaxis, you must treat it immediately.
If the patient is non-responsive or unconscious you should assume Cardiac Arrest. Start CPR (30 chest compressions, then 2 rescue breaths) and call for an Automated External Defibrillator (if available).
CIRCULATION
If the patient is non-responsive, you should have started CPR by now.
If conscious, check out the patient’s colour for pallor, cyanosis, mottling, or healthy pinkness.
Measure the pulse rate.
Measure the capillary refill time.
DISABILITY
Grade the level of consciousness. Use a simple classification such as
A – Alert
V – Verbal response
P – Responds to pain
U – Unresponsive
Examine the pupils.
At this stage, measure the blood glucose using a glucose meter, to test for hypoglycaemia.
EXPOSURE
It may be necessary to loosen or remove some of the patient’s clothes to assess and treat them properly. This will allow you to assess any anaphylactic rash, or undertake external defibrillation, if necessary. Respect the patient’s dignity.
What next?
When this initial assessment is complete, and you have instituted treatment for any life-threatening airway, breathing, or circulatory problems, you must next make a diagnosis based on your findings from the ABCDE assessment, and institute appropriate management for the problem you have diagnosed.
Self Assessment
What is the first thing you should do if you suspect your patient is becoming unwell ?
If you suspect an emergency is developing, (or it has developed!) you must first assess the patient using the ABCDE mnemonic.
What do ABCD and E stand for?
If while going through the assessment, you discover a life threatening condition, should you quickly finish the assessment, or immediately address the issue?
What does AIRWAY assessment consist of? When should you institute immediate treatment, and defer the rest of the assessment?
What does BREATHING assessment consist of? When should you institute immediate treatment, and defer the rest of the assessment?
What does CIRCULATION assessment consist of?
What does DISABILITY assessment consist of? When should you institute immediate treatment, and defer the rest of the assessment?
What does EXPOSURE mean? Why is it needed?
What next?
When this initial assessment is complete, and you have instituted treatment for any life-threatening airway, breathing, or circulatory problems, you must next make a diagnosis based on your findings from the ABCDE assessment, and institute appropriate management for the problem you have diagnosed.
The Recovery Position
If a patient is unconscious, but breathing and circulation and normal, he or she should be put into the recovery position if it is safe to do so. This allows a patient to continue breathing without the danger of aspiration.
The primary survey for a collapsed patient
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In this video, viewers will learn how to conduct a primary survey when encountering a collapsed individual. The primary survey is an initial and systematic assessment designed to identify and prioritise the necessary treatments for the casualty. The steps of the survey can be remembered using the acronym DR. ABC, which stands for Danger, Response, Airway, Breathing, and Circulation.
Starting with the first step, it is very important to assess any potential dangers in the surrounding environment to ensure the safety of both the responder and the casualty. Once safety is established, the next step involves checking for the casualty's response. The video outlines how to approach the casualty, introduce oneself, and ask questions to elicit a response. If the person is unresponsive, simple physical stimuli, such as gently shaking their shoulders or pinching their earlobe, can help gauge their level of response using the AVPU scale (Alert, Voice, Pain, Unresponsive).
If the casualty remains unresponsive, the next step is to open their airway by tilting their head back and lifting their chin. The video then guides viewers through checking for normal breathing by listening and observing for chest movements for ten seconds. If the casualty is found to be not breathing normally, the responder is instructed to call for emergency help and to initiate CPR if alone.
After confirming the casualty’s breathing, the focus shifts to checking for signs of severe bleeding. It emphasises the importance of controlling any significant bleeding to prevent life-threatening shock while waiting for emergency services. The video succinctly summarises the primary survey process, encouraging viewers to follow the DR. ABC steps and highlight the importance of calling for emergency assistance.
Overall, this instructional video serves as a quick guide for dental professionals and others, providing vital first aid steps to effectively manage a potential cardiac emergency or collapse.
The recovery position
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The video provides a step-by-step guide on how to place an unresponsive but breathing casualty into the recovery position, a very important technique for maintaining the airway in emergency situations. It begins by emphasising the importance of conducting a primary survey to assess the casualty's condition before proceeding.
To begin the process, the viewer is instructed to kneel beside the unresponsive person and remove glasses and any bulky items from their pockets, without searching for small objects. It's important that the casualty's legs are kept straight. The guide details the positioning of the arms: the arm closest to the first aider should be extended at a right angle with the palm facing up, while the other arm is crossed over the chest, with the back of the hand resting against the cheek nearest to the first aider.
Next, the video outlines how to manipulate the casualty's legs for rolling. The first aider should lift the far knee to ensure the foot is flat on the ground. While maintaining pressure on the hand resting against the cheek, the first aider rolls the casualty towards themselves onto their side. After rolling, the top leg should be adjusted to form a right angle, and the casualty's head should be tilted back to keep the airway open. If necessary, the position of the hand on the cheek can be adjusted to ensure the airway remains unobstructed.
The video concludes by reminding viewers to call emergency services (999 or 112) if it hasn't already been done and to monitor the casualty's level of responsiveness until help arrives. It also stresses the importance of being prepared to administer CPR if the casualty stops breathing at any point. The final message encourages support for St John Ambulance through donations.