Managing Adult Medical Emergencies in the Dental Office
Primary Survey

Assess level of consciousnes:

• Tap the patient on the shoulder and shout – “Are you OK?” (Figure 1)
  • Responsive patient
    • Alert
      • Awake and able to speak
    • Disoriented
      • May moan, cry, or make other sounds
      • Responds to verbal and/or painful stimuli. i.e., moves
  • Place responsive patient in the dental chair in an upright/semi-reclining position (Figure 2)
  • Unresponsive patient
    • Silent, does not respond to verbal and painful stimuli
      • Place unresponsive patient in the dental chair in a supine position on a firm, flat board (e.g., EMS board) to allow for adequate compressions later (Figure 3)
        • SUMMON THE OFFICE EMERGENCY TEAM
        • ACTIVATE EMERGENCY MEDICAL SERVICES (EMS)

Check airway:

• If the patient is responsive (i.e., alert and talking, even in a whisper) the airway is open, at least partially, at this time
• If the patient is unresponsive (i.e., does not respond to verbal and painful stimuli) evaluate airway
  • If the airway is not open, it may be due to relaxation of the soft tissues of the oropharynx
    • Perform head-tilt/chin-lift (Figure 4)
  • If obstruction is caused by foreign material it must be cleared
    • Suction thick, frothy, bloody saliva and vomitus
    • Foreign object must be removed (see Airway obstruction (foreign body)

Look for breathing and check pulse (minimum 5 seconds; maximum 10 seconds):

• Simultaneously, see if the patient’s chest rises and falls, listen for escaping air, and feel the airflow against the side of your cheek (Figure 5); and palpate the carotid artery (Figure 6)
  • Unresponsive patient
    • Normal breathing (quite, regular and effortless) and has a definite pulse
      • Monitor vital signs until EMS arrives
    • No normal breathing, but has a definite pulse
      • Initiate rescue breathing
        • 1 breath every 5-6 seconds (10 to 12 breaths/min.)
        • Check pulse every 2 minutes
          • If no pulse, begin cardiopulmonary resuscitation (CPR) and prepare for automated external defibrillation (AED) in accordance with current American Heart Association and/or American Red Cross guidelines.^20,21
    • No breathing or only agonal breaths (i.e., isolated or infrequent gasping) and no pulse
      • Begin CPR – cycles of 30 compressions and 2 breaths
        • Continue CPR until AED is turned on, the AED pads are applied, and the AED is ready to analyze the heart rhythm*
          • Ensure that everyone, including the rescuer performing CPR, is clear of the patient during AED rhythm analysis and shock
          • If the AED advises that a shock is not indicated
            • Resume CPR immediately until prompted by AED to allow rhythm check (about 2 minutes)
          • If the AED advises that a shock is indicated press the shock button
            • Resume CPR immediately until prompted by AED to allow rhythm check (about 2 minutes)
      • Continue with CPR and defibrillation until EMS takes over or the patient starts to move