ABCD Patient Collapses in Dental Chair

Today we will see about if anyone collapses on your chair then what should be done.

Before going further, I would like to recommend that everyone should know about course/training of basic life support.
This is not only for the clinic purpose but it can become useful to you at every place. Medical emergency could happen in a road side accident too.
Patient becomes unconscious on dental chair and most of the time patient goes in syncope after giving Angle A. other reasons could be orthostatic hypotension, psychogenic reason – patient want to get attraction or there may be asthma or heart attack.

Now, let’s see actual procedure of management.

At first critical management is done which can be called as primary survey too.
The purpose of primary survey is to search how we could help the patients in the best way.
This easy step is also known as DR. ABCDE which means

D – DANGER

R – RESPONSE

A – AIRWAY

B – BREATHING

C – CIRCULATION

D – DISABILITY

E – EXPOSURE.

When you see a person is unconscious then

Check the danger around him. Make sure that going to him is safe. We don’t want to become causality from our own.
First of all, make the patient fall in supine position. Now, we would like to see that patient is giving any response or not. Go to him, ask some questions and try to find the answers of those questions from him.
If you don’t get any response then shake his shoulder gently.

Like – Hello, Sagar open your eyes, can you hear me?

And if now also you are not getting any response then pinch their ear lobe, and see for pain response. After doing these three things only you can judge what you have to do further.
We use AVPU scale and each letter depict the level of response of patient.

A – ALERT

V – RESPONSE TO VOICE

P – RESPONSE TO PAIN

U – MEANS UNRESPONSIVE.

If you don’t get any response of patient from those three things which is given above then it’s time to start ABCDE.

First check airway

If the patient’s airway is blocked then everything is useless.

You have to take immediate action if airway is blocked or threatened. It means either the airway is partially blocked or you are afraid that it will be block.
- It is very important that patient should be conscious to keep the airway open.

CRT is of less than two sec in normal condition. And if it is more then it means blood is not reaching at the end of the finger which means poor peripheral perfusion.

CRT increases in anaphylaxis too because body is busy in transferring oxygen in vital organs.

Simultaneously BP should also be monitored, less than 90mm systolic BP tells about shock. BP becomes less and Heart rate becomes high in shock. And if the patient is telling about chest pain then it may be heart attack too.

Feel the skin of the patient that it is warm or cool.

MANAGEMENT OF PROBLEM WITH SOLUTION –

Low BP due to vasovagal episode or simple faint.
Lay the patient straight and raise the leg.

Next thing which we would like to check is D for Disability.

We would like to check that problem is related to nervous system or not.

In this, 4 things are to be done.

EXAMINE PUPIL – Compare size, equality and reaction to light. Pinpoint pupil opiate can occur due to overdose.
CHECK GLUCOSE LEVEL – So that hypoglycemia could be find.
CHECK THE LEVEL OF UNCONSIOUSNESS – Check the level of unconsciousness that how much alert a patient is, and do the scoring on GLASGOW COMA SCALE.
Check patient’s medication history that the reason is any drug induced or not.

MANAGEMENT –

Review the airway, breathing and circulation again so that you can rule out hypoxia or low BP.
Lay the patient in recovery position.
If hypoxia is there then give the treatment of hypoxia.
Put oxygen.
Call ambulance.

LAST IS E – E FOR EXPOSURE

If you have reached till E then take time to review that what you have missed.
Check temperature.
Look patient from top to bottom, in anaphylaxis skin will become urticasia and angloedema.
Loose patient’s cloth and minimize heart loss.

Medical emergency could be very stressful. By following ABCDE method, you can make sure that the work of priority should be done at first.

You will have to make sure that you should not forget anything.
And if you forget then keep calm and start again from A.

SOLUTIONS FOR DENTIST

Today we will see about if anyone collapses on your chair then what should be done.

Before going further, I would like to recommend that everyone should know about course/training of basic life support.

This is not only for the clinic purpose but it can become useful to you at every place. Medical emergency could happen in a road side accident too.

Patient becomes unconscious on dental chair and most of the time patient goes in syncope after giving Angle A. other reasons could be orthostatic hypotension, psychogenic reason – patient want to get attraction or there may be asthma or heart attack.

Now, let’s see actual procedure of management.

At first critical management is done which can be called as primary survey too.

The purpose of primary survey is to search how we could help the patients in the best way.

This easy step is also known as DR. ABCDE which means

D – DANGER

R – RESPONSE

A – AIRWAY

B – BREATHING

C – CIRCULATION

D – DISABILITY

E – EXPOSURE.

When you see a person is unconscious then

Check the danger around him. Make sure that going to him is safe. We don’t want to become causality from our own.

First of all, make the patient fall in supine position. Now, we would like to see that patient is giving any response or not. Go to him, ask some questions and try to find the answers of those questions from him.

If you don’t get any response then shake his shoulder gently.

Like – Hello, Sagar open your eyes, can you hear me?

And if now also you are not getting any response then pinch their ear lobe, and see for pain response. After doing these three things only you can judge what you have to do further.

We use AVPU scale and each letter depict the level of response of patient.

A – ALERT

V – RESPONSE TO VOICE

P – RESPONSE TO PAIN

U – MEANS UNRESPONSIVE.

If you don’t get any response of patient from those three things which is given above then it’s time to start ABCDE.

First check airway

If the patient’s airway is blocked then everything is useless.

You have to take immediate action if airway is blocked or threatened. It means either the airway is partially blocked or you are afraid that it will be block.

It is very important that patient should be conscious to keep the airway open.

CRT is of less than two sec in normal condition. And if it is more then it means blood is not reaching at the end of the finger which means poor peripheral perfusion.

CRT increases in anaphylaxis too because body is busy in transferring oxygen in vital organs.

Simultaneously BP should also be monitored, less than 90mm systolic BP tells about shock. BP becomes less and Heart rate becomes high in shock. And if the patient is telling about chest pain then it may be heart attack too.

Feel the skin of the patient that it is warm or cool.

MANAGEMENT OF PROBLEM WITH SOLUTION –

Low BP due to vasovagal episode or simple faint.

Lay the patient straight and raise the leg.

Next thing which we would like to check is D for Disability.

We would like to check that problem is related to nervous system or not.

In this, 4 things are to be done.

EXAMINE PUPIL – Compare size, equality and reaction to light. Pinpoint pupil opiate can occur due to overdose.

CHECK GLUCOSE LEVEL – So that hypoglycemia could be find.

CHECK THE LEVEL OF UNCONSIOUSNESS – Check the level of unconsciousness that how much alert a patient is, and do the scoring on GLASGOW COMA SCALE.

Check patient’s medication history that the reason is any drug induced or not.

MANAGEMENT –

Review the airway, breathing and circulation again so that you can rule out hypoxia or low BP.

Lay the patient in recovery position.

If hypoxia is there then give the treatment of hypoxia.

Put oxygen.

Call ambulance.

LAST IS E – E FOR EXPOSURE

If you have reached till E then take time to review that what you have missed.

Check temperature.

Look patient from top to bottom, in anaphylaxis skin will become urticasia and angloedema.

Loose patient’s cloth and minimize heart loss.

Medical emergency could be very stressful. By following ABCDE method, you can make sure that the work of priority should be done at first.

You will have to make sure that you should not forget anything.

And if you forget then keep calm and start again from A.

THANK YOU