Organization of emergency care and staff roles
Providing emergency medical care for acute diseases and injuries of the maxillofacial area (MFA) is one of the core tasks of a dental clinic. The traditional structure of the facility may include a specialized emergency care room. When life-threatening conditions arise, the primary role is assigned to the dentist, whose direct job responsibilities include managing such episodes. Meanwhile, the dental assistant ensures maximum patient comfort, monitors equipment functionality, and assists with procedures. It is essential that the workspace adheres to strict ergonomic principles: the absence of obstacles and unnecessary movements allows staff to instantly access the required instruments.
Office equipment for patient safety
To immediately respond to acute reactions (such as allergies or angioedema), an emergency kit is kept in an easily accessible location in every treatment room. In addition, the office is equipped with sophisticated devices whose operation may cause patient stress: electroodontometry devices, apex locators, and diathermy coagulators. Strict adherence to asepsis rules (using dry-heat sterilizers, glass bead sterilizers, and quartz lamps) prevents infectious complications, which in severe cases could trigger infectious collapse.
Syncope: pathogenesis and action algorithm
Syncope (acute vascular insufficiency) often occurs during medical interventions. If a patient develops presyncope, they must be quickly laid down horizontally or, if sitting, have their head and torso rapidly tilted downward.
If loss of consciousness has already occurred, the algorithm is as follows:
- Lay the patient supine.
- Elevate the legs — this is critical for improving venous blood return to the heart.
- Loosen tight clothing around the chest and neck.
- To accelerate the recovery of consciousness: splash cold water on the face, apply a cold towel, and allow inhalation of ammonia vapors.
After the episode resolves, the patient must remain in a horizontal position for another 10–15 minutes.
Etiology and prevention of syncopal conditions
Further management depends on the cause of the syncope:
- Neurogenic: typically, avoiding triggering factors (pain, fear) is sufficient.
- Orthostatic: the patient is forbidden from rapidly transitioning to a vertical position. Intake of 2–3 liters of fluid per day and etiopathogenetic treatment of the cause of hypotension are required.
- Cardiogenic: the most dangerous type. May require emergency resuscitation measures (use of a defibrillator, pacemaker installation). Prevention of recurrent episodes is managed by a cardiologist.
- Ischemic (against the background of a transient ischemic attack in the vertebrobasilar system): requires measures to prevent ischemic stroke.
Collapse: principles of intensive care
Collapse is a more severe form of vascular insufficiency. Treatment aims to restore cardiovascular activity with mandatory consideration of the etiological factor. Unlike shock therapy, collapse does not require correction of multiorgan dysfunction, as it does not have time to develop.
General principles of emergency therapy include:
- Eliminating the cause (stopping bleeding, detoxification, antibiotic therapy in case of infectious collapse).
- Horizontal position with elevated legs.
- Infusion therapy (administration of crystalloid and colloid solutions) to restore circulating blood volume (CBV).
- Administration of vasopressor agents (e.g., norepinephrine, phenylephrine) to restore vascular tone.
- Oxygen therapy and strict monitoring of blood pressure, pulse, and diuresis.
To remember first aid for syncope, use the rule of the "Three Ns": Legs up (No-gi), Ammonia (Nashatyr), No tight clothing (Net tesnoy odezhde).
Class and exam questions
What to do if a patient in the dental chair turns pale and complains of feeling faint?
These are signs of a presyncopal state. The dental chair must be immediately lowered to a horizontal position, or the patient should be asked to sharply bend their head down between their knees.
What is the main difference between treating collapse and treating shock?
In cases of collapse, correction of multiorgan dysfunction is generally not required, as it does not develop. The main focus is on restoring circulating blood volume and increasing vascular tone.
What are the duties of a dental assistant when an emergency occurs?
The assistant must ensure maximum patient comfort and promptly prepare the necessary equipment and medications from the emergency kit while the dentist performs clinical procedures.
What else to study on this topic
- Specific drug therapy regimens for collapse and shock, indicating exact dosages and routes of administration.
- Algorithms for providing emergency medical care for acute injuries of the maxillofacial area.
- Differential diagnosis of cardiogenic syncope and the tactics of using a defibrillator in an outpatient setting.
- Protocols for managing immediate-type allergic reactions and angioedema in a dental office setting.
- Assessment of temporary disability and issuance of sick leave certificates to patients after experiencing medical emergencies.
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