Medical Emergencies · patient case question
A patient in the chair is unresponsive with no pulse and no normal breathing. What is the immediate priority?
Patient case: Three Emergencies in One Afternoon
Patient: Three separate patients seen the same afternoon
Chief Complaint: (1) A crown slipped from the forceps and the patient swallowed it. (2) A patient's blood pressure reads 180/120 mmHg at screening. (3) A patient has a generalised seizure lasting seven minutes.
Background: Patient 1: routine crown cementation, coughed once then settled. Patient 2: known hypertensive, took no medication this morning, asymptomatic. Patient 3: known epilepsy, missed his medication.
Medications: Patient 2: amlodipine. Patient 3: levetiracetam.
Vital Signs: Patient 1: SpO₂ 99%, RR 16, speaking in full sentences. Patient 2: BP 180/120 mmHg confirmed on repeat, HR 88. Patient 3: post-ictal, then becomes cyanotic.
Findings: Patient 1: no stridor, no wheeze, no distress. Patient 2: no chest pain, no headache, no visual change, no neurological deficit. Patient 3: recovered consciousness briefly, then developed central cyanosis.
Show answer and explanation
Correct answer: A. Begin chest compressions and attach an AED as soon as one is available
- A. CORRECT. High-quality CHEST COMPRESSIONS begin immediately — the C-A-B sequence — and the AED is applied as soon as it arrives. Compressions maintain coronary and cerebral perfusion, and every minute of delay to defibrillation reduces survival by roughly 7–10%. Compressions and defibrillation are not alternatives; they are the two halves of the same response.
- B. The 2010 guidelines reversed the old A-B-C order to C-A-B precisely to eliminate the delay to compressions.
- C. Observing a pulseless patient wastes the only minutes that matter.
- D. Nothing is gained by waiting. Compressions are started at once and paused only for rhythm analysis and shock delivery.
Note: Defibrillation is the DEFINITIVE treatment for ventricular fibrillation and pulseless VT; CPR is what keeps the myocardium viable until the shock can be delivered. In the dental office this means an AED, an emergency drug kit and current BLS certification for the whole team.
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