ADEX Management of Medical Emergencies 3 — Questions and Answers
Question 1: A patient in the dental chair develops a tonic-clonic seizure. Which action is MOST appropriate during the seizure?
- Insert a bite block to prevent tongue biting
- Restrain the patient's limbs to prevent injury
- Clear the area and time the seizure while protecting the airway (Correct answer)
- Immediately administer oxygen by face mask
Correct answer: Clear the area and time the seizure while protecting the airway
During a seizure, the dental team should clear sharp objects, time the event, and protect the airway without restraining the patient or placing anything in the mouth.
Question 2: What is the primary concern when a seizure in a dental patient lasts longer than 5 minutes?
- Airway obstruction from saliva
- Status epilepticus requiring immediate EMS activation (Correct answer)
- Risk of the patient biting the clinician
- Aspiration of a dental instrument
Correct answer: Status epilepticus requiring immediate EMS activation
A seizure lasting more than 5 minutes is classified as status epilepticus, a medical emergency requiring EMS and potential administration of benzodiazepines.
Question 3: A dental patient with Type 1 diabetes becomes unresponsive. The hygienist cannot confirm whether blood glucose is low or high. What should be done?
- Withhold glucose in case the patient is hyperglycemic
- Administer oral glucose and activate EMS (Correct answer)
- Administer insulin and call 911
- Place the patient supine and monitor without intervention
Correct answer: Administer oral glucose and activate EMS
When uncertain about diabetic emergency type in an unresponsive patient, administering glucose is safer because hypoglycemia is rapidly fatal while hyperglycemia worsens slowly.
Question 4: Which of the following is a sign that distinguishes hyperglycemic emergency (diabetic ketoacidosis) from hypoglycemia?
- Diaphoresis
- Fruity acetone breath (Correct answer)
- Shakiness and anxiety
- Rapid onset of symptoms
Correct answer: Fruity acetone breath
Fruity acetone breath is pathognomonic of diabetic ketoacidosis due to ketone production from fat metabolism when insulin is absent.
Question 5: What does an AED's voice prompt 'No shock advised' indicate when used on an unresponsive patient?
- The patient has a normal heart rhythm and does not need CPR
- The rhythm detected is non-shockable; CPR should be continued immediately (Correct answer)
- The AED pads are not properly placed and must be repositioned
- The patient has recovered and no further action is needed
Correct answer: The rhythm detected is non-shockable; CPR should be continued immediately
A 'no shock advised' message means the AED detected a non-shockable rhythm (PEA or asystole); CPR must be resumed immediately as defibrillation cannot help these rhythms.
Question 6: A patient on beta-blocker therapy has a severe allergic reaction. Which clinical concern arises when administering epinephrine?
- Epinephrine will be ineffective because beta-blockers block all adrenergic receptors
- The beta-blockade may blunt epinephrine's bronchodilatory effect and paradoxically worsen bronchospasm (Correct answer)
- Epinephrine is contraindicated and should be replaced with diphenhydramine alone
- Beta-blockers potentiate epinephrine, causing excessive hypertension
Correct answer: The beta-blockade may blunt epinephrine's bronchodilatory effect and paradoxically worsen bronchospasm
Beta-blockers can oppose the beta-2 bronchodilatory effect of epinephrine and cause paradoxical bronchospasm and refractory hypotension in anaphylaxis.
Question 7: Which emergency medication in the dental office kit is used to manage a patient experiencing an adrenal crisis (acute adrenal insufficiency)?
- Nitroglycerin sublingual spray
- Hydrocortisone sodium succinate (Solu-Cortef) injectable (Correct answer)
- Glucagon IM injection
- Diphenhydramine IV
Correct answer: Hydrocortisone sodium succinate (Solu-Cortef) injectable
Hydrocortisone (Solu-Cortef) replaces the cortisol that patients on chronic corticosteroid therapy or with Addison's disease cannot produce during surgical stress.
ADEX Management of Medical Emergencies 3
A patient in the dental chair develops a tonic-clonic seizure.
Which action is MOST appropriate during the seizure?