ADEX Management of Medical Emergencies 4 — Questions and Answers
Question 1: Which of the following is the MOST common medical emergency encountered in the dental office?
- Anaphylaxis
- Vasovagal syncope (Correct answer)
- Myocardial infarction
- Hypoglycemia
Correct answer: Vasovagal syncope
Vasovagal syncope (fainting) is the most frequently encountered medical emergency in dental settings, often triggered by anxiety, pain, or the sight of blood.
Question 2: A conscious patient reports crushing substernal chest pain radiating to the left arm. The dental hygienist suspects myocardial infarction. Which medication should be given while awaiting EMS?
- Nitroglycerin 0.4 mg sublingual only
- Aspirin 325 mg chewed plus nitroglycerin if not already taken (Correct answer)
- Epinephrine 1:1000 IM
- Albuterol inhaler
Correct answer: Aspirin 325 mg chewed plus nitroglycerin if not already taken
Aspirin inhibits platelet aggregation and reduces infarct size; it is given along with nitroglycerin (if the patient has not already taken their dose) while awaiting EMS.
Question 3: During local anesthetic injection, a patient suddenly becomes pale, diaphoretic, and loses consciousness for 30 seconds then recovers. What most likely occurred?
- Allergic reaction to the local anesthetic
- Vasovagal syncope (Correct answer)
- Epinephrine overdose
- Local anesthetic toxicity
Correct answer: Vasovagal syncope
A brief loss of consciousness following an injection, preceded by pallor and diaphoresis, is classic vasovagal syncope caused by anxiety and pain-induced vagal response.
Question 4: At what depth should chest compressions be performed on an adult patient during CPR according to current AHA guidelines?
- 1–1.5 inches (2.5–3.8 cm)
- At least 2 inches (5 cm), not exceeding 2.4 inches (6 cm) (Correct answer)
- 3 inches (7.6 cm)
- As deep as needed to feel a pulse
Correct answer: At least 2 inches (5 cm), not exceeding 2.4 inches (6 cm)
AHA guidelines specify chest compressions of at least 2 inches (5 cm) but no more than 2.4 inches (6 cm) to optimize cardiac output without causing injury.
Question 5: A patient on a tricyclic antidepressant (TCA) inadvertently receives a high dose of local anesthetic. Which sign most specifically indicates local anesthetic systemic toxicity (LAST)?
- Urticaria and pruritus
- Perioral numbness followed by seizures and cardiovascular collapse (Correct answer)
- Bronchospasm and wheezing
- Bradycardia with normal blood pressure
Correct answer: Perioral numbness followed by seizures and cardiovascular collapse
LAST classically presents with CNS excitation (perioral numbness, tinnitus, seizures) followed by CNS and cardiovascular depression, especially in patients on TCAs which lower seizure threshold.
Question 6: Which of the following patients is at HIGHEST risk for an adrenal crisis during dental treatment?
- A patient taking 400 mg ibuprofen daily for arthritis
- A patient on long-term prednisone 20 mg/day for rheumatoid arthritis (Correct answer)
- A patient with well-controlled Type 2 diabetes on metformin
- A patient taking antihypertensive calcium channel blockers
Correct answer: A patient on long-term prednisone 20 mg/day for rheumatoid arthritis
Long-term systemic corticosteroid use suppresses the HPA axis, impairing the adrenal glands' ability to increase cortisol output in response to surgical stress.
Question 7: What is the rate of chest compressions recommended for adult CPR per current AHA guidelines?
- 60–80 compressions per minute
- 80–100 compressions per minute
- 100–120 compressions per minute (Correct answer)
- 120–140 compressions per minute
Correct answer: 100–120 compressions per minute
Current AHA guidelines recommend a compression rate of 100–120 per minute to maintain adequate cardiac output without reducing effectiveness from excessive speed.
ADEX Management of Medical Emergencies 4
Which of the following is the MOST common medical emergency encountered in the dental office?