ADEX Management of Medical Emergencies 5 — Questions and Answers
Question 1: A patient experiences a hypertensive crisis (BP 185/115 mmHg) and complains of a severe headache with visual changes. What is the dental hygienist's MOST appropriate action?
- Continue treatment but monitor blood pressure every 10 minutes
- Discontinue treatment, position the patient upright, and activate EMS immediately (Correct answer)
- Administer nitroglycerin sublingual to lower blood pressure
- Administer aspirin and wait for symptoms to resolve
Correct answer: Discontinue treatment, position the patient upright, and activate EMS immediately
A hypertensive emergency with neurological symptoms (headache, visual changes) requires immediate treatment cessation, upright positioning to reduce cerebral pressure, and EMS activation.
Question 2: Which of the following is the MOST important initial step when any medical emergency is recognized in the dental office?
- Retrieve the emergency drug kit
- Activate the office emergency team and call for help (Correct answer)
- Begin CPR regardless of patient status
- Document the time the emergency began
Correct answer: Activate the office emergency team and call for help
Activating the dental office emergency team ensures help is summoned and roles are assigned, forming the foundation of an organized emergency response before specific interventions.
Question 3: A pregnant patient in the third trimester becomes lightheaded and loses consciousness in the supine dental chair. What is the MOST likely cause?
- Hypoglycemia from missed meal
- Supine hypotensive syndrome from aortocaval compression (Correct answer)
- Vasovagal syncope from dental anxiety
- Eclampsia from pregnancy-induced hypertension
Correct answer: Supine hypotensive syndrome from aortocaval compression
In the third trimester, the gravid uterus compresses the aorta and inferior vena cava in the supine position, reducing venous return and causing supine hypotensive syndrome.
Question 4: When using an AED in the dental office, which action should be taken BEFORE the device analyzes the patient's heart rhythm?
- Deliver one rescue breath
- Ensure no one is touching the patient (Correct answer)
- Check the patient's blood pressure
- Administer epinephrine
Correct answer: Ensure no one is touching the patient
Everyone must be clear of patient contact during AED rhythm analysis and shock delivery to prevent the electrical current from passing through bystanders.
Question 5: Which of the following patients is MOST likely to have an exaggerated vasopressor response to the epinephrine in dental local anesthetic?
- A patient taking lisinopril for hypertension
- A patient taking a non-selective beta-blocker such as propranolol (Correct answer)
- A patient taking metformin for type 2 diabetes
- A patient taking sertraline for depression
Correct answer: A patient taking a non-selective beta-blocker such as propranolol
Non-selective beta-blockers block beta-2 vasodilatory receptors, leaving alpha-1 effects of epinephrine unopposed, potentially causing severe hypertension and reflex bradycardia.
Question 6: A child patient (8 years old, 25 kg) develops anaphylaxis. What is the correct epinephrine dose using an auto-injector?
- EpiPen (0.3 mg) — adult dose is used regardless of weight
- EpiPen Jr. (0.15 mg) — pediatric dose for children 15–30 kg (Correct answer)
- No epinephrine — use diphenhydramine only for children
- Double the adult dose to compensate for faster metabolism
Correct answer: EpiPen Jr. (0.15 mg) — pediatric dose for children 15–30 kg
Children weighing 15–30 kg should receive EpiPen Jr. (0.15 mg epinephrine), as the pediatric auto-injector delivers an appropriate weight-based dose for anaphylaxis management.
Question 7: A patient with a history of angina asks if their nitroglycerin spray is still effective for use in an emergency. What is the shelf life of nitroglycerin tablets once opened?
- 6 months (Correct answer)
- 3 months
- 1 year
- 2 years
Correct answer: 6 months
Nitroglycerin tablets lose potency rapidly once the bottle is opened, with an effective shelf life of approximately 6 months due to volatility of the active compound.
ADEX Management of Medical Emergencies 5
A patient experiences a hypertensive crisis (BP 185/115 mmHg) and complains of a severe headache with visual changes.
What is the dental hygienist's MOST appropriate action?