ADEX Managing Medical Emergencies 3 — Questions and Answers
Question 1: A patient taking warfarin presents with prolonged bleeding after a periodontal debridement. Which initial local measure is MOST appropriate?
- Apply a topical thrombin-soaked gauze with direct pressure (Correct answer)
- Discontinue treatment and refer immediately to a physician
- Administer vitamin K orally
- Apply a cold pack to the face
Correct answer: Apply a topical thrombin-soaked gauze with direct pressure
Direct pressure with hemostatic gauze (e.g., topical thrombin or oxidized cellulose) is the first local measure before considering systemic interventions.
Question 2: Which of the following is the MOST common cause of cardiac arrest in the dental office?
- Anaphylaxis to local anesthetic
- Acute myocardial infarction (Correct answer)
- Ventricular fibrillation due to drug interaction
- Air embolism
Correct answer: Acute myocardial infarction
Acute myocardial infarction is the most common cause of cardiac arrest in dental settings due to the cardiovascular stress of dental treatment.
Question 3: When performing rescue breathing for an adult during CPR, each breath should be delivered over how long?
- 0.5 seconds
- 1 second (Correct answer)
- 2 seconds
- 3 seconds
Correct answer: 1 second
Each rescue breath should be delivered over 1 second, causing visible chest rise, to minimize gastric inflation and interruption of compressions.
Question 4: A patient with asthma begins wheezing and shows signs of respiratory distress mid-appointment. After positioning the patient upright, what is the next step?
- Administer epinephrine 1:1000 IM
- Assist the patient in using their prescribed bronchodilator inhaler (Correct answer)
- Administer supplemental oxygen at 15 L/min via non-rebreather mask
- Call 911 immediately and do nothing else
Correct answer: Assist the patient in using their prescribed bronchodilator inhaler
The first pharmacologic intervention for a mild-to-moderate asthma attack is the patient's own short-acting beta-agonist bronchodilator (e.g., albuterol).
Question 5: Which symptom would most suggest a TIA (transient ischemic attack) rather than a simple syncopal episode in a dental patient?
- Brief loss of consciousness with rapid full recovery
- Unilateral facial drooping with slurred speech (Correct answer)
- Profuse sweating and nausea before losing consciousness
- Slow pulse and pallor
Correct answer: Unilateral facial drooping with slurred speech
Unilateral neurological deficits such as facial drooping, arm weakness, or slurred speech indicate a TIA or stroke rather than vasovagal syncope.
Question 6: A patient's blood pressure reading is 185/110 mmHg before treatment. According to ADA guidelines, what should the dental hygienist do?
- Proceed with treatment as this is within normal limits
- Reschedule treatment and refer for medical evaluation (Correct answer)
- Proceed with treatment but avoid epinephrine-containing local anesthetics
- Administer an antihypertensive from the emergency kit
Correct answer: Reschedule treatment and refer for medical evaluation
A BP ≥180/110 mmHg (Stage 2 hypertensive crisis) requires postponing elective dental treatment and referring the patient for medical evaluation.
Question 7: Nitroglycerin is contraindicated in a patient who has taken which of the following medications within 24-48 hours?
- Aspirin
- Phosphodiesterase-5 inhibitors (e.g., sildenafil) (Correct answer)
- Beta-blockers
- Calcium channel blockers
Correct answer: Phosphodiesterase-5 inhibitors (e.g., sildenafil)
Concurrent use of nitrates and PDE-5 inhibitors (sildenafil, tadalafil) causes severe, potentially fatal hypotension due to synergistic vasodilation.
ADEX Managing Medical Emergencies 3
A patient taking warfarin presents with prolonged bleeding after a periodontal debridement.
Which initial local measure is MOST appropriate?