ADEX Managing Medical Emergencies 5 — Questions and Answers
Question 1: A patient on beta-blocker therapy experiences anaphylaxis. The initial dose of epinephrine fails to improve symptoms. This resistance occurs because beta-blockers:
- Inactivate epinephrine by enzymatic degradation
- Block the beta-2 adrenergic bronchodilation effect of epinephrine (Correct answer)
- Prevent epinephrine absorption from the injection site
- Increase histamine release from mast cells
Correct answer: Block the beta-2 adrenergic bronchodilation effect of epinephrine
Beta-blockers antagonize the beta-2 adrenergic bronchodilatory effects of epinephrine, making anaphylaxis more refractory; glucagon may be needed as an alternative.
Question 2: During a procedure, a patient becomes unresponsive and has no pulse. The AED delivers a shock, but the patient remains pulseless. What is the immediate next step?
- Deliver a second shock immediately
- Resume CPR beginning with chest compressions for 2 minutes (Correct answer)
- Check the rhythm again before resuming any action
- Administer epinephrine via IM injection
Correct answer: Resume CPR beginning with chest compressions for 2 minutes
After any AED shock, regardless of outcome, immediately resume CPR starting with chest compressions for 2 minutes before re-analyzing the rhythm.
Question 3: A patient with hyperventilation syndrome presents with tingling in the hands and feet and carpopedal spasm. What is the pathophysiology?
- Hypercapnia causing cerebral vasodilation
- Hypocapnia causing respiratory alkalosis and decreased ionized calcium (Correct answer)
- Hypoxia causing anaerobic metabolism
- Metabolic acidosis from CO2 retention
Correct answer: Hypocapnia causing respiratory alkalosis and decreased ionized calcium
Rapid breathing causes CO2 exhalation, producing hypocapnia and respiratory alkalosis, which decreases ionized serum calcium and causes neuromuscular excitability (tetany).
Question 4: Which characteristic of a patient's medical history is MOST associated with increased risk of latex allergy in the dental setting?
- History of penicillin allergy
- Multiple prior surgeries (especially urologic or spinal) (Correct answer)
- Diabetes mellitus type 1
- Current use of anticoagulant therapy
Correct answer: Multiple prior surgeries (especially urologic or spinal)
Patients with multiple surgeries, especially urologic or spinal procedures, have repeated latex exposure that sensitizes the immune system, significantly increasing latex allergy risk.
Question 5: What is the primary reason dental offices must maintain a log of emergency drug expiration dates?
- To comply with OSHA bloodborne pathogen standards
- To ensure drugs are potent and effective when an emergency occurs (Correct answer)
- To meet HIPAA documentation requirements
- To qualify for reduced malpractice insurance premiums
Correct answer: To ensure drugs are potent and effective when an emergency occurs
Expired emergency drugs may have reduced or unpredictable potency, rendering them ineffective at a critical moment when reliable pharmacologic action is essential.
Question 6: A patient develops stridor (high-pitched inspiratory noise) after receiving a local anesthetic injection. This sign most likely indicates:
- Hyperventilation from anxiety
- Upper airway obstruction due to angioedema or anaphylaxis (Correct answer)
- Bronchospasm in the lower airways
- Aspiration of a dental instrument
Correct answer: Upper airway obstruction due to angioedema or anaphylaxis
Stridor is caused by partial upper airway obstruction and, in the post-injection setting, strongly suggests angioedema or anaphylaxis requiring immediate epinephrine administration.
Question 7: After managing a medical emergency in the dental office, what documentation should the dental hygienist complete?
- Only the patient's chief complaint in the progress notes
- A detailed incident report including timeline, signs, interventions, patient response, and EMS outcome (Correct answer)
- A brief note that the appointment was terminated due to a medical event
- Documentation is not required unless the patient was transported by EMS
Correct answer: A detailed incident report including timeline, signs, interventions, patient response, and EMS outcome
A thorough incident report documenting the timeline, clinical findings, interventions, drug doses, and outcome is required for legal, quality assurance, and continuity-of-care purposes.
ADEX Managing Medical Emergencies 5
A patient on beta-blocker therapy experiences anaphylaxis.
The initial dose of epinephrine fails to improve symptoms.
This resistance occurs because beta-blockers: