ORE Part 2 NHS Dental Contracts & Medical Emergencies 3 — Questions and Answers
Question 1: What is the 'steroid cover' protocol for a dental patient on long-term oral corticosteroids (prednisolone ≥ 5 mg/day) undergoing a stressful extraction?
- Continue usual dose; double the dose on day of procedure if on ≤ 10 mg/day; seek medical advice for complex cases (Correct answer)
- Always give 100 mg hydrocortisone IM before every procedure
- Stop steroids 24 hours before
- No extra steroid is needed for dental procedures
Correct answer: Continue usual dose; double the dose on day of procedure if on ≤ 10 mg/day; seek medical advice for complex cases
Current UK guidance advises continuing usual steroids; for minor procedures, no supplementation is needed for most; for major stressful procedures, medical advice should be sought; the previous routine doubling protocol is evolving based on evidence.
Question 2: What is the management of an epileptic seizure in a dental surgery?
- Protect from injury, time the seizure, do not restrain, call 999 if >5 min, give buccal midazolam if available and prolonged (Correct answer)
- Put something in the mouth to prevent tongue biting
- Restrain the patient to prevent injury
- Administer IM adrenaline
Correct answer: Protect from injury, time the seizure, do not restrain, call 999 if >5 min, give buccal midazolam if available and prolonged
During seizures: protect from injury (clear the area), time the duration, do not restrain or insert anything in the mouth, call 999 if >5 minutes, and administer buccal midazolam if available and the seizure is prolonged.
Question 3: What is the difference between Type 1 and Type 2 respiratory failure in the context of a dental emergency?
- Type 1: hypoxaemia with normal CO2 (e.g., acute asthma); Type 2: hypoxaemia with raised CO2 (e.g., COPD) (Correct answer)
- Type 1 is more severe than Type 2
- Type 2 occurs only with cardiac arrest
- They are identical in management
Correct answer: Type 1: hypoxaemia with normal CO2 (e.g., acute asthma); Type 2: hypoxaemia with raised CO2 (e.g., COPD)
Type 1 respiratory failure (low O2, normal CO2) occurs in conditions like acute asthma; Type 2 (low O2, high CO2) occurs in COPD exacerbations — management differs, particularly oxygen dose in COPD.
Question 4: What should be documented following a medical emergency in the dental practice?
- Full contemporaneous record: time, events, vital signs, drugs given, doses, personnel, outcome, and referral (Correct answer)
- Drug name only
- Simply note 'medical emergency' in the record
- No documentation required if resolved
Correct answer: Full contemporaneous record: time, events, vital signs, drugs given, doses, personnel, outcome, and referral
A full record of the medical emergency must be made contemporaneously, including timeline, all treatments, drugs with doses and routes, personnel present, patient response, and any referral or ambulance called.
Question 5: What is the recommended depth of chest compressions in adult CPR?
- 5–6 cm at a rate of 100–120 per minute (Correct answer)
- 2–3 cm
- 8–10 cm
- 3–4 cm at any rate
Correct answer: 5–6 cm at a rate of 100–120 per minute
Resuscitation Council UK guidelines specify chest compressions of 5–6 cm depth at a rate of 100–120 per minute, allowing full chest recoil between compressions.
Question 6: What is the purpose of an automated external defibrillator (AED) and when should it be used?
- Delivers an electric shock to restore normal rhythm in ventricular fibrillation or pulseless VT — use as soon as available (Correct answer)
- Used in all cardiac arrests regardless of rhythm
- Used after 10 minutes of CPR only
- Only used by paramedics
Correct answer: Delivers an electric shock to restore normal rhythm in ventricular fibrillation or pulseless VT — use as soon as available
AEDs analyse cardiac rhythm and deliver a shock for shockable rhythms (VF/pulseless VT); they should be applied and used as soon as available during cardiac arrest, as early defibrillation dramatically improves survival.
ORE Part 2 NHS Dental Contracts & Medical Emergencies 3
What is the 'steroid cover' protocol for a dental patient on long-term oral corticosteroids (prednisolone ≥ 5 mg/day) undergoing a stressful extraction?