ORE Part 2 NHS Dental Contracts & Medical Emergencies 1 — Questions and Answers
Question 1: What is the initial management of an anaphylactic reaction in a dental surgery?
- Call 999, administer IM adrenaline 0.5 mg (500 mcg) 1:1000, lie flat with legs elevated, give oxygen (Correct answer)
- Give oral antihistamine and monitor
- IV corticosteroids as first-line treatment
- Adrenaline 1:10,000 IV only
Correct answer: Call 999, administer IM adrenaline 0.5 mg (500 mcg) 1:1000, lie flat with legs elevated, give oxygen
Anaphylaxis management follows the Resuscitation Council algorithm: call 999, administer IM adrenaline 0.5 mg (1:1000) to the anterolateral thigh, position (supine/legs elevated unless breathing difficulty), and give high-flow oxygen.
Question 2: What is the correct dose of aspirin in the management of a suspected myocardial infarction in a dental practice?
- 300 mg dispersible aspirin orally (if not contraindicated) (Correct answer)
- 75 mg aspirin
- 500 mg aspirin
- 1000 mg aspirin
Correct answer: 300 mg dispersible aspirin orally (if not contraindicated)
300 mg dispersible aspirin (chewed or dissolved) is the recommended dose for suspected MI, providing rapid antiplatelet effect while awaiting emergency services.
Question 3: What is the recommended management of hypoglycaemia in a conscious diabetic patient in the dental surgery?
- 15–20 g of fast-acting carbohydrate orally (e.g., glucose gel, sugary drink), repeat if no improvement in 15 min (Correct answer)
- Glucagon IM only
- IV dextrose as first line
- Call 999 immediately without any oral treatment
Correct answer: 15–20 g of fast-acting carbohydrate orally (e.g., glucose gel, sugary drink), repeat if no improvement in 15 min
Conscious patients with hypoglycaemia can swallow; 15–20 g of rapidly absorbed oral carbohydrate (glucose gel, 150–200 ml fruit juice) is the first-line treatment, repeated after 15 minutes if no improvement.
Question 4: What drug and dose is used for an acute asthma attack not responding to a salbutamol inhaler in a dental practice?
- Repeat salbutamol puffs (10 puffs via spacer), call 999, give oxygen, and consider IM adrenaline if severe (Correct answer)
- Oral prednisolone tablet
- IV aminophylline in the surgery
- Nebulised ipratropium as first line
Correct answer: Repeat salbutamol puffs (10 puffs via spacer), call 999, give oxygen, and consider IM adrenaline if severe
For acute severe asthma: 10 puffs of salbutamol via spacer (100 mcg per puff), high-flow oxygen, call 999; if anaphylaxis-related or life-threatening, IM adrenaline is indicated.
Question 5: What is the correct management of a patient who collapses with a witnessed cardiac arrest in a dental surgery?
- Call 999, start CPR (30:2), use the AED as soon as available, continue until help arrives (Correct answer)
- Start CPR without calling 999
- Give adrenaline before starting CPR
- Perform precordial thump first in all cases
Correct answer: Call 999, start CPR (30:2), use the AED as soon as available, continue until help arrives
Cardiac arrest management: call for help/999 immediately, commence CPR at 30:2, attach and use the AED as soon as available, and continue until emergency services arrive.
Question 6: What emergency drug must all dental practices in the UK stock according to Resuscitation Council and GDC guidelines?
- Adrenaline 1:1000 (IM) (Correct answer)
- Atropine
- Digoxin
- Heparin
Correct answer: Adrenaline 1:1000 (IM)
Adrenaline 1:1000 for IM injection is the single most important emergency drug required in all dental practices, primarily for the management of anaphylaxis.
ORE Part 2 NHS Dental Contracts & Medical Emergencies 1
What is the initial management of an anaphylactic reaction in a dental surgery?