RDA Recognition and Management of Medical Emergencies 2 — Questions and Answers

Question 1: What is the FIRST action to take when a patient is found unresponsive in the dental chair?

Administer epinephrine
Activate EMS (call 911) and initiate the office emergency protocol (Correct answer)
Begin CPR immediately without checking for responsiveness first
Administer oxygen via nasal cannula

Correct answer: Activate EMS (call 911) and initiate the office emergency protocol

Upon finding an unresponsive patient, immediately activate the emergency medical services (call 911) and initiate the office emergency protocol while another team member assesses the patient.

When encountering an unresponsive patient, the American Heart Association's Chain of Survival begins with: 1) Recognition and activation of EMS (call 911); 2) Early CPR; 3) Rapid defibrillation; 4) Advanced life support; 5) Post-cardiac arrest care. In the dental setting, while one person calls 911 and retrieves the AED, another assesses the patient — checking responsiveness, calling for a response, checking breathing (no more than 10 seconds), and starting CPR if the patient is not breathing normally. The entire dental team should be trained in BLS.

Question 2: Which emergency drug is used to treat anaphylaxis in the dental office?

Nitroglycerin
Aspirin
Epinephrine (1:1,000) (Correct answer)
Diphenhydramine

Correct answer: Epinephrine (1:1,000)

Epinephrine 1:1,000 (0.3–0.5 mg IM) is the first-line treatment for anaphylaxis. It reverses bronchospasm, vasodilation, and hypotension — the life-threatening components of anaphylactic shock.

Anaphylaxis is a severe, systemic allergic reaction with bronchospasm, urticaria, angioedema, and cardiovascular collapse. Treatment: 1) Stop the offending agent; 2) Call 911; 3) Administer epinephrine 1:1,000 (0.3 mg adult, 0.15 mg child) IM in the anterolateral thigh; 4) Position supine with legs elevated (or sitting if dyspneic); 5) Administer oxygen; 6) Establish IV access; 7) Repeat epinephrine every 5–15 minutes if needed; 8) Consider H1/H2 antihistamines and corticosteroids as secondary treatment. Diphenhydramine alone is inadequate for acute anaphylaxis.

Question 3: What are the classic signs and symptoms of hypoglycemia (low blood sugar) in a diabetic patient?

Polyuria, polydipsia, and dry skin
Trembling, diaphoresis, confusion, and altered consciousness (Correct answer)
Hypertension and flushed skin
Slow pulse and low respiratory rate

Correct answer: Trembling, diaphoresis, confusion, and altered consciousness

Hypoglycemia presents with trembling, shakiness, sweating (diaphoresis), pale skin, confusion, anxiety, and can progress to unconsciousness if untreated.

Hypoglycemia occurs when blood glucose falls below approximately 70 mg/dL. Symptoms progress: mild (trembling, diaphoresis, hunger, anxiety, pallor, tachycardia) → moderate (confusion, difficulty concentrating, blurred vision) → severe (loss of consciousness, seizures). In the dental setting, risk is elevated if the diabetic patient skipped a meal or took extra insulin. Treatment for a conscious patient: administer 15–20 g oral glucose (4 oz juice, glucose tablets, regular soda). For unconscious patients: do not give anything orally; call 911; IV dextrose or IM/intranasal glucagon.

Question 4: A patient complains of chest pain radiating to the left arm during a dental appointment. What is the MOST likely emergency?

Panic attack
Angina or myocardial infarction (Correct answer)
Hyperventilation syndrome
Hypoglycemia

Correct answer: Angina or myocardial infarction

Chest pain radiating to the left arm (possibly also to the jaw, shoulder, or back), with associated shortness of breath, nausea, and sweating, is the classic presentation of angina or myocardial infarction.

When a patient develops chest pain in the dental chair: 1) Stop the procedure; 2) Assess — ask about history of angina (if patient carries nitroglycerin, administer 0.3–0.4 mg sublingual); 3) Call 911 if pain persists beyond 5 minutes or is unrelieved by nitro; 4) Administer aspirin 325 mg (chewed) if patient is not allergic and no contraindications; 5) Administer oxygen; 6) Position patient comfortably (upright if conscious); 7) Monitor vital signs; 8) Prepare AED. Time is critical — myocardial infarction requires immediate advanced care.

Question 5: What is the correct compression-to-ventilation ratio for adult CPR according to the AHA?

5:1
15:2
30:2 (Correct answer)
15:1

Correct answer: 30:2

For adult CPR, the American Heart Association recommends 30 chest compressions followed by 2 rescue breaths (30:2 ratio) when performed by a trained rescuer.

AHA Basic Life Support (BLS) guidelines for adult CPR: Rate = 100–120 compressions/minute; Depth = at least 2 inches (5 cm); Hand placement = lower half of sternum; 30:2 compression to ventilation ratio (for 1 or 2 rescuers without an advanced airway). When an advanced airway (ET tube) is placed: continuous compressions at 100–120/min with one breath every 6 seconds (10 breaths/minute) without pausing compressions. Minimize interruptions — high-quality CPR is the most important intervention before defibrillation is available.

Question 6: How should a patient with known epilepsy who experiences a grand mal (tonic-clonic) seizure in the dental chair be managed?

Restrain the patient's movements firmly to prevent injury
Clear the area, protect the patient from injury, time the seizure, and call 911 if it lasts more than 5 minutes (Correct answer)
Place a bite block between the teeth during the seizure
Administer oxygen via tight-fitting mask throughout the seizure

Correct answer: Clear the area, protect the patient from injury, time the seizure, and call 911 if it lasts more than 5 minutes

During a seizure, clear the area to prevent injury, do NOT restrain the patient or put anything in their mouth, time the seizure, place in recovery position post-ictal, and call 911 if it lasts more than 5 minutes (status epilepticus).

Seizure management in the dental office: 1) Remove objects from the mouth (if accessible safely); 2) Lower patient to the floor or recline chair fully; 3) Clear the area of sharp/hard objects; 4) Do NOT restrain patient's movements — this can cause fractures; 5) Do NOT put objects between teeth (tongue biting is rare; objects cause more harm); 6) Time the seizure — call 911 if it lasts more than 5 minutes; 7) After seizure: place in recovery position (left lateral), assess airway, give oxygen; 8) Do not leave the patient alone until fully conscious. Diazepam or midazolam may be used for status epilepticus.

RDA Recognition and Management of Medical Emergencies 2

What is the FIRST action to take when a patient is found unresponsive in the dental chair?