RDA Recognition and Management of Medical Emergencies 5 — Questions and Answers
Question 1: A patient with epilepsy has a tonic-clonic seizure in the chair. Which action is CONTRAINDICATED during the seizure?
- Timing the duration of the seizure
- Placing a bite block or tongue depressor between the teeth (Correct answer)
- Protecting the patient from nearby sharp objects
- Lowering the dental chair to prevent falling
Correct answer: Placing a bite block or tongue depressor between the teeth
Nothing should be inserted into the mouth of a seizing patient; bite blocks or tongue depressors can cause injury to the patient and clinician.
Question 2: Which of the following signs is MOST indicative of an impending hyperventilation episode?
- Bradycardia and flushing
- Rapid shallow breathing, dizziness, and tingling in the extremities (Correct answer)
- Profuse sweating and chest pain
- Slurred speech and unilateral weakness
Correct answer: Rapid shallow breathing, dizziness, and tingling in the extremities
Hyperventilation presents with rapid shallow breathing, dizziness, perioral tingling, and tingling in the hands/feet due to decreased CO2 levels.
Question 3: When managing a hyperventilating patient, the dental team should FIRST:
- Administer supplemental oxygen
- Have the patient breathe slowly and coach calm breathing (Correct answer)
- Place the patient in Trendelenburg position
- Administer epinephrine
Correct answer: Have the patient breathe slowly and coach calm breathing
Coaching slow, controlled breathing to raise CO2 levels is the primary treatment for hyperventilation; supplemental oxygen is not indicated.
Question 4: A patient loses consciousness during a procedure. After activating EMS, the patient has a pulse but is not breathing normally. The dental team should:
- Begin chest compressions at 100-120/min
- Deliver rescue breaths at 1 breath every 5-6 seconds (Correct answer)
- Place the patient in Trendelenburg and monitor
- Administer epinephrine immediately
Correct answer: Deliver rescue breaths at 1 breath every 5-6 seconds
When a pulse is present but breathing is absent or inadequate, rescue breathing at 1 breath every 5-6 seconds (10-12/min) is appropriate.
Question 5: Which of the following is the MOST reliable early sign of local anesthetic systemic toxicity (LAST)?
- Bradycardia
- Perioral numbness and metallic taste (Correct answer)
- Hypotension
- Cyanosis
Correct answer: Perioral numbness and metallic taste
Early CNS signs of LAST include perioral numbness, tingling, and metallic taste, which precede more severe cardiovascular and neurological effects.
Question 6: A patient taking a beta-blocker for hypertension experiences anaphylaxis. The usual dose of epinephrine produces minimal response. Which additional drug should be considered?
- Diphenhydramine
- Glucagon (Correct answer)
- Atropine
- Nitroglycerin
Correct answer: Glucagon
Glucagon can bypass beta-receptor blockade and produce positive inotropic and chronotropic effects in patients on beta-blockers who are unresponsive to epinephrine.
Question 7: During a procedure, a patient suddenly develops unilateral facial drooping, slurred speech, and arm weakness. The dental team suspects a stroke. The MOST appropriate immediate action is to:
- Administer aspirin 325 mg immediately
- Activate EMS and note the exact time symptoms began (Correct answer)
- Place the patient supine and monitor vital signs
- Administer oxygen and reassess in 10 minutes
Correct answer: Activate EMS and note the exact time symptoms began
EMS must be activated immediately and the exact time of symptom onset documented, as thrombolytic therapy is time-critical (within 3-4.5 hours) for ischemic stroke.
RDA Recognition and Management of Medical Emergencies 5
A patient with epilepsy has a tonic-clonic seizure in the chair.
Which action is CONTRAINDICATED during the seizure?