Medical History Evaluation Management of

Medical Emergencies

Workbook Questions & Answers

Question 1 Mrs. B is a recall patient who has come to your office for a routine exam and dental prophylaxis. You know from past experience that she is very nervous and anxious about dental treatment. During the dental prophylaxis, Mrs. B suddenly complains of being dizzy and of numbness and tingling in her hands and feet. You notice her breathing has become quick and deep. What is the probable cause of these symptoms? What action should you take?

Question 2 Mr. G is a 53 year-old recall patient who has come to your office for a routine exam and oral prophylaxis. During the appointment, you notice Mr. G has begun to perspire profusely. When you ask how he feels, he complains of severe chest pain radiating to his shoulders and of nausea. What is the probable cause of these symptoms? What action would you take?

Question 3 Ms. P is a new patient. Due to unforeseen circumstances her appointment runs into the noon hour. As you are completing the procedure, Ms. P becomes quite restless'. You notice a pallor to her complexion and her skin feels cold and clammy. When you feel her pulse, it is rapid and irregular. What is the probable cause of these symptoms? What action would you take?

Question 4 Mrs. T has come to your office for an extensive dental treatment requiring several hours in the dental chair. She is extremely nervous about the procedure and remains tense throughout the appointment. As she prepares to leave, she mentions feeling a little queasy. You notice a pallor to her complexion and that she is perspiring. As she begins to rise, she loses consciousness. What is the probable cause of these symptoms? What action would you take?

Question 5 Mr. V is a new patient. He has come in for a routine examination and dental prophylaxis. In the middle of his examination, he complains of chest pain. You check his vital signs and find they are normal. What is the probable cause of these symptoms? What action would you take?

Insight to Question 1 Mrs. B is hyperventilating. Stop the dental procedure. Attempt to calm the patient and have her breathe slowly and regularly. Provide basic life support as needed. Have the patient breathe into a small paper bag allowing the concentration of carbon dioxide to increase and be rebreathed. Oxygen is not indicated in the management of this patient. Once the symptoms clear and the patient returns to normal, continue the dental procedure.

Insight to Question 2 Until proven otherwise, assume that Mr. G is having a heart attack. Stop the dental procedure and take his pulse rate and blood pressure. Place the patient in a comfortable position, usually a semi-supine position. Provide basic life support as needed. Call About 5-10% of the patients infected with the hepatitis B virus become chronic carriers meaning they remain infective and many develop significant chronic liver disease. Refer Ms. P for medical evaluation to confirm her carrier status and whether chronic liver disease is present. Patients carrying the hepatitis B virus, need to be informed of the implications of this status, for example, sexual activity can transmit the virus. As with any other patient, use standard precautions when treating Ms. P. If chronic liver disease is present, she may be susceptible to bleeding and should be evaluated for such prior to invasive dental procedures. A bleeding problem can result from a deficiency of coagulation factors produced by the liver and excessive destruction of platelets by the spleen if portal hypertension is associated with the diseased liver. With chronic liver disease, use drugs metabolized by the liver in reduced dosage. Also, avoid drugs toxic to the liver.

Insight to Question 3 Ms. P may be hypoglycemic or showing the early symptoms of syncope. Give her a source of glucose such as cola, orange juice, or oral carbohydrate (glucose) preparation. Every dental office must provide glucose in some form for patients with symptoms of hypoglycemia. In most cases, hypoglycemic patients will be diabetic patients experiencing an insulin reaction. Monitor the patient's vital signs. If the symptoms clear, observe the patient for about an hour and then discharge her. If the symptoms continue, place the patient in a supine position with the feet elevated. Be prepared to implement basic life support procedures. If recovery is not immediate, call EMS and administer oxygen. If the patient loses consciousness, administer ammonia by inhalation. Place a cold towel on the patient's forehead and blankets over her body for warmth.

Insight to Question 4 Mrs. T appears to be having an attack of postural hypotension or vasodepressor syncope. Return the patient to the dental chair and place her in a supine position with feet elevated. Summon office staff for assistance. Open the patient's airway using the head tilt-chin lift maneuver. Assess airway patency and breathing. Then assess the patient's circulation by palpating the carotid pulse. If recovery is not immediate, call EMS. Administer oxygen and monitor the vital signs. Administer ammonia by inhalation. Place a cold towel on the patient's forehead and blankets over her body for warmth. Older patients and those with significant medical conditions should have the dental chair slowly brought back to a seating position and then after a brief wait helped out of the chair by supporting them for the first few steps.

Insight to Question 5 Mr. V may be having an attack of angina pectoris or a non-cardiac attack from a source such as anxiety or gastric pain. Stop the dental procedure and place the patient in a comfortable position, typically a semi-supine position. Call EMS. Administer sublingual nitroglycerin and oxygen (once every 5 minutes for 15 minutes). In most cases, the pain will be relieved within several minutes. If the pain is still present after 15 minutes, the patient may be having a myocardial infarct. Make arrangements to transport the patient to a medical facility for further evaluation and treatment if necessary.