EMQ/EMI Theme: Emergencies in the Dental Chair
A – Adrenaline 1:1000 (1 mg/ml)
B – Adrenaline 1:10 000 (1 mg/10 ml)
C – Aspirin oral
D – Chlorpheniramine
E – Diazepam
F – Glucagon
G – Glucose
H – Glyceryl trinitrate spray
I – Hydrocortisone (IV)
J – Oxygen
K – Salbutamol
For each of the following scenarios, the most appropriate management option from the list above are all EXCEPT.
1 Following oral administration of a 3 g sachet of amoxicillin, a 20-yearold woman reports shortness of breath and the development of a red rash over her body.
2 A 20-year-old man in your dental surgery waiting room is shaking involuntarily, frothing at the mouth and showing signs of incontinence.
3 A 57-year-old woman with type 1 diabetes collapses in the dental chair and a dipstick shows low blood glucose.
4 While being treated, a 60-year-old man complains of severe central crushing chest pain which radiates down the left arm and nausea. The pain does not respond to glyceryl trinitrate spray and oxygen.
5 A 30-year-old known asthmatic patient has just been told that she has to lose several of her teeth. She begins to wheeze and is short of breath.
EMQ/EMI Theme: Emergencies in the Dental Chair
A – Adrenaline 1:1000 (1 mg/ml)
B – Adrenaline 1:10 000 (1 mg/10 ml)
C – Aspirin oral
D – Chlorpheniramine
E – Diazepam
F – Glucagon
G – Glucose
H – Glyceryl trinitrate spray
I – Hydrocortisone (IV)
J – Oxygen
K – Salbutamol
For each of the following scenarios, the most appropriate management option from the list above are all EXCEPT.
1 Following oral administration of a 3 g sachet of amoxicillin, a 20-yearold woman reports shortness of breath and the development of a red rash over her body.
2 A 20-year-old man in your dental surgery waiting room is shaking involuntarily, frothing at the mouth and showing signs of incontinence.
3 A 57-year-old woman with type 1 diabetes collapses in the dental chair and a dipstick shows low blood glucose.
4 While being treated, a 60-year-old man complains of severe central crushing chest pain which radiates down the left arm and nausea. The pain does not respond to glyceryl trinitrate spray and oxygen.
5 A 30-year-old known asthmatic patient has just been told that she has to lose several of her teeth. She begins to wheeze and is short of breath.
💡 Explanation
**Core Concept**
The management of emergencies in the dental chair requires prompt recognition and treatment of various conditions, including allergic reactions, anaphylaxis, hypoglycemia, myocardial infarction, and asthma exacerbation. Each scenario requires a specific treatment approach, and the correct choice of medication or intervention is crucial to prevent further complications or even death.
**Why the Correct Answer is Right**
1. **Anaphylaxis**: The patient's symptoms, including shortness of breath and a red rash, suggest anaphylaxis, a severe, life-threatening allergic reaction. Adrenaline 1:1000 (1 mg/ml) is the most appropriate treatment, as it rapidly reverses anaphylaxis by increasing heart rate, blood pressure, and bronchodilation. Adrenaline 1:1000 is the preferred choice because it contains a higher concentration of adrenaline, which is essential for rapid treatment.
2. **Tetanus**: The patient's symptoms, including shaking, frothing at the mouth, and incontinence, suggest tetanus, a bacterial infection characterized by muscle rigidity and spasms. Diazepam is the most appropriate treatment, as it rapidly relaxes muscles and helps control spasms. Diazepam has a rapid onset of action and is effective in managing tetanus symptoms.
3. **Hypoglycemia**: The patient's symptoms, including collapse and low blood glucose, suggest hypoglycemia. Glucagon is the most appropriate treatment, as it rapidly increases blood glucose levels by stimulating glycogenolysis and gluconeogenesis. Glucagon is a rapid-acting medication that can help prevent further complications.
4. **Myocardial Infarction**: The patient's symptoms, including central crushing chest pain and nausea, suggest myocardial infarction (MI). However, the lack of response to glyceryl trinitrate spray and oxygen suggests that the patient may be experiencing a non-ST-elevation MI (NSTEMI). In this case, aspirin oral is the most appropriate treatment, as it helps prevent further clot formation and reduces the risk of MI recurrence.
5. **Asthma Exacerbation**: The patient's symptoms, including wheezing and shortness of breath, suggest an asthma exacerbation. Salbutamol is the most appropriate treatment, as it rapidly reverses bronchospasm and improves airflow. Salbutamol is a rapid-acting medication that can provide quick relief for asthma symptoms.
**Why Each Wrong Option is Incorrect**
**Option A:** Adrenaline 1:1000 (1 mg/ml) is not the correct choice for hypoglycemia (scenario 3), as glucagon is the preferred treatment. **Option B:** Adrenaline 1:10 000 (1 mg/10 ml) is not the correct choice for anaphylaxis (scenario 1), as the higher concentration of adrenaline in 1:1000 is preferred. **Option C:** Aspirin oral is not the correct choice for tetanus (scenario 2), as diazepam is the preferred treatment. **Option D:** Diazepam is not the correct choice for asthma exacerbation (scenario 5), as salbutamol is the preferred treatment.
**Clinical Pearl / High-Yield Fact**
In the event of anaphylaxis, rapid administration of adrenaline 1:1000 (1 mg/ml) via intramuscular
✓ Correct Answer: D. 4 K Salbutamol
📤 Share this MCQ
Share Card Preview
👆 1080x1080 square card — fills the full width in WhatsApp and Telegram