MEDICAL HISTORY TAKING/EMERGENCIES OSCE

Question 1

List FOUR emergency drugs* essential for every dental practise:

Answer 1

GTN spray
Adrenaline
Salbutamol Inhaler
Aspirin (300mg tablets)

Question 2

List FOUR emergency pieces of equipment* essential for every dental practise:

Answer 2

• Oxygen face mask & tubing
• External defibrillator
• Pulse oximeter
• Blood glucose measurement device

Question 3

A patient appears to go into anaphylaxis shock in the dental chair, what steps would you follow?

Answer 3

• call 999, state anaphylaxis
• lie flat, administer oxygen 15litres/minute
• administer adrenaline 500 micrograms IM
• repeat adrenaline at 5 minute intervals until adequate response

Question 4

A 50 y/o patient appears to go into anaphylaxis shock in the dental surgery, you decide to administer a drug to help. What drug & dosage would you use?

Answer 4

ADRENALINE

• 500 micrograms (0.5mls 1:1000) IM
• may be repeated at 5 minute intervals until an adequate response is achieved

Question 5

A patient within the dental practise becomes increasingly breathless & wheezy, they reveal to you that they suffer from asthma. What do you do?

Answer 5

• sit upright and follow patients asthma plan if they have it
• if not administer 2 puffs of Beta2 Bronchodilator inhaler such as salbutamol
• if no response/life threatening: call 999, oxygen 15Litres/Min, via spacer give one puff at a time of salbutamol (every 60 secs, max 10 puffs)

Question 6

Why would GTN spray need to be used in the dental practise? What dose?

Answer 6

• angina or suspected heart attack
• 2 sprays (sublingually)
• may be repeated

Question 7

An adult patient begins complaining of sudden chest pain and a tingling sensation down their arm while in the dental chair, they appear pale and begin to sweat. What would your immediate response be?

Answer 7

• call 999, state “heart attack”
• get the patient in a comfortable position
• give GTN spray (1-2 sprays sublingually)
• give patient aspirin to chew
  (be ready to give BLS if condition worsens)

Question 8

When might aspirin need to be used in the dental practise? (explain dosage)

Answer 8

• suspected heart attack

- 300mg oral chewed

Question 9

A patient suddenly collapses in the surgery and loses consciousness, they begin jerking and breathing noisily as well as frothing at the mouth. What is happening? What is your immediate response?

Answer 9

Epileptic Seizure

• get patient in a safe environment, remove anything from mouth and do not restrain
• administer oxygen 15L/min
• note timings of seizure
• call 999 if necessary
• if seizure is prolonged (>5mins) give midazolam oromucosal solution

Question 10

Why might midazolam oromucosal solution be used in the dental practise? What dosage would be used?

Answer 10

Prolonged convulsive seizures (> 5 mins) or repeated seizures (> 3 in one hour)
- buccal route as a single dose of 10mg

Question 11

Why might glucose be used in the dental practise? What dosage would be given?

Answer 11

Patient suffering from a hypoglycaemic attack (able to swallow & co-operative)
- 15-20g quick acting glucose

Question 12

Why might glucagon be used in the dental practise? What dosage would be given?

Answer 12

Patient is suffering from a hypoglycaemic attack (unable to swallow safely e.g unconscious)
- 1mg IM

Question 13

what aspects should be covered when taking a patients medical history?

Answer 13

• cardiovascular
• respiratory
• endocrine
• gastrointestinal
• blood disorders
• seizures/fits/headaches
• mucoskeletal
  THEN MEDICATIONS AT END & ALLERGY

Question 14

how would you assess a patients cardiovascular health?

Answer 14

• do you have any heart conditions such as angina/heart attack/heart failure?
• any blood pressure problems?
• history of a stroke or clot?

Question 15

how would you assess a patients respiratory health?

Answer 15

• do they have any breathing problems such as asthma/COPD

- do they ever use inhaler

Question 16

how would you assess a patients gastrointestinal health?

Answer 16

• do they have any gut problems such as Crohn’s/Ulcerative colitis
• do they have any reflux or stomach problems
• any liver problems?

Question 17

how would you assess a patient neurological health?

Answer 17

• do you have history of fits/seizures/faints

- any headache history

Question 18

how would you assess a patients endocrinological health?

Answer 18

• any history of diabetes

- any history of thyroid dysfunction

Question 19

how would you assess a patients mucoskeletal health?

Answer 19

• do you have any history of arthritis or joint problems?

- any bone disorders?

Question 20

how would you assess if a patient has any blood disorders?

Answer 20

• do you experience prolonged bleeding after a cut?
• any blood disorders such as haemophilia?
• any transmitted blood disorders eg HIV/Hepatitis?

Question 21

how do you know if a patients allergy to something is mild or severe?

Answer 21

ask if they have had any hospital admissions related to the allergy

Question 22

If you suspect a patient is going through/went through a traumatic health disorder, how would you raise your concern in a polite way?

Answer 22

Ask if they had any previous hospital admissions/seen any specialists for a problem

Question 23

How does aspirin work to help a patient suffering from a suspected heart attack?

Answer 23

Inhibits platelet aggregation

- thins the blood making it less likely to clot

Question 24

How does GTN spray work to help a patient suffering acute anginal distress?

Answer 24

• Dilates veins which reduces preload to heart

- Dilates colateral coronary artery supply (reduce anginal pain)