Medical Emergencies: Case Studies
2025/2026 new!!
Your 1:00 p.m. oral prophylaxis patient, John Brown, is a 79-year-old male retired
service salesman for an automobile dealership. He is in fair health and suffered from a
previous myocardial infarction four years ago. You take his vital signs (pulse,
respiration, and blood pressure) and find the following readings:
Pulse: 102 beats/minute
Respiration: 22 respirations/minute and exaggerated
Blood pressure: 150/98 mmHg
What can you conclude from the vital signs?
Vital signs are significantly elevated. His/Her pulse is 102, and the normal range is 60-
90 beats/minute. His/Her respirations are 22 and exaggerated, whereas the normal RR
is 12-20. His/Her blood pressure places him/her in the Stage 1 hypertension
range. Taken in combination, this individual should be referred to his/her physician for
an examination prior to treatment.
Your 2:00 p.m. patient, Harry Fredericks, is a 62-year-old male postal worker and is new
to your practice. His history indicates daily intake of hypertension medications, but he
states that he does not like to take them due to the side effects. Other
than hypertension, his medical history is negative.
Blood pressure: 188/112 mmHg
Pulse: 86 beats/minute
Respiration: 16 respirations/minute
What is the medical significance of the information stated by the patient and the
recorded blood pressure?
Indicated that he/she has a history of hypertension, but is noncompliant in the use of
antihypertensives. His/her extremely high blood pressure and lack of any other form of
target end organ damage should indicate to the clinician that he is most likely suffering
from hypertensive urgency; however, the final determination on the diagnosis will be
performed in the emergency department. The clinician retook his/her blood pressure
and determined it to be significantly elevated at 186/110 mmHg. He/She were seated
upright, and EMS was contacted. Oxygen was administered via nasal cannula at 4
L/minute. He/She was treated in the emergency room for hypertensive urgency and was
given Captopril, an angiotensin- converting enzyme inhibitor. He/She was administered
the drug orally, and within 30 minutes his/her blood pressure had returned to a
reasonable range. After this experience he/she was convinced that his hypertension
was a serious concern and he/she took his antihypertensive medication as prescribed.
Your third patient this morning, David Michaels, is a 52 year old male. He was seen last
week for an initial examination. He has not received Dental or dental hygiene care in
approximately 7 years. At his last visit last week, it was determined that he has a class 3
periodontitis and moderate to heavy calculus deposits requiring four quadrants of
periodontal debridement with anesthesia.The patient reluctantly agreed to this treatment
plan in today is 5 minutes late for his 10 a.m. appointment to begin debridement of the
mandibular right quadrant. You greet him in the reception area and accompany him to
,the operatory. You review his medical history and perform an intra/extraoral
examination and find no significant findings or contradictions to treatment. His vital signs
are within normal limits although slightly elevated, which you attribute to his anxiety.
(pulse 88, respirations 16, BP 138/88 mm Hg) Reviewing his personal oral hygiene
seems to place him at ease. You're prepared with the anesthetic syringe prior to his
arrival and approach him with a topical anesthetic on a cotton tipped applicator. You
notice that he's become quite pale and the hairs on his arms are standing up. He is
beginning to sweat profusely & frequently yawns. You ask him if he's feeling well, he
states that he's fine, just a little nervous and a bit dizzy. You pick up the syringe and
notice that he has lost consciousness.
Syncope is the most common medical emergency to occur in the dental office,
therefore, it is imperative that the dental professional be familiar with the physiology,
types, signs and symptoms, and treatment procedures. Usually syncope is a benign
condition and if treated promptly incorrectly results without further complication. It is
apparent that the patient in the case scenario, was experiencing syncope. His/her
symptoms of pallor, diaphoresis, yawning, pillow erection, and dizziness were key
indicators that his autonomic nervous system had been activated and vasovagal
syncope resulted. He/she was not experiencing any chest pain or severe headache
prior to his loss of consciousness (common in MI & CVA), so these two emergencies
can most likely be ruled out. The operator placed him/her in a Supine position with his
feet elevated and placed a cool cloth on his head. Within a very short time he/she
regained consciousness, and he remained in a supine position for 15 minutes. His wife
was called to drive him home. Treatment was postponed, and a prescription for
Lorazepam was provided to him/her. He/She will take a Lorazepam as directed before
his next visit to reduce the likelihood of another syncopal
Your first patient after lunch is Beth Crockett, a 21 year old normally healthy female who
is in your office for her initial examination. While you review the medical history, Beth
informs you that yesterday she had an automobile accident in which her airbag
deployed. She was sent to the emergency department, where she was treated for minor
cuts and abrasions and released. Today she presents with the following symptoms:
increase blood pressure of mm Hg, increase pulse rate of 92 that is weak, and
thready, pale skin, and she seemed somewhat confused and is becoming less coherent
as time goes on. Beth reports that she had some pain in her abdominal area since the
accident.
Shock could be a very serious condition that requires early intervention. The symptoms
our patient exhibited seemed rather benign, however, when they are coupled with a
recent automobile accident and his/her confused state, the concept of shock could be
considered. Also, his/her weak, thready pulse, pale skin, and reduction in coherence
should prompt the clinician to suspect hypovolemic shock due to internal hemorrhage
from the accident. He/She was given 6 liters of oxygen per minute via a non-rebreather
mask. EMS was contacted for transport to the emergency department. Her vital signs
were monitored until EMS arrived. Once in the emergency department he/she was
administered IV fluids, and it was determined that he/she had a liver laceration for which
he/she was treated surgically. He/She recovered fully within 2 weeks and returned to
work.
, Your 34 year old, female patient, Alexandra Harnish, is scheduled for her first
periodontal debridement appointment. She's a fairly new patient to your office and was
seen last week for her initial examination. She informs you that this is not an experience
she enjoys, she has had an unpleasant dental experience in the past. Her medical
history is negative but today she seems unusually anxious and complains of being dizzy
and lightheaded. You take her Vital Signs and find them elevated (pulse 84, respiration
18, blood pressure mm Hg) but still within the normal range, so you begin
treatment. Following the anesthetic injection, you begin the debridement procedure and
Alexandria begins to breathe rapidly and deeply. She could not seem to catch her
breath. She complains of a tingly feeling in her face particularly around her mouth. You
noticed that her fingers are beginning to tense and curl. Her skin is pale, moist, and
cool.
Hyperventilation is a common emergency seen by the dental professional because for
many patients a visit to the dental office could be an anxiety inducing experience. The
patient in the case scenario presented to the office with a negative medical history but
today he/she seemed quite anxious. His/Her vital signs were slightly elevated as
compared to his/her baseline readings. His/Her sudden onset of tachypnea and a
feeling of suffocation are common symptoms of hyperventilation. The circumoral
paresthesia that he/she exhibited is the result of respiratory alkalosis. The tension and
her fingers, carpopedal spasms, is the result of the hypocalcemia accompanying
hyperventilation. The clinician places the patient in an upright position and asks the
patient to count to ten in one breath and to breathe through her nose. The proper
method was demonstrated. In addition, the dental practitioner monitored his/her Vital
Signs, Which shortly returned to normal, as did her breathing pattern. The clinician and
he/she discussed their concerns regarding her treatment, and the clinician thoroughly
explained the procedure and this seemed to put the patient at ease. The periodontal
debridement was performed without further incident.
Your patient Cindy Rainey, a 15 year old female, comes into the office for her six-month
checkup accompanied by several of her friends. From past visits and from the medical
history update, you know that she is under treatment for a seizure disorder and that
she's had a tonic-clonic seizure about a month ago. Cindy informs you that her seizures
seem to occur more frequently around her menstrual cycle, which she is experiencing
presently. She answers your questions with a somewhat irritable attitude and indicates
that she is taking her medication (200 mg of Topiramate bid). She states that she does
not want to discuss her medical problems any further. Her oral hygiene is poor, and you
start to reinforce brushing instructions when she states that she has a bad headache.
Her body becomes rigid and she starts having convulsions.
The back of the dental chair should be lowered and an assistant should be summoned.
All dental equipment is moved out of the way, and he/she should be positioned on her
side. The first operator remains at her head while the second operator stations himself
or herself at the foot of the chair. The dental receptionist calls 911 and his/her parents.
In this scenario the 3rd operator is responsible for monitoring his/her vitals and timing
the seizure. He/She should not be restrained but should be prevented from falling out of
the chair or injuring herself on another dental equipment. Oxygen should be
administered at a rate of 6-8 liters per minute. After the seizure has ceased, he/she is
very disoriented and embarrassed at having become incontinent. Operator one remains
2025/2026 new!!
Your 1:00 p.m. oral prophylaxis patient, John Brown, is a 79-year-old male retired
service salesman for an automobile dealership. He is in fair health and suffered from a
previous myocardial infarction four years ago. You take his vital signs (pulse,
respiration, and blood pressure) and find the following readings:
Pulse: 102 beats/minute
Respiration: 22 respirations/minute and exaggerated
Blood pressure: 150/98 mmHg
What can you conclude from the vital signs?
Vital signs are significantly elevated. His/Her pulse is 102, and the normal range is 60-
90 beats/minute. His/Her respirations are 22 and exaggerated, whereas the normal RR
is 12-20. His/Her blood pressure places him/her in the Stage 1 hypertension
range. Taken in combination, this individual should be referred to his/her physician for
an examination prior to treatment.
Your 2:00 p.m. patient, Harry Fredericks, is a 62-year-old male postal worker and is new
to your practice. His history indicates daily intake of hypertension medications, but he
states that he does not like to take them due to the side effects. Other
than hypertension, his medical history is negative.
Blood pressure: 188/112 mmHg
Pulse: 86 beats/minute
Respiration: 16 respirations/minute
What is the medical significance of the information stated by the patient and the
recorded blood pressure?
Indicated that he/she has a history of hypertension, but is noncompliant in the use of
antihypertensives. His/her extremely high blood pressure and lack of any other form of
target end organ damage should indicate to the clinician that he is most likely suffering
from hypertensive urgency; however, the final determination on the diagnosis will be
performed in the emergency department. The clinician retook his/her blood pressure
and determined it to be significantly elevated at 186/110 mmHg. He/She were seated
upright, and EMS was contacted. Oxygen was administered via nasal cannula at 4
L/minute. He/She was treated in the emergency room for hypertensive urgency and was
given Captopril, an angiotensin- converting enzyme inhibitor. He/She was administered
the drug orally, and within 30 minutes his/her blood pressure had returned to a
reasonable range. After this experience he/she was convinced that his hypertension
was a serious concern and he/she took his antihypertensive medication as prescribed.
Your third patient this morning, David Michaels, is a 52 year old male. He was seen last
week for an initial examination. He has not received Dental or dental hygiene care in
approximately 7 years. At his last visit last week, it was determined that he has a class 3
periodontitis and moderate to heavy calculus deposits requiring four quadrants of
periodontal debridement with anesthesia.The patient reluctantly agreed to this treatment
plan in today is 5 minutes late for his 10 a.m. appointment to begin debridement of the
mandibular right quadrant. You greet him in the reception area and accompany him to
,the operatory. You review his medical history and perform an intra/extraoral
examination and find no significant findings or contradictions to treatment. His vital signs
are within normal limits although slightly elevated, which you attribute to his anxiety.
(pulse 88, respirations 16, BP 138/88 mm Hg) Reviewing his personal oral hygiene
seems to place him at ease. You're prepared with the anesthetic syringe prior to his
arrival and approach him with a topical anesthetic on a cotton tipped applicator. You
notice that he's become quite pale and the hairs on his arms are standing up. He is
beginning to sweat profusely & frequently yawns. You ask him if he's feeling well, he
states that he's fine, just a little nervous and a bit dizzy. You pick up the syringe and
notice that he has lost consciousness.
Syncope is the most common medical emergency to occur in the dental office,
therefore, it is imperative that the dental professional be familiar with the physiology,
types, signs and symptoms, and treatment procedures. Usually syncope is a benign
condition and if treated promptly incorrectly results without further complication. It is
apparent that the patient in the case scenario, was experiencing syncope. His/her
symptoms of pallor, diaphoresis, yawning, pillow erection, and dizziness were key
indicators that his autonomic nervous system had been activated and vasovagal
syncope resulted. He/she was not experiencing any chest pain or severe headache
prior to his loss of consciousness (common in MI & CVA), so these two emergencies
can most likely be ruled out. The operator placed him/her in a Supine position with his
feet elevated and placed a cool cloth on his head. Within a very short time he/she
regained consciousness, and he remained in a supine position for 15 minutes. His wife
was called to drive him home. Treatment was postponed, and a prescription for
Lorazepam was provided to him/her. He/She will take a Lorazepam as directed before
his next visit to reduce the likelihood of another syncopal
Your first patient after lunch is Beth Crockett, a 21 year old normally healthy female who
is in your office for her initial examination. While you review the medical history, Beth
informs you that yesterday she had an automobile accident in which her airbag
deployed. She was sent to the emergency department, where she was treated for minor
cuts and abrasions and released. Today she presents with the following symptoms:
increase blood pressure of mm Hg, increase pulse rate of 92 that is weak, and
thready, pale skin, and she seemed somewhat confused and is becoming less coherent
as time goes on. Beth reports that she had some pain in her abdominal area since the
accident.
Shock could be a very serious condition that requires early intervention. The symptoms
our patient exhibited seemed rather benign, however, when they are coupled with a
recent automobile accident and his/her confused state, the concept of shock could be
considered. Also, his/her weak, thready pulse, pale skin, and reduction in coherence
should prompt the clinician to suspect hypovolemic shock due to internal hemorrhage
from the accident. He/She was given 6 liters of oxygen per minute via a non-rebreather
mask. EMS was contacted for transport to the emergency department. Her vital signs
were monitored until EMS arrived. Once in the emergency department he/she was
administered IV fluids, and it was determined that he/she had a liver laceration for which
he/she was treated surgically. He/She recovered fully within 2 weeks and returned to
work.
, Your 34 year old, female patient, Alexandra Harnish, is scheduled for her first
periodontal debridement appointment. She's a fairly new patient to your office and was
seen last week for her initial examination. She informs you that this is not an experience
she enjoys, she has had an unpleasant dental experience in the past. Her medical
history is negative but today she seems unusually anxious and complains of being dizzy
and lightheaded. You take her Vital Signs and find them elevated (pulse 84, respiration
18, blood pressure mm Hg) but still within the normal range, so you begin
treatment. Following the anesthetic injection, you begin the debridement procedure and
Alexandria begins to breathe rapidly and deeply. She could not seem to catch her
breath. She complains of a tingly feeling in her face particularly around her mouth. You
noticed that her fingers are beginning to tense and curl. Her skin is pale, moist, and
cool.
Hyperventilation is a common emergency seen by the dental professional because for
many patients a visit to the dental office could be an anxiety inducing experience. The
patient in the case scenario presented to the office with a negative medical history but
today he/she seemed quite anxious. His/Her vital signs were slightly elevated as
compared to his/her baseline readings. His/Her sudden onset of tachypnea and a
feeling of suffocation are common symptoms of hyperventilation. The circumoral
paresthesia that he/she exhibited is the result of respiratory alkalosis. The tension and
her fingers, carpopedal spasms, is the result of the hypocalcemia accompanying
hyperventilation. The clinician places the patient in an upright position and asks the
patient to count to ten in one breath and to breathe through her nose. The proper
method was demonstrated. In addition, the dental practitioner monitored his/her Vital
Signs, Which shortly returned to normal, as did her breathing pattern. The clinician and
he/she discussed their concerns regarding her treatment, and the clinician thoroughly
explained the procedure and this seemed to put the patient at ease. The periodontal
debridement was performed without further incident.
Your patient Cindy Rainey, a 15 year old female, comes into the office for her six-month
checkup accompanied by several of her friends. From past visits and from the medical
history update, you know that she is under treatment for a seizure disorder and that
she's had a tonic-clonic seizure about a month ago. Cindy informs you that her seizures
seem to occur more frequently around her menstrual cycle, which she is experiencing
presently. She answers your questions with a somewhat irritable attitude and indicates
that she is taking her medication (200 mg of Topiramate bid). She states that she does
not want to discuss her medical problems any further. Her oral hygiene is poor, and you
start to reinforce brushing instructions when she states that she has a bad headache.
Her body becomes rigid and she starts having convulsions.
The back of the dental chair should be lowered and an assistant should be summoned.
All dental equipment is moved out of the way, and he/she should be positioned on her
side. The first operator remains at her head while the second operator stations himself
or herself at the foot of the chair. The dental receptionist calls 911 and his/her parents.
In this scenario the 3rd operator is responsible for monitoring his/her vitals and timing
the seizure. He/She should not be restrained but should be prevented from falling out of
the chair or injuring herself on another dental equipment. Oxygen should be
administered at a rate of 6-8 liters per minute. After the seizure has ceased, he/she is
very disoriented and embarrassed at having become incontinent. Operator one remains
