Medical Emergencies · patient case question
A blood pressure of 180/120 mmHg in an asymptomatic patient with no end-organ signs is best managed by:
Patient case: Three Emergencies in One Afternoon
Patient: Three separate patients seen the same afternoon
Chief Complaint: (1) A crown slipped from the forceps and the patient swallowed it. (2) A patient's blood pressure reads 180/120 mmHg at screening. (3) A patient has a generalised seizure lasting seven minutes.
Background: Patient 1: routine crown cementation, coughed once then settled. Patient 2: known hypertensive, took no medication this morning, asymptomatic. Patient 3: known epilepsy, missed his medication.
Medications: Patient 2: amlodipine. Patient 3: levetiracetam.
Vital Signs: Patient 1: SpO₂ 99%, RR 16, speaking in full sentences. Patient 2: BP 180/120 mmHg confirmed on repeat, HR 88. Patient 3: post-ictal, then becomes cyanotic.
Findings: Patient 1: no stridor, no wheeze, no distress. Patient 2: no chest pain, no headache, no visual change, no neurological deficit. Patient 3: recovered consciousness briefly, then developed central cyanosis.
Show answer and explanation
Correct answer: C. Deferring elective treatment and arranging prompt medical evaluation, same day
- A. Emergency transport is for hypertensive EMERGENCY — the same pressures WITH end-organ damage: chest pain, dyspnoea, severe headache, visual disturbance, neurological deficit, or altered consciousness. This patient has none.
- B. No elective dental treatment should proceed at this pressure, with or without vasoconstrictor modification.
- C. CORRECT. Systolic 180 or above, or diastolic 120 or above, is a HYPERTENSIVE CRISIS. Without symptoms or evidence of end-organ damage it is a hypertensive URGENCY, which requires that elective dental treatment be deferred and the patient be evaluated medically promptly — the same day — but does not require an ambulance.
- D. A three-month deferral is dangerously complacent at this pressure.
Note: ⚑ The recall keyed 'send to the ER'. That is correct for a hypertensive EMERGENCY. For an asymptomatic urgency the accepted answer is defer and refer urgently — recognise which one the stem is describing. Thresholds for deferral: BP ≥180/110–120 defer; 160–179 / 100–109 proceed with caution, short appointments, minimal stress and limited epinephrine; below 160/100 proceed normally.
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