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Medical Emergencies · patient case question

A hypertensive patient on lisinopril needs an extraction. After local anaesthesia the blood pressure reads 150/95. What would you do?

Patient case: The medically complex patient in the chair

Scenario: Three management questions in patients with cardiovascular and metabolic disease.

  1. No modification needed — proceed with treatment
  2. Administer an extra 10 mg of lisinopril
  3. Place the patient supine and administer oxygen by mask
  4. Cancel and refer for urgent hypertensive management
Show answer and explanation

Correct answer: A. No modification needed — proceed with treatment

  • A. Correct. 150/95 is a mild, transient elevation entirely consistent with anxiety and the anaesthetic injection. It is well below the threshold for deferring care, so treatment proceeds with routine monitoring.
  • B. A dentist does not dose a patient's antihypertensive. Adjusting prescribed medication is the physician's role, and an extra dose risks hypotension.
  • C. Oxygen and repositioning treat hypotension or syncope, not a mildly raised reading in a comfortable patient.
  • D. Urgent referral is reserved for readings around 180/110 or above, or for a patient with symptoms of end-organ damage.

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