Medical Emergencies · patient case question
On being returned to the upright position, a patient reports dizziness and light-headedness. What has occurred?
Patient case: Emergencies and risk assessment
demo: Assorted patients
chief: Several patients present with findings that alter the safety of planned dental care.
history: One patient with well-controlled asthma using albuterol reports her last attack was ten months ago. Another feels faint on being returned to upright. A third has type 1 diabetes and presents unwell with deep rapid breathing and a fruity breath odour.
meds: Albuterol; insulin; various.
findings: Not applicable.
Show answer and explanation
Correct answer: B. Orthostatic hypotension
- A. A hypertensive crisis produces headache and visual change with markedly raised pressure, not positional light-headedness.
- B. Correct. Orthostatic hypotension is a fall in blood pressure on assuming an upright position, when gravity pools blood in the lower body faster than baroreceptor reflexes compensate. It is common in older patients and in anyone on antihypertensives, diuretics or drugs with anticholinergic effects. Return them to supine, then raise the chair slowly with a pause seated before standing.
- C. Hypoglycaemia produces tremor, sweating, hunger and confusion and is not related to chair position.
- D. Vasovagal syncope is triggered by pain, anxiety or the sight of instruments and is preceded by pallor, nausea and sweating rather than by the change in position alone.
Practice Medical Emergencies questions Medical Emergencies study notes