Medical Emergencies · patient case question
What is the appropriate next step?
Patient case: Blood pressure rise after local anaesthetic
Patient: Male, 41 years old
Chief Complaint: “The outside of my back tooth broke.”
Background: No systemic disease, no medications, no allergies. Reports being anxious about injections.
Vital Signs: On seating BP 105/65 mmHg · HR 72 bpm. Five minutes after infiltration with 2% lidocaine with 1:100,000 epinephrine: BP 138/86 mmHg · HR 96 bpm. Patient is alert, comfortable, no chest pain, no shortness of breath, no palpitations reported.
Findings: Fractured buccal cusp of tooth #4 with the fracture line above the gingival margin. No pulp exposure. Tooth vital.
Show answer and explanation
Correct answer: A. Continue with the planned treatment, monitoring the blood pressure
- A. CORRECT. A rise from 105/65 to 138/86 in a healthy, anxious patient after an injection is a NORMAL physiological response — endogenous catecholamine release from anxiety, with a small contribution from the injected epinephrine. The reading remains within normal limits, the patient is asymptomatic, and the anaesthesia itself REDUCES stress once it takes effect. Proceed and monitor.
- B. Prescribing an antihypertensive to treat a transient, normal-range reading is dangerous and outside the dentist's scope. A dose of an ACE inhibitor in a normotensive patient risks symptomatic hypotension.
- C. EMS activation is for genuine emergencies — chest pain, neurological signs, airway compromise, or a hypertensive crisis at or above 180/120 with symptoms. None applies.
- D. Cancelling teaches the anxious patient that anxiety ends appointments, and abandons a treatable tooth for a reading that is not abnormal.
Note: The thresholds that matter: proceed with routine care below 160/100 and refer for evaluation; use caution and limit elective care between 160/100 and 179/109; DEFER elective treatment at 180/110 and above and arrange urgent assessment. A single elevated reading is repeated after five minutes of rest before any decision is made on it.
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