Medical Emergencies · patient case question
What should the dentist do?
Patient case: Controlled Hypertension, and a Moment of Lightheadedness
Patient: 63-year-old male
Chief Complaint: Scheduled restoration of tooth #30.
Background: Hypertension, well controlled for six years. Attends his physician regularly. Ate breakfast this morning.
Medications: Lisinopril 20 mg daily, hydrochlorothiazide 25 mg daily
Vital Signs: Pre-operative BP 132/80 mmHg · HR 74 bpm · RR 16 · T 98.4°F
Findings: Ten minutes into the procedure, reclined in the chair, he reports feeling lightheaded. He is conscious, speaking normally, mildly pale, skin slightly moist. No chest pain, no shortness of breath, no weakness or slurred speech.
Show answer and explanation
Correct answer: C. Stop, place him supine with the legs slightly elevated, and monitor
- A. Aromatic ammonia is an adjunct AFTER positioning, not instead of it, and continuing treatment through the episode remains inappropriate.
- B. Reassurance alone does not restore cerebral perfusion, and continuing while the patient is symptomatic risks a full faint with the airway unprotected and instruments in the mouth.
- C. CORRECT. Lightheadedness with pallor and moist skin is PRESYNCOPE. The management is the same whatever the cause: stop treatment, place the patient SUPINE with the legs slightly elevated to restore cerebral perfusion, ensure a patent airway, give oxygen, and monitor vital signs. Most episodes resolve within a minute or two in that position. Only when he is fully recovered and stable do you decide whether to continue.
- D. Dismissing the symptom is unsafe. It also forecloses on the differential — orthostatic hypotension from his antihypertensives, hypoglycaemia, or an arrhythmia.
Note: ⚑ FLAG FOR THE GROUP. The recall recorded 'reassure and continue' as the chosen answer. Positioning is the standard first response to presyncope and should be your default. Note also the specific relevance of his medication: both an ACE inhibitor and a thiazide predispose to orthostatic hypotension, so raise him SLOWLY at the end of the appointment.
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