Patient Assessment, Diagnosis, Treatment Planning, and Emergency Care
What this domain tests
This domain tests structured assessment, diagnosis, sequencing of care, informed consent, and management of medical emergencies in the dental chair.
Core rules
- History: chief complaint, medical and drug history, allergies, previous anaesthetic complications, social history, and review of systems.
- Examination: extraoral, intraoral, periodontal, occlusal, and radiographic as indicated; record vital signs when relevant.
- ASA classification guides setting and referral: ASA I healthy, II mild systemic disease, III severe disease limiting activity but not incapacitating, IV incapacitating.
- Problem list then sequencing: emergency care, disease control, definitive restorative care, rehabilitation, maintenance.
- Informed consent covers diagnosis, options including no treatment, risks, benefits, and costs, documented in the record.
- Emergencies: syncope (pallor, bradycardia, brief loss of consciousness), angina (crushing chest pain, managed with rest and glyceryl trinitrate), myocardial infarction (persistent pain, diaphoresis; call emergency services), anaphylaxis (urticaria, bronchospasm, hypotension; adrenaline intramuscularly), hypoglycaemia (sweating, confusion), asthma, seizure, and choking.
Worked example
A patient becomes pale and sweaty immediately after an injection and briefly loses consciousness with a slow pulse. Reasoning: this is vasovagal syncope, not anaphylaxis. Lie the patient flat with legs raised, monitor, and give oxygen if needed; anaphylaxis would show urticaria, wheeze, and tachycardia or hypotension and would need intramuscular adrenaline.
Traps
Treating without a diagnosis; ignoring ASA status; having no emergency drugs or oxygen checked.