Special Links
ISOMS Events:
Visit our Calendar of
Events for details on
upcoming programs,
meetings, and events of
interest and importance
to ISOMS members.
The Illinois Society of Oral
and Maxillofacial Sureons
is a not-for-profit
professional assocation.
ISOMS is dedicated to the
advancement of public
welfare through education
programs that help improve
standards of practice in the
specialty of Oral and
Maxillofacial Surgery in
Illinois.
Active ISOMS members are
graduates of accredited
dental schools who have
also completed an
accredited training
program in Oral and
Maxillofacial Surgery, are
licensed to practice
dentistry or medicine in the
State of Illinois, and limit
their practice exclusively to
Oral and Maxillofacial
Surgery.
ISOMS Events:
Visit our Calendar of
Events for details on
upcoming programs,
meetings, and events of
interest and importance
Sample Case Scenarios to Review American Association
Prior to Office Anesthesia of Oral and
Maxillofacial Surgery
Evaluations American Academy of
Oral and Maxillofacial
Radiology
Reference AAOMS Office Anesthesia Evaluations Manual,
8th Edition (Copyright 2012) available to purchase. Contact American Academy of
AAOMS Publications at 800-366-6725, or go to Otolaryngology - Head
www.AAOMS.org. Ask about member discounts. and Neck
American Dental
This page was updated August 28, 2012, by the ISOMS Anesthesia Committee.
Association
All completed evaluation forms must be signed and ADSA - American
submitted to ISOMS headquarters by mail to: Dental Society of
Anesthesiology
ISOMS AHIMA - American
810 S. Waukegan Rd., Suite 104 Health Information
Lake Forest, IL 60045 Management
Association
Centers for Disease
Control and Prevention
EMERGENCY SIMULATION Centers for Medicare
and Medicaid Services
A healthy 18-year-old presents for elective removal of four third
molars under deep intravenous sedation. After induction, she Illinois State Dental
Society
develops difficulty breathing.
Oral & Maxillofacial
A) A crowing sound is noticed Surgery Foundation
B) Progressive labored breathing results in no breath sounds and
paradoxical breathing with suprasternal notch retraction. OSHA Home Page
University of Illinois at
#1 Respiratory - Laryngospasm Chicago Department of
Oral and Maxillofacial
Surgery
Defined as partial or complete adduction of rima glottis with vocal
cord adduction. Illinois Department of
Direct cause - irritation of cords by blood or mucous during light Professional Regulation
planes of anesthesia.
Indirect cause - by parasympathomimetic stimulation from drugs
such as Methohexital or nitrous oxide.
TREATMENT
Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,
page 79.
EMERGENCY SIMULATION
A 55-year-old mild asthmatic presents for immediate denture
 to ISOMS members. insertion following extraction of remaining anterior teeth under IV
sedation. The patient is a smoker by history.

A) As induction proceeds, labored breathing is noted with wheezing

and prolonged expiration.

B) After conservative measures and an extended period of time,

tightness progresses until respiratory arrest ensues.

The Illinois Society of Oral #2 Respiratory - Bronchospasm

and Maxillofacial Sureons
is a not-for-profit TREATMENT
professional assocation.
ISOMS is dedicated to the Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,
advancement of public pages 79 and 80.
welfare through education
programs that help improve
standards of practice in the EMERGENCY SIMULATION
specialty of Oral and
Maxillofacial Surgery in A healthy 40-year-old businessman presents for removal of a
Illinois. retained root from a broken tooth #30. The patient had a few drinks
the night before and a large meal at a meeting.
Active ISOMS members are
graduates of accredited A) After 3 cc of Brevital are given, the patient suddenly vomits.
dental schools who have
also completed an B) After evacuation of the oral cavity the patient's color turns ashen
accredited training and tightness is noted in the chest and aspiration is suspected.
program in Oral and
Maxillofacial Surgery, are #3 Respiratory - Emesis and Aspiration
licensed to practice
dentistry or medicine in the TREATMENT
State of Illinois, and limit
their practice exclusively to Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,
Oral and Maxillofacial page 80.
Surgery.

EMERGENCY SIMULATION
A 14-year-old boy presents for the removal of 4 bicuspids for dental
purposes under local anesthetic. During the course of the extractions
#28 shoots behind the pharyngeal screen and into the hypopharynx
and lodges in the patient's throat.

A) Coughing and choking ensues and the patient is in distress as he

cannot clear the tooth.
B) He lapses into a somnolent state with clearly inadequate
ventilation and is cyanotic.

#4 Respiratory - Airway Obstruction

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

page 80.

EMERGENCY SIMULATION
A 65 year-old with known coronary artery disease presents for
removal of several decayed and non-restorable teeth under local
anesthetic. Mr. Jones takes nitroglycerin three times daily as needed.

A) Following injection of the local anesthetic, he develops a sudden

chest pain radiating into his left arm.
 Web Link
B) After taking his blood pressure it is noted to be elevated and chest
pain continues to be severe. SteriSafe.com view
a virtual demo of online
#5 A Cardiovascular - Stable Angina OSHA Compliance
Tools and Online
Continuing Education
TREATMENT Training Center. Also,
Stericycle.com, main
Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition, site showing all of the
service offered as well
pages 80 and 81. as information on the
company.

#5B Cardiovascular - Unstable Angina/Myocardial

Infarction

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

pages 80 and 81.

EMERGENCY SIMULATION
A 22-year-old professional ball player presents for tooth extraction.
Upon seeing the syringe, he

A) becomes ashen and loses consciousness.

B) Pulse is 42; B/P is 80/30; Sinus bradycardia on EKG

#6 Cardiovascular - Hypotension

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

page 81.

EMERGENCY SIMULATION
A 49-year-old female presents for several extractions under 2%
lidocaine with 1:100,000 epinephrine. She has had to take an
unknown thyroid medication in the past. Her resting blood pressure
is 140/90. As surgery proceeds, she complains of a headache and
becomes extremely flushed and apprehensive.

A) B/P is 230/140

B) 5 minutes later, B/P is 240/160

#7 Cardiovascular - Hypertension

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

page 81.

EMERGENCY SIMULATION
Your patient with a history of occasional chest pain presents with a
referral slip for removal of several teeth under local anesthetic. As she
enters the operatory and is seated,

A) she passes out and,

B) there is no breathing, pulse or blood pressure; EKG shows
ventricular fibrillation

#8 Cardiac Arrest

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

pages 87 and 88.

EMERGENCY SIMULATION
A 16-year-old with a history of hay fever presents for a frenectomy.
After an injection of a local anesthetic,

A) she has itching and a noticeable rash.

The next patient, her twin sister who is allergic to bee stings, is in for
the same procedure. Following injection

B) she has difficulty breathing and proceeds to have swelling about

the lips and eyes.

#9 Severe Allergic Reactions

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

pages 83 and 84.

EMERGENCY SIMULATION
A 20-year-old epileptic male patient presents for removal of carious
teeth under nitrous oxide - oxygen sedation. Upon placement of
mask, the patient demonstrates loss of consciousness with alternating
periods of body rigidity and rhythmic thrashing of the extremities.

#10 Seizures

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

page 83.

EMERGENCY SIMULATION
A nervous 16-year-old female has a third molar removed under
intravenous sedation in an uneventful manner. Upon completion of
the procedure, she emerges from anesthesia with irregular breathing
pattern and crying. She continues to be highly disoriented and
integrates very rapid shallow breathing with 15 - 30 second periods of
apnea. Pulse O2 reads 85-90 percent saturation. Her hands become
clenched.

#11 Hyperventilation Syndrome

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

page 82.
 EMERGENCY SIMULATION
#12 SYNCOPE

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

page 82.

EMERGENCY SIMULATION
#13 Malignant Hyperthermia

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

pages 84 and 85.

EMERGENCY SIMULATION
#14 Venipuncture Complication - Phlebitis

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

page 82.

EMERGENCY SIMULATION
#15 Venipuncture Complication - Intra-Arterial Injection

TREATMENT

Refer to AAOMS Office Anesthesia Evaluation Manual, 8th Edition,

page 82.

ISOMS - Illinois Society of Oral and Maxillofacial Surgeons

810 S. Waukegan Road, Suite 104
Lake Forest, Illinois 60045
Phone 847 482.0222 eFax 847 574.0445
Copyright 2017, All Rights Reserved

ISOMS - Illinois Society of Oral and Maxillofacial Surgeons

810 S. Waukegan Road, Suite 104
Lake Forest, Illinois 60045
Phone 847 482.0222 eFax 847 574.0445
Copyright 2017, All Rights Reserved