Every doctor must be familiar with the contents of the medical emergency kit available in their office and how to administer the emergency drugs. The medical emergency kit should be prepared according to the background and training of the individual doctor.
Essential Drugs: These are basic emergency drugs that must be available in all dental offices, regardless of the level of training.
Epinephrine
Mechanism of Action
- Alpha-agonist: Shrinks mucosal swelling.
- Beta-1 agonist: Increase systolic blood pressure and heart rate.
- Beta-2 agonist: Relaxes bronchial smooth muscles.
- Stabilise mast cells.
Indication: Severe bronchospasm, Anaphylaxis, Cardiac arrest.
Emergency Kit: Single dose 1 ml vials (1 mg/ml).
Administration & Dosage
- Intramuscular, injected into the lateral thigh or deltoid muscle: Concentration 1:1,000 (1 mg/ml).
- Above 12 years: 0.3 mg.
- 6-12 years: 0.15 mg.
- 6 months to 6 years: 0.12 mg.
Diphenhydramine
Mechanism of Action
- Antihistaminic: Blocks histamine receptors that mediate cutaneous reactions
- Does not counter the effect of other mediators such as leukotrienes.
Indication: Mild (non-life threatening) and moderate (primarily dermatologic) allergic reactions.
Emergency Kit: 25-50 mg tablets or 50 mg/ml single dose vials.
Administration & Dosage
- Administered orally in mild, non-life threatening reactions and intramuscularly in case of moderate allergy.
- Adult : 25-50 mg.
- Children : 12.5-25 mg.
Chlorpheniramine (alternative antihistamine)
- Available as 4 mg tablets or multi-dose vials.
- Above 12 years: 4 mg.
- 6-12 years: 2 mg.
- 2-6 years: 1 mg.
Albuterol
Mechanism of Action
- Beta-2 agonist: Relaxes bronchial smooth muscles.
- Have little or no action on cardiac beta-1 receptors.
Indication: Bronchospasm (allergic or asthmatic).
Emergency Kit: Albuterol inhaler with spacer.
Administration & Dosage
- Dosage: 90 mcg per spray.
- Adults: 2 sprays.
- Children: 1 spray.
- If unable to administer albuterol inhaler, epinephrine can be given IM.
- If both bronchospasm and laryngeal edema are present, it suggests anaphylaxis and epinephrine is the drug of choice.
Nitroglycerine
Mechanism of Action
- Vasodilator: Dilates blood vessels.
- Reduces venous return.
- Decreases strain-induced myocardial oxygen demand.
Indication: Acute onset chest pain and undiagnosed angina with symptoms of MI.
Emergency Kit: 0.4 mg tablets or lingual spray.
Administration & Dosage
- The tablet is to be placed under the tongue and allowed to dissolve and absorb through the mucosa.
- Can be repeated every 5 minutes, upto a maximum of 3 doses.
Aspirin
Mechanism of Action
- Anti-platelet action: Prevents platelet aggregation and formation of thrombus.
Indication: Chest pain suggestive of ischemia, and any symptoms of acute MI.
Emergency Kit: Non-enteric coated tablets (325 mg).
Administration & Dosage
- 162-325 mg tablet to be chewed for 30 seconds and swallowed with water.
Atropine
Mechanism of Action
- Anticholinergic (vagolytic).
- Counters vagal influences on the heart and allows heart rate to increase.
- Leads to increase in blood pressure and return of consciousness.
Indication: Hypotension accompanied by bradycardia.
Emergency Kit: Single dose 1 ml vials (1 mg/ml).
Administration & Dosage
- 0.5 mg or 0.5 ml IM or sublingually.
- Concentrations of 0.3 and 0.4 mg/ml not recommended : Doses lower than 0.5 mg may be associated with paradoxical vagotonic effects that result in further slowing of heart rate.
Ephedrine
Mechanism of Action
- Sympathomimetic: Stimulates endogenous norepinephrine release.
- Activates alpha receptors on veins to improve venous return.
- Activated beta-1 receptors to improve cardiac contractility.
Indication: Hypotension accompanied by normal heart rate.
Emergency Kit: 1 ml single dose vials (50 mg/ml).
Administration & Dosage
- 25 mg (0.5 ml) IM or sublingually.
Antihypoglycemic Agents
Emergency Kit
- Candies or sugar cubes.
- Fruit juices containing sugar.
- Glucagon injection.
Administration & Dosage
-
Conscious patients: Oral glucose such as candies or fruit juice (15-20 gm).
-
Unconscious patients: Glucagon IM (20-30 mcg/kg/dose).
- Above 20 kg: 1 mg.
- Below 20 kg: 0.5 mg.
Advanced Emergency Kit
This includes drugs that an advanced healthcare provider such as dental anaesthesiologist or oral and maxillofacial surgeon can have in the dental office.
- 50% Dextrose.
- Phenylephrine.
- Epinephrine.
- Labetalol.
- Esmolol.
- Lignocaine.
- Amiodarone.
- Succinylcholine.
Emergency Supplies for the Dental Office
Basic Equipments
- Stethoscope.
- Sphygmomanometer.
- Pulse oximeter.
- Thermometer.
- Glucometer.
- Band-aid and sterile gauze.
- Ice packs.
- Magill forceps.
For Airway Management & Oxygen Administration
- Clear face mask.
- Resuscitation bag / Air mask bag unit (AMBU) bag.
- Extension oxygen tubing (with or without nasal catheters).
- Oxygen cylinder with flow valve.
- Oral and nasal airways.
- Endotracheal tube.
- Demand valve oxygen mask.
For High-volume Suction
- Large diameter suction tip.
- Tonsillar suction tip.
- Extension tubing.
- Connectors to adapt tubing to office suction.
For Drug Administration
- Plastic syringes (1, 5 and 10 ml).
- Needles (18, 21 and 25 gauge).
For Establishment & Maintenance of IV Access
- IV tubing with flow valve.
- Cannula.
- Tourniquet.
- 1-inch wide surgical tape.
- Crystalloid solution: Normal saline, 5% dextrose.
References
- Becker DE. Emergency drug kits: pharmacological and technical considerations. Anesth Prog. 2014 Winter;61(4):171-9. doi: 10.2344/0003-3006-61.4.171. PMID: 25517555; PMCID: PMC4269359.
- Contemporary Oral and Maxillofacial Surgery, 6 edition, James R. Hupp, Myron R. Tucker, Edward Ellis III, Mosby.
*This article is an excerpt from the above mentioned sources and Medical Sutras does not make any ownership or affiliation claims.