Essentials of the Emergency Kit

Here are the Bare Minimum Drugs that must be kept in your dental office’s Emergency Kit

  1. Epinephrine:
    • When to Use: Acute allergic reaction, Hypersensitivity reaction, anaphylaxis
    • What Does it Look Like: Starts with an itchy/runny nose, and/or a skin rash begins to develop(usually red). Progresses to much worse symptoms e.g., Hives, Shortness of breath, swollen tongue and lips, coughing, wheezing, and weak pulse. Patients then may begin to feel dizzy, sense of confusion, and fainting is possible. Can Be Life Threatening
    • Drug Importance: Rapidly relaxes bronchial smooth muscle to help with airway. Increases blood pressure and helps to restore myocardial function. Potent Histamine antagonist.
    • When to Administer: Immediately when signs and symptoms present
    • Dosing:
      1. Body Weight Over 30kg/66Lbs: 0.3-0.5mg subcutaneously or intramuscularly
      2. Body Weight Less Than 30kg/66Lbs: 0.15mg subcutaneously or intramuscularly
      3. Half life=2 minutes, so multiple doses may be required
    • In the Kit: (1mg/mL) 1mL Epinephrine ampule, or 2 (1:1000) adult preloaded auto injectors and 2 (1:2000) pedo, preloaded auto injectors—-some controversy on auto-injector use (Epi-Pens)
    • Special care should be taken if given to pregnant patients and ASA IV patients.
  2. Benadryl/Diphenhydramine:
    • When to Use: For delayed onset allergic reactions, or mild reactions that involve just the skin, redness/rashes.
    • What Does it Look Like: Mild runny nose, itchy and red skin, itchy eyes.
    • When to Administer: Only administer if the allergic reaction is involving the skin.
    • Dosing: 50 mg IM injection followed by 25mg orally every 3-4 hours.
    • In the Kit: at minimum two 1mL ampules of (50mg/mL) Diphenhydramine
    • Contraindicated in acute asthmatic episodes
  3. Nitroglycerin:
    • When to Use: Vasodilator for Angina
    • What Does it Look Like: patient experiencing chest pain, drops in blood pressure,
    • When to Administer: If a patient is experiencing chest pain. helps to also aid in diagnosis
    • Dosing:0.4- and 0.8-mg doses of translingual spray.
    • In the Kit: One bottle of metered translingual nitroglycerin spray
    • Contraindicated in patients who have taken Levitra, Viagra, Sildenafil, and Revatio (woman viagra essentially). Cialis if within 48 hours.
  4. Albuterol:
    • When to Use: during bronchospasm/acute asthmatic episodes
    • What Does it Look Like: Shortness of breath, wheezing, dyspnea, sensation of congestion in chest that increases as the attack occurs, patient appears fighting for air.
    • When to Administer: immediately when signs present
    • Dosing: 2 sprays with inhalation for adults, 1 spray for pediatrics
    • In the Kit: 1 Albuterol Inhaler and Spacer
  5. Glucose/Sugar
    • When to Use: Management of Hypoglycemic patients, primarily in Diabetic patients
    • What Does it Look Like: Patient feels shaky, nervous, sweaty. Chills, clamminess, blurred vision, headaches, nausea, irritability and confusion.
    • When to Administer: As soon as symptoms present
    • Dosing: 15 grams of carbohydrates, then check blood sugar in 15 minutes. Should be above 70mg/dL
    • In the Kit: Actually, the American Diabetes Association recommends a half cup of regular soda. Make sure it’s not a Diet
  6. Aspirin:
    • When to Use: Suspected myocardial infarction
    • What Does it Look Like: Angina. Sometimes mistakenly thought to be indigestion or heartburn. Difficulty breathing or shortness of breath. Tightness, pressure, aching, burning, numbness, fullness or squeezing feeling that lasts for more than a few minutes or goes away and comes back.
      • Women: sometimes different symptoms: Jaw pain, unusual fatigue.
    • When to Administer: As soon as symptoms present
    • Dosing: minimum of 162mg for adults
    • In the Kit: Chewable 325mg Aspirin Tablets
  7. Portable Oxygen:
    • When to Use: During any emergency situation except during hyperventilation
    • What Does it Look Like: Respiratory distress
    • When to Administer: ASAP
    • In the Kit: One E cylinder with oxygen mask

Bonus: These drugs must be in your kits if you do any type of sedation/also just good to have around

8. Flumazenil (Romazicon)

  • When to Use: Benzodiazepine Overdose/if you feel your patient is too sedated
  • What Does it Look Like: Excessive Sedation, delirium, significant respiratory depression.
  • Dosing: 0.2mg every minute-up to five doses. Can be injected submucosally at the floor of the mouth
  • In the Kit: One 10mL multi dose vial of Flumenazil

9.Naloxone (Narcan)

  • When to Use: Opioid Overdose
  • What Does it Look Like: slow, erratic, and/or stopped breathing, blue/purple skin or gray for darker skinned people.
  • Dosing: 0.4mg-0.8mg
    • Half Life=30-60 minutes
    • Rapid Onset ~2 minutes
  • In the Kit: 2, 0.4 Narcan Nasal Sprays

Donaldson, M., Goodchild, J. H. (2016). Pharmacological Reversal Agents in Dental Practice: Keys to Patient Safety. Compendium of Continuing Education in Dentistry. November/December 681-687.

Haas, D. A. (2006). Management of Medical Emergencies in the Dental Office: Conditions in Each Country, the Extent of Treatment by the Dentist. Anesthesia Progress,53(1), 20-24. doi:10.2344/0003-3006(2006)53[20:momeit]2.0.co;2

Heart Attack (Myocardial Infarction). Retrieved January 13, 2021, from https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction

Hypoglycemia (Low Blood Glucose). Retrieved January 13, 2021, from https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia

Malamed, S. F. (2015). Medical emergencies in the dental office. St. Louis: Elsevier Mosby.

The Author of this post does not assume any liability for any injury and/or damage to persons or property as a matter of products liability, malpractice, negligence, or otherwise, or from any use or operation of any methods, instructions or ideas contained. The foregoing parties will not be liable for any direct, special, indirect, incidental, consequential, or punitive damages as a result of the reader’s use of this information.

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