Emergency Drugs

Emergency drugs may be divided into two categories. The first category is drugs that are essential and should be part of every emergency drug kit. The second category consists of drugs that are useful but are optional depending on the practitioner’s training in emergency medical procedures and whether sedation and general anesthesia are used for behavior and anxiety management. Thus, emergency drug kits will vary from office to office. A dentist trained to administer general and intravenous sedation with greater proficiency in venipuncture would have a more comprehensive drug kit than a dentist without such training. For dentists not proficient in venipuncture, optional drugs that can be administered orally, intramuscularly/intralingually and intranasally will be discussed.

At the very least, a basic dental office emergency drug kit should contain the eight drugs summarized in Table 1.

Table 1. Essential Emergency Drugs.
Drug Indication Initial Dose
Oxygen Almost any emergency 100% inhalation
Epinephrine Anaphylaxis
Asthma unresponsive to albuterol/salbutamol
Adult 1:1000 Child 1:2000
0.01 mg/kg IM every 15 minutes as needed
Nitroglycerin Angina pain 0.3-0.4 mg sublingual
Antihistamine (diphenhydramine) Allergic reactions Adult: 25-50 IM or 25-50 mg qid orally
Child: 1 mg/kg orally qid
(See table 2 for dosage by age)
Albuterol/salbutamol Asthmatic bronchospasm 2 sprays inhalation
Aspirin Myocardial infarction 160-325 mg
Sugared drink, juice Hypoglycemia
(patient conscious)
Administer until patient recovers.
Glucagon Hypoglycemia
(patient unconscious)
Adult: 1 mg IM
Child: 0.5 mg IM stat, 0.5 mg 20 minutes later
Ammonia inhalant ampules Syncope Crush ampule between fingers and hold under nose
Source: Malamed SF. Medical Emergencies in the Dental Office. Sixth Edition.
Table 2. Oral Diphenhydramine Liquid Dosing (12.5mg/5ml).
Age Dose
Under 3 months Consult physician
4-11 months (12-17 lbs) ¼ tsp every 4-6 hours
12-23 months (18-23 lbs) ½ tsp every 4-6 hours
2-3 years (24-35 lbs) ¾ tsp every 4-6 hours
4-5 years (36-47 lbs) 1 tsp every 4-6 hours
6-8 years (48-59 lbs) 1¼ tsp every 4-6 hours
9-10 years (60-71 lbs) 1½ tsp every 4-6 hours
11 yrs (71-95 lbs) 1¾ tsp every 4-6 hours
12+ years (96+ lbs) 2 tsp every 4-6 hours
Source: Benadryl package insert - dosing information. McNeil Consumer Healthcare Information.

For the dentists with advanced training and skills in sedation and general anesthesia, the additional emergency drugs in Table 3 may be added to the drug kit.

Table 3. Additional Emergency Drugs.
Drug Indication Dose
Atropine Clinically significant bradycardia 0.5 mg IV or IM
Ephedrine Clinically significant hypotension 5 mg IV or IM
Hydrocortisone Adrenal insufficiency
Recurrent anaphylaxis
100 mg IV or IM
100 mg IV or IM
Morphine or nitrous oxide Angina pain unresponsive to nitroglycerin Titrate 2 mg IV, 5 mg IM
~ 35% N2O inhalation
Naloxone Reversal of opioid overdose 0.1 mg/kg up to 2mg IV or IM
Lorazepam or Midazolam Status epilepticus 4 mg IM or IV
5 mg IM or IV
Flumazenil Benzodiazepine overdose 0.01-0.02 mg/kg at 1 minute intervals up to1 mg IV or IM
Source: Melamed SF. Medical Emergencies in the Dental Office. Sixth Edition.