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/sublingually and intranasally will be discussed. For a more comprehensive review, kindly refer to American Dental Association’s recently published guide on preparation of a dental team for medical emergencies.5

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.6,7
Drug Indication Dose Quantity
Oxygen Almost any emergency 100% inhalation 1 “E” cylinder with adjustable regulator (0-15L)
Epinephrine Anaphylaxis
Asthma unresponsive to albuterol/salbutamol
1: 1000 (1mg/ml), auto injector 0.3 mg/ml (EpiPen), 0.15 mg/ml (EpiPen Jr) 1:1000 mg/ml ampule, 1 EpiPen, 1 EpiPen Jr auto injectors
Nitroglycerin Angina pain 0.4 mg sublingual every 3-5 minutes 1 metered spray bottle (0.4 mg)
Diphenhydramine Allergic reactions 1 mg/kg IM/IV; max 50 mg
(See table 2 for dosage by age)
50 mg/ml vials and 1 box 25 mg tablets
Albuterol/salbutamol Asthmatic bronchospasm 2 puffs; repeat as needed Metered dose inhaler 2.5 mg/3ml nebulized solution
Aspirin Myocardial infarction 81 mg chewable tablet Chewable tablet, bottle baby aspirin (81 mg)
Glucose Hypoglycemia
(patient unconscious)
37.5 mg; repeat as needed 1 tube (37.5 mg)

For the dentists with advanced training and skills in sedation and general anesthesia, the additional emergency drugs in Table 2 may be added to the drug kit.

Table 2. Additional Emergency Drugs.6
Drug Indication Dose Quantity
Atropine Clinically significant bradycardia 0.5 mg IV or IM 1 ampule (1 mg/10 ml)
Hydrocortisone Adrenal insufficiency
Recurrent anaphylaxis
100 mg IV or IM
(mixed with 3-5ml sterile water)
1 vial (100 mg)
Morphine or nitrous oxide Angina pain unresponsive to nitroglycerin Titrate 2 mg IV, 5 mg IM
~ 35% N2O inhalation
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 4 mg/10 ml
multi-dose vial
Lorazepam or Midazolam Status epilepticus 4 mg IM or IV
5 mg IM or IV
50 mg/10 ml
multi-dose vial
Flumazenil Benzodiazepine overdose 0.01 mg/kg at 1-minute intervals up to 1 mg IV
or IM
0.5 mg / 5 ml
multi-dose vial