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.
DrugIndicationInitial Dose
OxygenAlmost any emergency100% inhalation
EpinephrineAnaphylaxis
Asthma unresponsive to albuterol/salbutamol
Adult 1:1000 Child 1:2000
0.01 mg/kg IM every 15 minutes as needed
NitroglycerinAngina pain0.3-0.4 mg sublingual
Antihistamine (diphenhydramine)Allergic reactionsAdult: 25-50 IM or 25-50 mg qid orally
Child: 1 mg/kg orally qid
(See table 2 for dosage by age)
Albuterol/salbutamolAsthmatic bronchospasm2 sprays inhalation
AspirinMyocardial infarction160-325 mg
Sugared drink, juiceHypoglycemia
(patient conscious)
Administer until patient recovers.
GlucagonHypoglycemia
(patient unconscious)
Adult: 1 mg IM
Child: 0.5 mg IM stat, 0.5 mg 20 minutes later
Ammonia inhalant ampulesSyncopeCrush 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).
AgeDose
Under 3 monthsConsult 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.
DrugIndicationDose
AtropineClinically significant bradycardia0.5 mg IV or IM
EphedrineClinically significant hypotension5 mg IV or IM
HydrocortisoneAdrenal insufficiency
Recurrent anaphylaxis
100 mg IV or IM
100 mg IV or IM
Morphine or nitrous oxideAngina pain unresponsive to nitroglycerinTitrate 2 mg IV, 5 mg IM
~ 35% N2O inhalation
NaloxoneReversal of opioid overdose0.1 mg/kg up to 2mg IV or IM
Lorazepam or MidazolamStatus epilepticus4 mg IM or IV
5 mg IM or IV
FlumazenilBenzodiazepine overdose0.01-0.02 mg/kg at 1 minute intervals up to1 mg IV or IM
Source: Melamed SF. Medical Emergencies in the Dental Office. Sixth Edition.