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.
|Oxygen||Almost any emergency||100% inhalation|
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|
|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/salbutomol||Asthmatic bronchospasm||2 sprays inhalation|
|Aspirin||Myocardial infarction||160-325 mg|
|Sugared drink, juice||Hypoglycemia|
|Administer until patient recovers.|
|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|
Table 2. Oral Diphenhydramine Liquid Dosing (12.5mg/5ml).
|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|
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.
|Atropine||Clinically significant bradycardia||0.5 mg IV or IM|
|Ephedrine||Clinically significant hypotension||5 mg IV or IM|
|100 mg IV or IM|
100 mg IV or IM
|Angina pain unresponsive to nitroglycerin||Titrate 2 mg IV, 5 mg IM|
~ 35% N2O inhalation
|Naloxone||Reversal of opioid overdose||0.1mg IV|
|Status epilepticus||4 mg IM or IV|
5 mg IM or IV
|Flumazenil||Benzodiazepine overdose||0.1 mg IV|