Dental News - Dental office emergency drugs, Part 2

John Roberson, USA

Tue. 25 September 2012

save

Key points from Part 1: Every dentist should realize that medical emergencies can, do and will happen during the course of practice. These emergencies could be related to dental treatment, patient risk factors, or they could occur unexpectedly. A medical emergency could evolve into a life-threatening emergency without proper treatment. It is for these reasons emergency medications should be present in dental offices.

Part 2 looks in detail at the CORE (Critical Office Resuscitative Emergency) eight emergency drugs needed for dental offices and suggested emergency medications for practices doing advanced anesthesia.

The CORE 8

Albuterol

Definition: Bronchodilator — stimulates beta-2 adrenergic receptors causing bronchodilation.
Use: Bronchospasm (acute asthmatic attack).
Dosage: One to two puffs per dose.
Caution: No contraindications to using albuterol in acute episodes of bronchospasm.
Suggested stock: One albuterol MDI inhaler.

Ammonia inhalants

Definition: A respiratory stimulant.
Use: Syncope/fainting/loss of consciousness.
Dosage: 1–2 vaporules.
Suggested stock: One box of ammonia vaporules.

Aspirin

Definition: Anti-platelet — inhibits prostaglandin synthesis and inhibits platelet aggregation irreversibly.
Use: Suspected myocardial infarction.
Dosage: One 325-mg non-enteric, coated aspirin tablet, chewed and swallowed or four 81 mg chewable tablets, chewed and swallowed.
Caution: Aspirin should not be given to persons who are allergic to it or have active gastrointestinal bleeding.
Suggested stock: One or two packets of chewable 325-mg non-enteric, coated aspirin or four 81 mg chewable tablets.

Diphenhydramine

Definition: Antihistamine — antagonizes histamine at the H-1 receptor, causes sedation and has an anti-cholinergic effect.
Use Allergic reaction/anaphylaxis.
Dose: 50 mg IM or IV.
Caution: No contraindications to giving diphenhydramine during an allergic reaction unless noted allergy or hypersensitivity to diphenhydramine.
Suggested stock: 1) Two 1-ml ampules or vials of diphenhydramine 50 mg/ml and/or 2) Diphenhydramine HCL capsules 25 mg.

Epinephrine 1:1,000

Definition: Cardiac stimulant/anaphylaxis — activates alpha and beta-adrenergic receptors increasing heart rate, myocardial contractility, bronchial dilation and decreases peripheral vascular resistance.
Use: Anaphylaxis/bronchospasm.
Dosage: 0.3 mg IM q5 minutes.
Caution: No contraindications to giving epinephrine during anaphylaxis.
Suggested stock: 1) Two auto-injectors of epinephrine in adult form and pediatric form (EpiPen and EpiPen Jr) and 2) Two 1-ml ampules or vials of epinephrine 1:1,000.

Glucose source

Definition: Anti-hypoglycemic — increases glucose level for treatment of hypoglycemia.
Use: Hypoglycemia.
Dosage: One tube of glucose gel.
Caution: Unconsciousness. Never administer anything orally to an unconscious person.
Suggested stock: 1) Three tubes of glucose gel (InstaGlucose™) and 2) Three tubes of glucose tablets.

Nitroglycerin

Definition: Anti-anginal — stimulates cGMP production, which relaxes vascular smooth muscle specifically in the coronary arteries in the presence of an anginal attack.
Use: Chest pain (angina).
Dosage: The usual dose of nitroglycerin is one sublingual (0.4mg) tablet or one spray (0.4mg) from nitroglycerin spray atomizer administered q5m.
Caution: Patients with low blood pressure.
Suggested stock: One bottle of 25 tablets or one spray atomizer.

Oxygen

Use: Almost any type of medical emergency.
Dosage: At least 2 liters/minute.
Caution: Do not use with hyperventilation.
Suggested stock: One portable “E” cylinder of oxygen with regulator and the equipment necessary to deliver O2 to the victim (nasal cannula and ambu-bag).

Additional emergency drugs for consideration

These additional emergency drugs are suggested for practices that do any type of advanced anesthesia, such as PO sedation, IV sedation, or general anesthesia.

Practitioners may have their own choices of emergency drugs due to their type of practice as well as training background.

Reversal agent — benzodiazepine

Flumazenil (Romazicon) — benzodiazepine antagonist: reverses effect of benzodiazepines by competively inhibiting the GABA receptors.

Reversal agent — narcotics

Naloxone (Narcan) — narcotic antagonist: reverses the effect of narcotics by competively inhibiting narcotic receptor sites.

Injectable anti-convulsant

Midazolam or diazepam: a benzodiazepine that acts on the inhibitory neurotransmitter gamma amino butyric acid (GABA), limbic system, hypothalamus and thalamus to produce sedation, anti-anxiety effect and skeletal muscle relaxation.

Injectable anti-hypoglycemics

Dextrose (50 percent dextrose) — anti-hypoglycemic: a source of calories and fluid for patients that are not able to take oral fluids in the event of a hypoglycemic reaction.
Glucagon (GlucoGen) — anti-hypoglycemic: causes a rise in blood glucose levels by promoting hepatic glycogenolysis and gluconeogenesis.

Injectable anti-cholinergic

Atropine — anti-cholinergic: antagonizes acetylcholine at the muscarinic receptors, increasing the heart rate as well as having an anti-sialagogue effect.

Injectable corticosteriod

Hydrocortisone (Solu-Cortef) — anti-inflammatory: a corticosteroid secreted by the adrenal cortex which has anti-inflammatory, anti-allergic, mineralocorticord activity and stimulates gluconeogenesis.
Dexamethasone — anti-inflammatory: a corticosteroid secreted by the adrenal cortex; it has anti-inflammatory, anti-allergic, glucocorticord activity and stimulates gluconeogenesis.

Injectable anti-hypertensive

Esmolol — beta-antagonist: is a cardioselective beta1 receptor blocker with rapid onset and a very short duration of action, with no significant intrinsic sympathomimetic or membrane stabilizing activity at therapeutic dosages. It decreases the force and rate of heart contractions by blocking beta-adrenergic receptors of the sympathetic nervous system.
Labetolol — beta-antagonist: is a mixed alpha/beta adrenergic antagonist, which is used to treat high blood pressure.
Hydralazine: is a direct-acting smooth muscle relaxant used to treat hypertension by acting as a vasodilator primarily in arteries and arterioles.

Injectable anti-arrhythmic

Adenosine (Adenocard) — anti-arrhythmic: used for treatment of paroxysmal supraventricular tachycardia by slowing conduction time through the AV node as well as interrupting the re-entry pathways through the AV node.
Amiodarone (Cordarone) — anti-arrhythmic: a class III agent that inhibits adrenergic stimulation, which prolongs the action potential, decreases AV conduction and sinus node function. It is used for life-threatening recurrent ventricular fibrillation or hemdynamically unstable ventricular tachycardia.
Lidocaine – anti-arrhythmic: is a class 1B anti-arrhythmic drug that is used intravenously for the treatment of ventricular arrhythmias.
Verapamil (Isoptin/Calan) – anti-
arhythmic: used for the treatment of paroxysmal supraventricular tachycardia, atrial flutter and atrial fibrillation.
Vasopressin (Pitressin) – an anti-diuretic hormone: adjunctive treatment used in pulseless ventricular tachycardia/ventricular fibrillation.

Conclusion

In conclusion, the emergency drug kit is essential for the practice of dentistry. No practitioner is able to determine when he or she will be faced with a medical emergency that will require the use of emergency drugs. It is for that reason alone, dental healthcare practitioners should stay up-to-date on medical emergencies as well as the drugs used to treat them. Develop a regular protocol to where you and your staff are able to rehearse various emergencies using your emergency drugs. Know their actions along with the route of administration.

You and your staff should always know the location of your emergency drugs. Assign a staff member the role of reviewing your emergency drugs each month to prevent expiration of these drugs. Check out the emergency drug tracker from Emergency Drug Resource (www.buildyourowndrugkit.com) as another way to assist you in developing an expiration prevention program. None of us know when our patient’s life may depend on our readiness — and having the proper emergency drugs.

Disclaimer

The publisher and author are not responsible (as a matter of product liability, negligence or otherwise) for any injury resulting from any material herein.

This publication contains information relating to general principles of medical care that should not be construed as specific instructions for individual patients.

Manufacturers’ product information and package inserts should be reviewed for current information, including contraindications, dosages, and precautions.

The purpose of this article is to provide information only, rather than advice or opinion. Nothing in this article should be construed as setting a standard of care or practice recommendations.

Dental health care professionals accessing this article agree to assume full responsibility for the use of this information and hold harmless any third party, including, but not limited to the author and publisher for any claim, loss, injury or damage arising from the use or dissemination of information within this program.

It is the sole responsibility of the dental health care practitioner to determine drugs, doses and administration techniques based upon his or her evaluation of each individual situation. Dental health care practitioners are advised to continually seek confirmation of this material with other reputable sources and are advised to stay current with information as it becomes available.

The publisher and author have made every effort to trace the copyright-holders of any borrowed material to make proper attribution. If they have inadvertently failed to attribute any copyrighted material to the correct holder, proper attribution will be given upon receipt of appropriate notice.

Note: This article appeared in Dental Tribune U.S. Edition, Vol. 7, No. 9, September 2012. A complete list of references is available from the publisher.

To post a reply please login or register

Dental office emergency drugs, Part 1

Key points on emergency drug kits: 1) An emergency drug kit is critical in the dental setting. The ADA states that all dentists should have an emergency ...

Five reasons why your office needs an emergency drug kit

‘An unforeseen combination of circumstances or the resulting state that calls for immediate action.’ That’s how Merriam-Webster defines ...

Manhattan dental office accepting cryptocurrency

NEW YORK, US: A Manhattan dental clinic’s adoption of cryptocurrency as a payment method has highlighted the growing acceptance of digital currencies by ...

Interview: Biosecurity in the dental office

As a pioneer and market leader in sterilization, Austria-based company W&H is renowned for developing high-quality sterilization devices for the dental ...

Total digitization of the dental office

NEW YORK, N.Y., USA: At the Henry Schein Digital Dentistry Forum, held during the recent Greater New York Dental Meeting, Henry Schein Chairman and CEO ...

Registration opens for dental office manager conference

RED BANK, N.J., USA: The American Association of Dental Office Managers (AADOM) has announced that registration is open for this year’s conference, to...

Disposable saliva ejectors offered free to dental practices handling emergency procedures

CHESTERFIELD, Mo., USA: In response to the Covid-19 pandemic, through June 31, DOVE Dental Products will provide 25 SE Plus Single-use Disposable Saliva ...

PRF brings new challenges to the dental office

Platelet-rich fibrin can play an important role in oral and maxillofacial surgery, implant dentistry, periodontal regeneration and post-extraction site ...

New dental office uses 70 percent less energy

ROANOKE, Va., USA: Three dentists have opened a practice built with special technology that is designed to reduce energy use by 70 percent. The new building...

Two sedation drugs for outpatient dental procedures compared for effectiveness

NEW YORK, N.Y., USA: The demand for outpatient dental procedures is increasing and, along with it, the requirement for sedatives that meet the needs of both...

Education

Live webinar
Mon. 22 April 2024
10:00 AM EST (New York)