Preparing for Medical Emergencies: The Essential Drugs and Equipment for the Dental Office
Section snippets
EQUIPMENT
Oxygen is of primary importance in any medical emergency and must be available in a portable E cylinder that can be transported easily to any office location in which an emergency may arise. A dental office should be equipped with a device for the administration of supplemental oxygen to a spontaneously breathing patient—such as nasal cannulae, nonrebreathing masks with an oxygen reservoir or a nitrous oxide-oxygen nasal hood.
Every office must have the ability to deliver oxygen under positive
EMERGENCY DRUG KITS
Practitioners can organize emergency kits themselves or purchase them. Many dentists are not comfortable choosing and purchasing individual drugs for their emergency kits, and a high-quality, commercially available emergency drug kit modified for dentistry can provide consistent drug availability (an automatic drug updating service often is included) in an organized fashion.11 Emergency drugs generally are powerful, rapidly acting compounds. The correct approach to using drugs in any medical
BASIC EMERGENCY DRUGS
All dentists must keep a fresh supply of critical drugs in the office for immediate administration (Table 2). Dentists must know reflexively when, how and in what doses to administer these specific agents for life-threatening situations. The drugs described should be included in a basic medical emergency kit for the general dental practice. They consist of agents that are noninjectable or can be administered via subcutaneous, intramuscular or sublingual routes, and, for dentists with advanced
SUPPLEMENTAL INJECTABLE DRUGS AND EQUIPMENT
Dentists with advanced training may consider including drugs and equipment in addition to those described earlier. These might include the following injectable drugs:
analgesics;
anticholinergics;
anticonvulsants;
antihypertensives;
antihypoglycemics;
corticosteroids;
vasopressors.
ADJUNCTIVE GENERAL ANESTHESIA DRUGS AND EQUIPMENT
Educationally qualified dentists16 who use deep sedation and general anesthesia must have additional emergency drugs immediately available (for example, if they use depolarizing neuromuscular blocking agents, they must have dantrolene sodium, as well as other drugs specific to these practices, such as those for advanced cardiac life support [ACLS]), and additional equipment, such as advanced monitoring systems and airway rescue equipment.
REVERSAL DRUGS
If dentists administer opioids or benzodiazepines to induce moderate or deep sedation, general anesthesia or both, they must include antidotal drugs in the emergency kit. Naloxone is a specific opioid antagonist that reverses opioid-induced respiratory depression.17 Flumazenil is a specific benzodiazepine antagonist that reverses sedation and respiratory depression resulting from benzodiazepine administration.18
INJECTABLE DRUG ACCESS
The injection of many emergency drugs into the vascular system is crucial to speed drug action. The intravenous route is rapid but requires skill in venipuncture. The intramuscular route, either into the vastus lateralis or mid-deltoid regions, results in slower uptake but perhaps easier access for many dentists, as does the sublingual approach. Establishing intravenous access may be difficult or impossible during medical emergencies. As advocated in the AHA's ACLS/PALS guidelines, intraosseous
ADVANCED CARDIAC LIFE SUPPORT
ACLS for adults and pediatric advanced life support (PALS) for children are the standards of care for comprehensive resuscitation by health care providers with advanced skills and training. Pharmacotherapy plays an important role in the treatment of these patients, with guidelines for specific drug therapies centering on the use of many antidysrhythmic and vasoactive drugs.8, 19
ADVANCED AIRWAY DEVICES
Dentists with advanced training may wish to include advanced airway devices in their emergency kits. The indications for, the technique in using, and ensuring correct placement of these devices require training and clinical experience. Endotracheal intubation is accomplished with the use of a laryngoscope and an endotracheal tube. Gaining in popularity in airway rescue are supra-glottic devices such as the laryngeal mask airway.22
CONCLUSION
Urgent and emergent medical emergencies can and do occur in the dental office. Early diagnosis, telephone calls for help and proper management will increase the likelihood of a successful response. Accomplishing this depends on the combination of training and preparation by the dentist and staff members and the immediate availability of basic and critical emergency drugs and equipment.
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Drugs for medical emergencies in the dental office
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Disclosure. Dr. Rosenberg did not report any disclosures.