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Management of Pediatric Medical Emergencies in the Dental Office

Course Number: 391

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

OxygenAlmost any emergency100% inhalation1 “E” cylinder with adjustable regulator (0-15L)
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
NitroglycerinAngina pain0.4 mg sublingual every 3-5 minutes1 metered spray bottle (0.4 mg)
DiphenhydramineAllergic reactions1 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/salbutamolAsthmatic bronchospasm2 puffs; repeat as neededMetered dose inhaler 2.5 mg/3ml nebulized solution
AspirinMyocardial infarction81 mg chewable tabletChewable tablet, bottle baby aspirin (81 mg)
(patient unconscious)
37.5 mg; repeat as needed1 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

AtropineClinically significant bradycardia0.5 mg IV or IM1 ampule (1 mg/10 ml)
HydrocortisoneAdrenal insufficiency
Recurrent anaphylaxis
100 mg IV or IM
(mixed with 3-5ml sterile water)
1 vial (100 mg)
Morphine or nitrous oxideAngina pain unresponsive to nitroglycerinTitrate 2 mg IV, 5 mg IM
~ 35% N2O inhalation
Titrate 2 mg IV, 5 mg IM ~ 35% N2O inhalation
NaloxoneReversal of opioid overdose0.1 mg/kg up to 2mg IV or IM4 mg/10 ml
multi-dose vial
Lorazepam or MidazolamStatus epilepticus4 mg IM or IV
5 mg IM or IV
50 mg/10 ml
multi-dose vial
FlumazenilBenzodiazepine overdose0.01 mg/kg at 1-minute intervals up to 1 mg IV
or IM
0.5 mg / 5 ml
multi-dose vial