Chapter 23
Emergency Drugs
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Medical Emergencies
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The vast majority of medical emergencies that occur
in a dental office occur in the waiting room.
More often than not, the patient has a preexisting
medical condition.
Several factors have increased the incidence of
medical emergencies in the dental office.
An increasing number of older patients taking multiple
medications are seeking dental treatment.
Advances in science, medications that allow for
longer dental appointments, and the increased use of
medication in dental practice have also contributed to
older and sicker patients seeking dental treatment.
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Methods of Minimizing Medical
Emergencies in the Dental Office
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Observe the patient's stature, build, gait, coloring,
age, facies, and respiration.
Observe and record the amount of anxiety; use active
listening to determine hidden nervousness.
Take the patient's blood pressure and pulse rate, and
perform any necessary laboratory examination.
Take a complete patient history, including medication
history, past dental and anesthetic experiences,
restrictions on physical activity, diseases, and present
condition.
Request medical consultations as needed.
Prescribe premedication, if appropriate, and avoid
drug interactions.
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General Measures for Preparing Dental
Office Staff for a Medical Emergency
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Training
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All office personnel should be trained in
emergency procedures to include CPR and
basic first aid.
Each person should have a specific role in
treating a medical emergency.
Dental offices should have emergency practice
drills.
The phone number for outside emergency
assistance should be posted by the phone.
911 should be programmed into the speed dial
function of the office phones.
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General Measures for Preparing Dental
Office Staff for a Medical Emergency
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Emergency Medical Kits
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The choice of drugs and devices kept in an
emergency medical kit usually depends on
individual circumstances, professional
experience, and personal experience.
The kits can be homemade or purchased as a
set through a company.
Kits should be checked every 3 months for
outdated medications.
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Emergency Drugs
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Level 1 (Critical Drugs)
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Albuterol inhaler
Diphenhydramine
Epinephrine
Glucose, oral, cake frosting or orange juice
Nitroglycerin
Oxygen
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Emergency Drugs
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Level 2 (Secondary Drugs)
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Beta blockers
 Dextrose 50%
 Diazepam/alprazolam
 Hydrocortisone
 Morphine
 Spirits of ammonia
 Lidocaine
 Naloxone
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Equipment
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An oxygen mask, manual resuscitation
bag, and oxygen tank with flow gauge are
necessary to administer positive oxygen
pressure.
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A blood pressure cuff and stethoscope are also
necessary.
Dental practices should also be equipped with
automated external defibrillators.
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Emergency Devices
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Level 1 (Critical Devices)
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Syringes/needles
 Tourniquets
 System to give oxygen
 Automated external defibrillator
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Level 2 (Secondary Devices)
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Cricothyrotomy device
Endotracheal tube
Laryngoscope
System to give IV infusions
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Medical Emergencies
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Many different emergencies can occur.
There are several steps that can be taken
to treat any type of medical emergency.
The most common types of emergencies
include cardiac, respiratory, changing
consciousness, other emergencies, and
drug-related.
The dental practitioner should know the
signs and symptoms of these emergencies
and how to respond to them.
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General Treatment of
Medical Emergencies
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Recognize the abnormal occurrence.
Make a proper diagnosis.
Call 911 (or appropriate emergency number).
Note the time.
Position the patient properly.
Maintain an airway.
Administer oxygen.
Monitor vital signs.
Provide symptomatic treatment.
Administer cardiopulmonary resuscitation (CPR)
if there is no pulse.
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