Emergency drugs and equipment in primary dental care

3 Emergency drugs in the dental practice

The following drugs^[1] must be available at all times. For details of drug doses, refer to the BNF Guidance for Prescribing in Dental Practice or SDCEP Guidance for Medical Emergencies.

1. Adrenaline (1 ml ampoules or pre-filled syringes of 1:1000 solution [1 mg per ml] for intramuscular injection)

Note: Pre-filled syringes are useful in an emergency situation for ease of use. However, some pre-filled syringes for patient use (e.g. EpiPen©) contain less adrenaline than recommended for the management of medical emergencies. The recommended initial adult dose is 0.5 ml (0.5 mg). If the initial dose is administered using an auto-injector syringe, the second dose if required, should be from an ampoule.

2. Aspirin (300 mg dispersible tablets)

3. Glucagon (for intramuscular injection of 1 mg [1 unit])

4. Glyceryl trinitrate spray (400 µg per metered dose)

5. Midazolam oromucosal solution (or when permitted,4 midazolam injection solution, 5 mg per ml, 2 ml ampoules, for topical buccal administration).

6. Oral glucose/sugar (several alternative forms are available commercially including non-diet fizzy drinks, glucose gel, powdered glucose and sugar lumps)

7. Oxygen cylinder:

Every practice should have sufficient oxygen to ensure at least 30 minutes supply at 15 litres per minute e.g. two Size D or two Size CD or one Size E cylinder.

If the ambulance response times are likely to be prolonged (e.g. for remote practices), additional cylinder capacity may be required to ensure that a collapsed patient can be adequately maintained on oxygen.

The oxygen cylinders should be able to provide a flow rate of at least 15 litres per minute, should be at least 75% full, within the expiry date, checked regularly and serviced at least every 5 years (or according to manufacturer’s instructions).

Notes:

i. In dental practices, oxygen cylinders that are typically used include: -

Size D - contain 340 litres of oxygen when full and should provide oxygen for approximately 22 minutes;

Size CD - contain 460 litres of oxygen when full and should provide oxygen for approximately 30 minutes;

Size E - contain 680 litres of oxygen when full and should provide oxygen for up to 45 minutes.

ii. Some cylinders have a built-in (integral) regulator whereas others have a bolt on regulator. These are not interchangeable and dental staff should ensure they are aware of the type of cylinder in use and that spare cylinders are fit for use.

iii. Ensure that medical oxygen supplies are procured from authorised and licensed manufacturers or authorised wholesale dealers of medical oxygen.5,6

iv. For information about storage of medical oxygen cylinders see Appendix 2.

8. Salbutamol inhaler (100 µg per actuation)

9. Flumazenil (0.5 mg/ 5 ml): only required for dental settings where conscious sedation using benzodiazepines is undertaken.