National Dental Advisory Committee - Emergency Drugs & Equipment in Primary Dental Care

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

2. Salbutamol inhaler (100 µg per activation)

3. Adrenaline (1 ml ampoules or pre-filled syringes of 1:1000 solution for intramuscular injection)

Note that pre-filled syringes are useful in an emergency situation for ease of use.

4. Aspirin (300 mg dispersible tablets)

5. Glucagon (for intramuscular injection of 1 mg)

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

7. Midazolam buccal liquid (10 mg/ml), or Midazolam injection (as hydrochloride) (5 mg/ml 2 ml ampoules) for topical buccal administration

8. Oxygen cylinder:

Size: Every practice should have sufficient oxygen to ensure at least 30 minutes supply at 15 litres/minute. Three main sizes of cylinder are in current use in dental practices:

• A full Size D cylinder contains 340 litres of oxygen and will provide oxygen for less than 30 minutes;
• A full Size CD cylinder contains 460 litres of oxygen and should provide oxygen for 30 minutes;
• A full Size E cylinder contains 680 litres of oxygen and should provide oxygen for up to 45 minutes.

An urban practice should either have two Size D or two Size CD or one Size E cylinder. In rural areas the ambulance response times may be prolonged. In these circumstances additional cylinder capacity may be required to ensure that a collapsed patient can be adequately maintained on oxygen. In order to achieve this it is recommended that rural practices should have two E cylinders.

Flow: The oxygen cylinder should provide flow of at least 15 litres per minute.

Serviced: at least every 5 years (or according to manufacturer's instructions).

Charged: at least 75% full and evidence of regular checks.

Note: some cylinders have a built-in regulator whereas others have a bolt on regulator; these are not interchangeable; dental staff should ensure there is awareness of the type of cylinder in use and that spare cylinders are useable.

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