Emergency dental kitD. Gassan y hamed
Life –threatening medical emergencies may occur in the dental environment .The dentist must be prepared to recognized & properly manage patient of medical emergencies in the dental office .
Dentist should have training in the prevention , recognition & management of common emergencies like seizures , cardiovascular & respiratory distress , altered consciousness , chest pain & drugs related emergencies .
AdrenalineIt is indicated in
*anaphylactic shock (type one hypersensitivity ) precipitated by any material or drugs
*acute asthmatic attack
it is available in concentration of 1:1000 for IM & subcutaneous
Volume of 1:1000
• Mode of action of adrenaline
• -contraction of vascular smooth muscle so increase the blood pressure
• -increase the cardiac out put
• -relaxation of the bronchial muscle lead to re-establish airflow
• -inhibition of histamine release
It is contraindicated for pregnant because it will lead to decrease in the placental blood flow & may induce premature labour.
*Antihistamine (diphenhydramine , chlorpheniramine )Antihistaminic drugs are useful in the treatment of the delayed allergic reaction & act as a competitive antagonist of histamine . The mode of action of these drugs by prevent access of histamine to it is receptor site in the cell
• Potential side effect of most antihistamines is a degree of cortical depression which causes sedation therefore chlorpheniramine is preferred
• over diphenhydramine as it has less sedative effect .
these drugs may given orally ,IM . subcutaneous & IV 4mg in adult (4-6) time daily . The maximum dose 24 mg daily
*OxygenIt is the most important drug in the emergency kit Oxygenation prevent hypoxia that may be damaging the vital organs such as brain & heart
Administration :-ensuring airway patency before oxygen is delivered -the airway may be re-established by using the head tilt & chin lift
-oropharyngeal airway may be used in the unconscious patient
-Face mask with an attached oxygen supply running at flow rate between 4-6/ mint
*Nitroglycerine & Amyl nitrateIt is used as coronary vasodilators & immediate management of chest pain
Administration : sublingual tablet (300micrograme) spry (400micrograme)Side effect :
• -sudden hypotension
• -headache & postural hypotension
• -flashing of face
• - tolerance is developed rapidly
• - unstable drug in tablet form
*Anticonvulsant ( diazepam , midazolam )Convulsion may occur due to overdose or toxicity to the local anaesthesia , epileptic & febrile convulsion .
• Dose :• midazolam 5mg/ml in 1, 2,5 & 10 ml vial
• Diazepam 5mg/ml in 2ml ampoules
Side effect : respiratory depression & arrest , however with proper titration during administration this unlikely to occur
It is indicated in unconscious hypoglycemic patient(less than 2.5 mmol/l) . glucagon increase plasma glucose by stimulating glycogenolysis & gluconeogenesis in liver . An additional action is inhibition of glycogen synthesis & glucose oxidation .
Administration : in adult 1mg IM
In children up to 12 years 0.5mg IM
Salbutamol:It is indicated in asthmatic patient & patient with allergic reaction manifested primarily by respiratory difficulty
Salbutamol is administrated by inhalation to produce the most rapid onset of action & minimize the overdose effect .
Hydrocortisone Dexamethasone:These exogenous hydrocortisone should be administrated preoperatively to patient have adrenal insufficiency to prevent adrenal crisis & restore the normal physiological response to stress
Corticosteroid is indicated in
acute allergic reactionprevention of recurrent episode of anaphylaxis
The dose varies according to the age &situation ( 25-200 mg).
It is contraindicated in person of pre-existing
infection , peptic ulcer & diabetic mellitus
• Atropine:It is a parasympathetic blocking agent , it is recommended for the management of symptomatic bradycardia
Atropin acts to mantain adequate cardiac output & cerebral circulation . Large dose of atropine produce clinical signs of overdose which include hot dry skin , eadache , dry mouth , disorientation & hallucination . Atropine is contraindicated in glaucoma . It is available in 0.5 mg /ml in 1ml vial
Aromatic ammoniaIt is strong respiratory stimulant . It is available in silver gray vaporole which is crushed & placed under the victim's nose until respiratory is effected . It stimulate the respiratory & vasomotor centre of the medulla . it is indicated in vasodepressor syncope , respiratory depression & contraindicated in asthma
DRUGS FOR ADVANCED CARDIOVASCULAR LIFE SUPPORT :These drugs should be included only by those dentist who have complete the course in ACLS . Essential ACLS drugs include epinephrine , oxygen , lidocain , atropine , dopamine , morphine sulphate & verapamil .
* Lidocain is considered the primary antidysrhythmic drug that developed after myocardial infarction. Over dose of lidocaine produce myocardial ,circulatory & CNS depression.
* Dopamine is a chemical precursor of norepinephrin . in large dose stimulate both the ( Alfa & Beta ) adrenergic receptor . At lower dose dilate renal , mesenteric & cerebral arteries . It is also indicated in hypotension in the absence of hypovolmia . It is available in 200mg ,400mg , 800mg in 5ml ampole
Morfine sulphat –meperidine *These drugs are indicated for analgesia . the side effect of these drugs are potent central nervous & respiratory system depression .
They are contraindicated in head injury . Dose: morfine is available 8, 10, 15 mg/ml