(2) Emergency Drugs In Dental Practice

EMERGENCY DRUGS IN DENTAL PRACTICE INTRODUCTION Collapse of a patient in the dental surgery is an infrequent occurrence whose incidence is largely unknown. Dentists must be aware of the potential medical complications that may arise through the delivery of dental care to medically compromised patients. This article reviews the more common emergency drugs that the dental team may have to administer in general dental practice. Practitioners administrating general anesthetics and using intravenous sedation techniques should undergo recognized training in advance cardiac life support. The drugs commonly used are 1. oxygen 2. adrenaline 3. glyceryl trinitrate 4. nitrous oxide 5. glucagon 6. glucose 7. salbutamol 8. hydrocortisone 9. diazepam 10. flumazenil ; and 11. chlorpheniramine In all cases, the best method of managing medical emergencies is by preventing them from occurring in the first place. With this in mind, it is essential to take a comprehensive medial history from any patient about to receive dental care. This will: • help to warn the clinician about any potential complications that may arise during dental treatment; • indicate necessary preventive measures that can be taken to help prevent a crisis; and • aid in the rapid diagnosis of the cause of collapse.

Drug

Indications

Administration

Dose Adults

Oxygen Adrenaline

All emergencies except hyperventilation Anaphylaxis

Face mask Bag valve mask

Glyceryl trinitrate

Acute chest pain Sublingual

Nitrous oxide

Myocardial infarction

Inhalation

Glucagon

Hypoglycaemia

Intramuscular

1mg

Glucose

Hypoglycaemia

Intravenous

Acute asthma

Inhalation

Prophylaxis and treatment of acute adrenal crisis; anaphylaxis; asthma Status epilepticus

Intramuscular

50ml of 50% 2 puffs upto 20times 200mg

Intravenous Rectal solution

10 mg 10mg

Flumazenil

Benzodiazepine -induced respiratory depression

Intravenous

Chlorpheniramine

Anaphylaxis Urticaria

Intramuscular Oral

200µg over 15s, then 100µg every 60s.max 1mg 10-20mg 4mg tds

intramuscular

Salbutamol Hydrocortisone

Diazepam

children 4-6l/min 10 l/min

0.5-1mg

10µg/kg

0.3-1mg

Not appropriate 50% oxygen +50% nitrous oxide 0.5mg(under 12 years) 1-2ml/kg of 50% 1 puff upto 20 times 25mg(<1yr); 50mg(1-5yrs); 100mg(6-12yrs)

200-300µg/kg 5mg(1-3yrs); 100mg(6-12yrs) Inadequate data

200µg/kg (<12yrs); 1mg/12h(12yrs); 1mg/8h(2-5yrs) 2mg/8h(612yrs)

Approximate child weight (kg) can be calculated using the formula (age + 4)x 2

LOOKING AFTER EMERGENCY DRUGS It is best to store drugs in a cool place (between 4˚C and 25˚C) to ensure that all members of the dental team are aware of their location. The expiry dates should be checked every 6 months and recorded, and expiry items replaced immediately. CONCLUSION Management of medical emergencies should involve the whole dental team. All members must be familiar with the practice protocol in the event of collapse. Each team member should be allocated and rehearse a role so that all emergencies are managed efficiently. Dentists are advised to attend courses regularly on the management of medical emergencies and to keep up to date with new protocols, equipment and drugs. Resuscitation routines should be practiced regularly within the dental surgery under simulated conditions; this has been shown to be essential to help retain the skills involved. References: 1. General Dental Council. Recommendations Concerning the Dental Curriculum, vol.12.London: General Dental Council, 1990; 15. 2. James DW. General anaesthesia, sedation and resuscitation in dentistry. Br Dent J 1991; 171: 345-347. 3. Scully C, Cawson RA. Medical Problems in Dentistry, 5th ed. Oxford: Wright, 2005.