Management of Pediatric Medical Emergencies in the Dental Office
Course Number: 391
Course Contents
Emergency Drugs
Emergency drugs may be divided into two categories. The first category is drugs that are essential and should be part of every emergency drug kit. The second category consists of drugs that are useful but are optional depending on the practitioner’s training in emergency medical procedures and whether sedation and general anesthesia are used for behavior and anxiety management. Thus, emergency drug kits will vary from office to office. A dentist trained to administer general and intravenous sedation with greater proficiency in venipuncture would have a more comprehensive drug kit than a dentist without such training. For dentists not proficient in venipuncture, optional drugs that can be administered orally, intramuscularly/sublingually and intranasally. For a more comprehensive review, kindly refer to American Dental Association’s guide on preparation of a dental team for medical emergencies.5
At the very least, a basic dental office emergency drug kit should contain the eight drugs summarized in Table 1.
| Drug | Indication | Dose | Quantity |
|---|---|---|---|
| Oxygen | Almost any emergency | 100% inhalation | 1 “E” cylinder with adjustable regulator (0-15L) |
| Epinephrine | Anaphylaxis Asthma unresponsive to albuterol/salbutamol | 1: 1000 (1mg/ml), auto injector 0.3 mg/ml (EpiPen), 0.15 mg/ml (EpiPen Jr) | 1:1000 mg/ml ampule, 1 EpiPen, 1 EpiPen Jr auto injectors |
| Nitroglycerin | Angina pain | 0.4 mg sublingual every 3-5 minutes | 1 metered spray bottle (0.4 mg) |
| Diphenhydramine | Allergic reactions | 1 mg/kg IM/IV; max 50 mg (See table 2 for dosage by age) | 50 mg/ml vials and 1 box 25 mg tablets |
| Albuterol/salbutamol | Asthmatic bronchospasm | 2 puffs; repeat as needed | Metered dose inhaler 2.5 mg/3ml nebulized solution |
| Aspirin | Myocardial infarction | 81 mg chewable tablet | Chewable tablet, bottle baby aspirin (81 mg) |
| Glucose | Hypoglycemia (patient unconscious) | 37.5 mg; repeat as needed | 1 tube (37.5 mg) |
For the dentists with advanced training and skills in sedation and general anesthesia, the additional emergency drugs in Table 2 may be added to the drug kit.
Table 2. Additional Emergency Drugs.6
| Drug | Indication | Dose | Quantity |
|---|---|---|---|
| Atropine | Clinically significant bradycardia | 0.5 mg IV or IM | 1 ampule (1 mg/10 ml) |
| Hydrocortisone | Adrenal insufficiency Recurrent anaphylaxis | 100 mg IV or IM (mixed with 3-5ml sterile water) | 1 vial (100 mg) |
| Morphine or nitrous oxide | Angina pain unresponsive to nitroglycerin | Titrate 2 mg IV, 5 mg IM ~ 35% N2O inhalation | Titrate 2 mg IV, 5 mg IM ~ 35% N2O inhalation |
| Naloxone | Reversal of opioid overdose | 0.1 mg/kg up to 2mg IV or IM | 4 mg/10 ml multi-dose vial |
| Lorazepam or Midazolam | Status epilepticus | 4 mg IM or IV 5 mg IM or IV | 50 mg/10 ml multi-dose vial |
| Flumazenil | Benzodiazepine overdose | 0.01 mg/kg at 1-minute intervals up to 1 mg IV or IM | 0.5 mg / 5 ml multi-dose vial |