in order to deal with dental emergencies this thorough knowledge is what we all need

1. WHY TEACHING??
• PROCESS OF PERSONAL DEVELOPMENT
• BETTER UNDERSTANDING OF THE SUBJECT
• INCREASED CONCENTRATION,PATIENCE
• WAY TO PROPAGATE AND PREACH YOUR KNOWLEDGE

2. EMERGENCY DRUGS
IN DENTISTRY
PRESENTED BY
DR KRITIKA AGARWAL
BDS

3. BRIEF OVERVIEW
• INTRODUCTION
• BASIC EMERGENCY DRUG KIT
• ESSENTIAL EMERGENCY DRUGS
• ADDITIONAL EMERGENCY DRUGS
• OTHER DRUGS USED IN ADVANCED CVLS
• ANTIDOTAL DRUGS

4. INTRODUCTION
• PREPARATION,PREVENTION AND MANAGEMENT OF LIFE-THREATNING
SITUATIONS
• 60% -SYNCOPE 7%-HYPERVENTILATION
• FREELY AVAILABLE EMERGENCY KIT
• PERIODIC CHECKING OF KIT AND PROMPT RECTIFICATION IF NEDDED

5. BASIC EMERGENCY DRUG KIT
Essential emergency drugs
• Oxygen
• Adrenaline
• Chlorpheniramine
• Nitrates & Nitrites
• Salbutamol/Albuterol
Additional emergency drugs
• Nitrous oxide
• Diazepam/Midazolam
• Methoxamine/phenylephrine
• Antihypoglycemic
• Hydrocortisone/Dexamethasone
• Atropine
• Aromatic ammonia

6. ESSENTIAL EMERGENCY DRUGS

7. OXYGEN
• MOST USEFUL DRUG OF THE EMERGENCY KIT
• INDICATED IN EMERGENCY SITUATIONS WHERE RESPIRATORY DISTRESS IS
EVIDENT
• NO SIDE EFFECTS
• CONTRAINDICATED IN HYPERVENTILATION
• OXYGENATION FOR SPONTANEOUS BREATHER : FACE MASK ATTACHED TO
OXYGEN SUPPLY , RUNNING AT A RATE OF 10 LTS/MIN

8. ADRENALINE
• DRUG OF CHOICE IN ACUTE ALLERGIC REACTIONS
DESIRABLE PROPERTIES:-
• RAPID ONSET OF ACTION
• POTENT BRONCHO SMOOTH MUSCLE DILATOR
• HISTAMINE BLOCKER
• INCREASES CARDIAC OUTPUT
UNDESIRABLE ACTION:- TACHYDYSRHYTHMIAS AND RELATIVELY SHORT
DURATION OF ACTION

9. AVAILABILITY -PRELOADED SYRINGE
1) 1:1000 INTRAMUSCULAR/SUBCUTANEOUS
2) 1:10000 INTRAVENOUS
-1 ML PRE-FILLED AMPULES
DOSE - ADULT DOSE:-0.5-1.0 ML
- PEDIATRIC DOSE:- 0.2-0.5 ML
CONTRAINDICATION:- IN PREGNANCY – DECREASES PLACENTAL BLOOD FLOW
- INDUCES PREMATURE LABOUR

10. CHLORPHENIRAMINE
• DRUG OF CHOICE FOR – DELAYED ALLERGIC RESPONE
-DEFINITIVE MANAGEMENT OF ACUTE ALLERGY
-AS LOCAL ANESTHETIC IN CASE OF ALLERGY TO
CONVENTIONALS
• DESIRABLE PROPERTIES
-COMPETITIVE ANTAGONIST OF HISTAMINE
-PREVENTS HISTAMINE’S ACCESS TO RECEPTOR SITE
-BLOCKS RESPONSE OF EFFECTOR CELL TO HISTAMINE

11. • UNDESIRABLE ACTION – CNS DEPRESSION
- DECREASED BLOOD PRESSURE
- THICKENING OF BRONCHIAL SECRETIONS
• AVAILABILITY AND DOSE – 1ML & 2ML AMPULES(10MG/ML)
- 1ML PRELOADED SYRINGES
- 4MG ORAL ADMINISTRATION EVERY 4 TO 6 HOURLY
IN CASE OF
LOCALISED ALLERGIC REACTIONS OF SKIN
• CONTRAINDICATION – ACUTE ASTHAMATIC ATTACK

12. NITRATES & NITRITES
(GLYCERYL TRINITRATE OR
NITROGLYCERINE & AMYL NITRATE)
• PRIMARY INDICATED FOR CHEST PAIN (IN ACUTE MI & ANGINA PECTORIS)
• DESIRABLE PROPERTIES – RELAXATION OF MYOCARDIAL SMOOTH MUSCLE CELLS
- REDUCTION IN MYOCARDIAL OXYGEN REQUIREMENT
- RELIEF IN ANGINA
- REDUCTION IN CARDIAC WORKLOAD
- REDUCTION IN RESTING BP

13. • UNDESIRABLE PROPERTIES – SUDDEN HYPOTENSION
- FACIAL FLUSHING
- THREADY PULSE,FAINTING AND COMPLETE NITRATE
SYNCOPE
• AVAILABILITY –
- 0.3,0.4,0.6 MG DOSES OF SUBLINGUAL TABLETS
- 0.4,0.8 MG METRED DOSE TRANSLINGUAL SPRAY
• CONTRAINDICATION – HYPOTENSIVE PATIENTS

14. SALBUTAMOL
/ALBUTEROL/METAPROTERENOL
• DRUG OF CHOICE IN ASTHMATIC AND ALLERGIC REACTIONS(MANIFESTED
PRIMARILY BY RESPIRATORY DIFFICULTY)
• DESIRABLE PROPERTY – BRONCHIAL SMOOTH MUSCLE RELAXATION
• AVAILABILITY – ALBUTEROL INHALERS( VENTOLIN, PROVENTIL)
- METAPROTERENOL INHALERS (ALUPENT)
• CONTRAINDICATION – PRE-EXISTING TACHYDYSRHYTHMIAS

15. ASPIRIN(ACETYLSALICYLIC ACID)
• DRUG OF CHOICE IN ACUTE MYOCARDIAL INFARCTION
• DESIRABLE PROPERTIES-
-IRREVERSIBLY ACETYLATES PLATELET CYCLOOXYGENASE
-REMOVES ALL CYCLOOXYGENASE ACTIVITY FOR THE LIFESPAN OF PLATELET
-STOPS PRODUCTION OF THROMBOXANE A2
-DIMINISHES FORMATION OF PROSTACYCLINES
• AVAILABILITY – 65,81,162,325 MG TABLETS

16. • CONTRAINDICATIONS AND SIDE EFFECTS –
- LIFE THREATNING HAEMORRHAGE( BLEEDING PEPTIC ULCER)
- HISTORY OF ASPIRIN ALLERGY

17. ADDITIONAL EMERGENCY DRUGS

18. NITROUS OXIDE
• INDICATED IN THE INITIAL MANAGEMENT OF MI DUE TO ITS ANALGESIC
PROPERTIES
• ACHIEVES THE DESIRABLE EFFECT BY DIRECTLY OR INDIRECTLY ALTERING THE
MEMBRANE PROTIENS INVOLVED IN CONDUCTION OF NERVE IMPULSES
• DOSAGE- COMBINATION OF 50% NITROUS OXIDE & 50% OXYGEN RESULTS IN
ANALGESIA WITHOUT LOSS OF CONSCIOUSNESS

19. ANTICONVULSANTS
(DIAZEPAM,MIDAZOLAM)
• DRUG OF CHOICE TO MANAGE CHAIRSIDE CONVULSIONS OR SEIZURES
• DESIRABLE ACTION- TERMINATES THE SEIZURE ACTIVITY WITHOUT
PRONOUNCED DEPRESSION OF RESPIRATORY AND CARDIOVASCULAR SYSTEM
• AVAILABILITY AND DOSAGE- VALIUM – 5MG/ML GIVEN I.V. OR I.M.
- CALMPOSE 5,1O MG TABS
• SIDE EFFECT AND CONTRAINDICATION- RESPIRATORY DEPRESSION AND ARREST

20. VASOPRESSOR DRUGS
(METHOXAMINE/PHENYLEPHRINE)
• USED IN ORDER TO MEET THE SHORTCOMINGS OF ADRENALINE IN CASES OF-
-HYPOTENSION(STATUS OF HEART UNKNOWN)
-SYNCOPAL REACTIONS -POST SEIZURE STATES
-DRUG OVERDOSE REACTIONS -ALLERGIES
-ACUTE ADRENAL INSUFFICIENCY
• DESIRABLE EFFECT- MODERATELY INCREASE IN BP W/O UNDULY STIMULATING
MYOCARDIUM
- PERIPHERAL VASOCONSTRICTION

21. • AVAILABILITY – 10MG/ML PHENYLEPHRINE OR METHOXAMINE
• PRECAUTIONS- HYPERTHYROIDISM
- BRADYCARDIA
- PARTIAL HEART BLOCK
- MYOCARDIAL DISEASE
- SEVERE ATHEROSCLEROSIS
• CONTRAINDICATIONS – HIGH BP
- VENTRICULAR TACHYCARDIA

22. ANTIHYPOGLYCEMICS
(50% DEXTROSE OR 50% GLUCAGON)
• INDICATED TO MANAGE HYPOGLYCAEMIA IN A CONSCIOUS OR UNCONSCIOUS
PATIENT
• DESIRABLE ACTION- STIMULATES HEPATIC GLYCOGENOLYSIS &
GLUCONEOGENESIS
- LIPOLYSIS
• AVAILABILITY – 50% DEXTROSE IN 30 ML WATER (CONSCIOUS PATIENT)
- IMG, IN ADULTS (0.5 IN CHILDREN) I.M. INTO DELTOID OR
GLUTEAL AREAS
(UNCONSCIOUS PATIENT)
• CONTRAINDICATION- STARVATION OR CHRONIC HYPOGLYCEMIA

23. HYDROCORTISONE/DEXAMETHASONE
• DRUG OF CHOICE IN ALLERGIES AND ACUTE ADRENAL INSUFFICIENCY
• AVAILABILITY AND DOSE-25 TO 200MG ORAL, I.M. OR I.V. DOSE DEPENDING ON
THE AGE
• CONTRAINDICATIONS- PRE EXISTING INFECTION
- PEPTIC ULCER
- DIABETES MELLITUS

24. ATROPINE
• DRUG OF CHOICE IN PATIENTS WITH SINUS BRADYCARDIA ALONG WITH
SYMPTOMATIC HYPOTENSION
• DESIRABLE ACTION-TACHYCARDIA DUE TO BLOCKADE OF M2 RECEPTOR ON SA
NODE
- DECREASES VAGAL TONE
• DOSE – 0.6 TO 2 MG I.M. OR I.V. ATROPINE SULPHATE
• SIDE EFFECTS- DRY MOUTH & SKIN, HALLUCINATIONS, RESTLESSNESS, CVS
COLLAPSE
• CONTRAINDICATIONS – GLAUCOMA AND PROSTATE HYPERTROPHY

25. AROMATIC AMMONIA
• DRUG OF CHOICE FOR TREATMENT OF SYNCOPE & RESPIRATORY DEPRESSION
NOT INDUCED BY OPIOID ANALGESICS
• DESIRABLE ACTION- IRRITATES THE MEMBRANE OF UPPER RESPIRATORY TRACT
- STIMULATES RESPIRATORY & VASOMOTOR CENTRE OF
MEDULLA
- INCREASES RESPIRATION & BP
• AVAILABLE DOSE – 0.3 ML OF SILVER GREY VAPOROLE ,CRUSHED & PLACED
UNDER VICTIM’S
NOSE
• PRECAUTION – CHRONIC OBSTRUCTIVE PULMONARY DISEASE OR ASTHAMA

26. OTHER DRUGS USED IN ADVANCED
CARDIOVASCULAR LIFE SUPPORT
• LIDOCAINE
• DOPAMINE/DOBUTAMINE
• MORPHINE SULPHATE/MEPERIDINE
• VERAPAMIL

27. ANTIDOTAL DRUGS
• OPIOD ANTAGONISTS- NALOXONE OR NALBUPHINE
• BENZODIAZEPINE ANTAGONIST – FLUMAZENIL
• ANTIEMERGENCE DELIRIUM – PHYSOSTIGMINE
• VASODILATOR - PROCAINE