2. Emergency drugs &
equipment must be
available in every dental
office
Life-saving
Secondary role to basic life
support in overall
management
3. It is a collection of drugs & equipments highly
effective in managing life-threatening situations
Should be as simple to use as possible
Should be intended to use for adult or pediatric
patients
They are presented in 4 levels or modules based
on level of training & experience of the doctor
Drugs in each module
i. Injectables
ii.Non-injectables
5. 1) Cleanse the area of needle insertion
2) Grab the muscle & pull it away from the bone
3) Holding the syringe like a dart, quickly insert the
needle into the muscle mass to a depth of
approximately 1 inch
4) Aspirate to ensure nonvascular penetration
5) Quickly administer the drugs
6) Remove the syringe, placing a dry gauze under
pressure at the injection site for a minimum of 1-2
minutes
7) Rubbing the area may increase vascularity &
speed the rate of drug absorption
6.
7. 1) Place the tourniquet above the antecubital fossa
2) If possible have the patient open & close the fist
to help distend the veins
3) When the patient cannot open & close his/her fist
(unconscious) – place arm below the level of
patient’s heart to help distend the veins
4) Cleanse & then dry the area in which the
venipuncture is to be placed
8. 5) Use an indwelling catheter , scalp-vein needle or
syringe with the bevel of the needle facing up held
at about 30 – 45 angle to the vein to be entered
6) Advance the needle into the vein until a return of
blood is noted
7) Remove the tourniquet & either start the IV
infusion or administer the desired drug
8) Secure the needle with a tape to maintain venous
access
9.
10.
11.
12. MODULE ONE- Basic emergency kit (critical
drugs &
equipment)
MODULE TWO – non critical drugs & equipment
MODULE THREE – advanced cardiac life support
MODULE FOUR – antidotal drugs
21. SIDE EFFECTS
Tachydysrhythmias
- Supraventricular
- Ventricular
PRECAUTIONS
In pregnancy
-decreases placental blood flow
-premature labour
NO CONTRA INDICATIONS
22. AVAILABILITY
Preloaded syringes
- 1:1000 intramuscular and subcutaneous
-1:10000 intravenous
1ml ampules
DOSE
Adult dose
0.3 -0.5 ml intramuscular and subcutaneous
Pediatric dose
0.15mg
23. In Emergency kits
- 1 preloaded syringe(1 ml of 1:1000 epinephrine)
- 3 or 4 ampules(1:1000 epinephrine)
24. Drug class - Histamine blockers
Proprietary - Chlor- Trimeton
Alternative drug -Diphenhydramine
Histamine blockers
Drug of choice
- delayed allergic response
- definitive management of acute allergy
MODE OF ACTION
Competitive antagonists of histamine
Prevent histamine’s access to receptor site
Blocking response of effector to histamine
25. THERAPEUTIC INDICATIONS
Delayed onset allergic reactions
As local anesthetics in allergic patient
Definitive management of acute allergic
reactions
Side Effects
- CNS Depression
-Decreased Blood Pressure
-Thickening of bronchial secretions
Contraindications
26. AVAILABILITY
- 1ml and 2ml ampules(10mg|ml)
-1ml pre loaded syringes
DIPHENHYDRAMINE
-10&30ml multidose vials(10mgml)
-1ml ampules(50mgml)
-1ml pre-loaded syringes
IN EMERGENCY KITS
-Three or Four 1ml ampules
Chlorpheniramine(10mg/ml)
or
Diphenhydramine(50mglml)
28. DRUG CLASS -NONE
ALTERNATIVE DRUG-NONE
PROPRIETARY -NONE
29. Most useful drug in emergency kit
THERAPEUTIC INDICATIONS
Emergency situations where respiratory
distress is evident
SIDE EFFECTS-NONE
CONTRAINDICATIONS-HYPERVENTILATION
39. Drug of choice in patients with hypoglycemic
reactions in Diabetes mellitus & non-diabetic
patients with hypoglycemia
Therapeutic indications: management of
unconscious hypoglycemic state
Contraindications : patients without active
gag reflex, or unable to drink without
assistance
Side effects: none
42. Drug of choice in suspected myocardial infarction
Mode of action:
- irreversibly acetylates the platelet cycloxygense
- removes all cycloxygenase activity for the
lifespan of platelet
- stops production of proaggregatory thromboxane
A2
- non platelet effects: diminishes formation of
prostacyclines
Therapeutic indications: suspected myocardial
infarction
unstable angina
Contraindications & side effects :life-threatening
haemorrhage (bleeding peptic ulcer), history of aspirin
46. POSITIVE PRESSURE
Adaptable to the E-cylinder
Delivers oxygen under positive pressure
Examples: Positive pressure or demand valve
- Reservoir bag
The devices should be fitted with a clear face mask
Efficient delivery of 100% oxygen
Permit the rescuer to inspect the victim’s mouth for
the presence of foreign matter like vomitus, blood,
saliva, water
Should be available in child, small adult & large adult
sizes
47. Portable
Self-inflating
Source of positive pressure oxygen or
ambient air or enriched oxygen
(>21%, <100%)
Attached to oxygen delivery tube
Rescuer should be able to maintain an air-tight seal
Should have patent airway with one hand while
using the other hand to activate the device &
ventilate the victim
48. Clear, full-faced mask
Rescuer applies exhaled air ventilation ( 16%
oxygen) to ventilate the victim
Exhalation occur through one way valve located on
the side of the mask
Also available with supplemental oxygen port
permitting the attachment of the mask to an
oxygen tube & deliver enriched oxygen ventilation
It enables the rescuer to provide mouth to mask
ventilation
Advantage: prevention of transmission of disease,
49. IN PEDIATRIC PATIENTS
Simply invert the mask, holding the narrow
nose side of the mask in the cleft of the chin
& the wider chin side on the bridge of the
child’s nose
50. IN EMERGENCY KIT
One portable oxygen cylinder (E-cylinder)
with positive pressure mask
One portable, self-inflating, bag-valve-mask
device
One pocket mask for each staff member
Sizes: child, small adult, large adult
Advanced training for safe &effective use
52. Plastic , disposable syringes with 18 or 21
gauge needles
2 ml syringes – emergency drug delivery
In emergency kit: 2-4 2 ml disposable
syringes
53. In emergency kit: 2 plastic evacuators or
tonsil suction tips
54. To administer IV drugs
For bloodless phlebotomy in acute pulmonary
oedema
In emergency kit: 3 tourniquets & a
sphygmomanometer
55. To place endotracheal tube
during nasal intubation
It is a blunt ended scissor with
a right angled bend which
permits the forceps to grasp
objects deep in the
hypopharynx
In emergency kit: one pediatric
size Magill intubation forceps
58. DRUG OF CHOICE: Midazolam
PROPRIETARY: Versed
DRUG CLASS: Benzodiazepine
ALTERNATIVE DRUG: Diazepam
59. DRUG OF CHOICE: Morphine sulphate
PROPRIETARY: none
DRUG CLASS: Opioid agonist
ALTERNATIVE DRUG: Meperidine; nitrous oxide &
oxygen (N2O-O2)
THERAPEUTIC INDICATIONS: Pain & anxiety in
ischemic chest pain
SIDE EFFECTS: potent CNS & respiratory depressants
CONTRAINDICATIONS: injury & multiple trauma
AVAILABILITY: 8,10, 15 mg/ml in 2 ml ampules & 20 ml vials
morphine sulfate,
50, 100 mg/ ml Meperidine in 1 ml ampule & 20, 30 ml
vials
In emergency kit: 10 mg/ml morphine sulfate (2, 2ml
ampules)
50 mg/ml Meperidine (2, 2ml ampules)
60. DRUG OF CHOICE: Phenylephrine
PROPRIETARY: Many
DRUG CLASS: Vasopressor
ALTERNATIVE DRUG: none
THERAPEUTIC INDICATIONS:
1.manage hypotension
2.Syncopal reactions
3.Drug-overdose reactions
4.Post-seizure states
5.Acute adrenal insufficiency
6.allergy
61. PRECAUTIONS: hyperthyroidism, bradycardia,
partial heart block, myocardial disease, severe
atherosclerosis
CONTRAINDICATIONS: parenteral
administration is contraindiacted in patients
with high BP, or ventricular tachycardia
AVAILABILITY: 10 mg/ml in 1 ml ampules
IN EMERGENCY KIT: 10 mg/ml 2 – 3, 1 ml
ampules
62. DRUG OF CHOICE: Dextrose, 50 % solution
PROPRIETARY: none
DRUG CLASS: Antihypoglycemics
ALTERNATIVE DRUG: Glucagon
THERAPEUTIC INDICATIONS: treatment of hypoglycemia,
diagnostic aid in unconsciousness or seizures of unknown
origin
SIDE EFFECTS: 50% dextrose solution administered IV –
tissue necrosis if extravascular infiltration occurs
CONTRAINDICATIONS: IV or IM glucagon in starvation or
chronic hypoglycemia
AVAILABILITY: 50 % dextrose in 30 ml glass
Glucagon in 1mg of dry powder with 1 ml of diluents
IN EMERGENCY KIT: 50% dextrose 1-2 vials (IV) or 1mg/ml
glucagon (IV or IM)
63. DRUG OF CHOICE: Hydrocortisone sodium
succinate
PROPRIETARY: Solu-Cortef
DRUG CLASS: Adrenal glucocorticosteroid
ALTERNATIVE DRUG: none
65. DRUG OF CHOICE: Esmolol
PROPRIETARY: Brevibloc
DRUG CLASS: β-Adrenergic blocker
ALTERNATIVE DRUG: Propanolol
THERAPEUTIC INDICATIONS: acute hypertensive episodes,
as antidysrhythmic agent in PSVT, intra-operative & post-
operative tachycardia
CONTRAINDICATIONS: sinus bradycardia, heart block
greater than 1st
degree, cardiogenic shock, overt heart
failure
AVAILABILITY: 2.5 g in 10 ml ampule which is diluted to a 10
mg/ml concentration prior to infusion
IN EMERGENCY KIT: 2 ampules (100 mg/ml) with diluents
66. DRUG OF CHOICE: Atropine
PROPRIETARY: none
DRUG CLASS: Anticholinergic
ALTERNATIVE DRUG: none
THERAPEUTIC INDICATIONS:bradycardia,
hemodynamically significant bradydysrhythmias
SIDE EFFECTS: hot, dry skin, headache, blurred near-
sightedness , dry mouth throat, disorientation &
hallucinations
CONTRAINDICATIONS: glaucoma, prostatic hypertrophy
AVAILABILITY:0.5 mg/ml in 1 ml vials 7 1 mg/ml in 10 ml
pre-loaded syringes
IN EMERGENCY KIT: 2 or 3 ampules of 0.5 mg/ml (IM) or 2,
1o ml syringes (IV)
68. DRUG OF CHOICE: Aromatic ammonia
PROPRIETARY: none
DRUG CLASS: Respiratory stimulant
ALTERNATIVE DRUG: none
69. THERAPEUTIC INDICATIONS:to treat
respiratory depression not induced by opioid
analgesics ,vasodepressor syncope
SIDE EFFECTS:irritating effects on mucous
membrane of upper respiratory tract
precipitates bronchospasm
CONTRAINDICATIONS: chronic obstructive
pulmonary disease or asthma
Availability :silver grey vaporoles containing 0
.3ml of ammonia
IN EMERGENCY KIT: one or two boxes of
vaporoles
70. DRUG OF CHOICE: Nifedipine
PROPRIETARY: Procardia
DRUG CLASS: Calcium channel blocker
ALTERNATIVE DRUG: Nitroglycerin
THERAPEUTIC INDICATIONS:hypertension,acute
anginal pain
SIDE EFFECTS:excessive hypotension
CONTRAINDICATIONS: in patients receiving β-blockers,
patients undergoing anasthesia with high doses of
fentanyl
AVAILABILITY:10mg or20 mg capsules
IN EMERGENCY KIT: one bottle of 10mg capsules
72. Indicated when all other noninvasive
procedure fail to secure a patent airway
In emergency kit: 1 scalpel with a disposable
blade
1 cricothyrotomy device
73. Plastic or rubber oropharyngeal or nasopharyngeal
airways used
Used to assist in maintenance of patent airway in
unconscious patient
Act by lifting the base of the tongue off the posterior
pharyngeal wall
In patients who are not deeply unconscious – gagging,
regurgitation, vomiting
Available in variety of sizes: child, small adult & large
adult
In emergency kit: 1 set of each adult & pediatric
nasopharyngeal airways
74.
75. These are advanced airway devices
Endotracheal intubation uses a laryngoscope
to visualize the trachea & an endotracheal
tube
Advantages: isolation of the airway
preventing aspiration
Facilitation of ventilation & oxygenation
For the easy administration of emergency
drugs
In emergency kits: 1 laryngoscope & a set of
76. Laryngeal mask airway maintains airway
during anaesthesia
The airway is a tube & a small mask with an
inflatable circumferential cuff intended for
placement in victim’s posterior pharynx
which seals the base of the tongue &
laryngeal opening
Very high success rate; low complication rate
78. CATEGORY GENERIC
NAME
PROPRIETARY
NAME
ALTERNATIVE QUANTITY AVAILABILTY
Cardiac arrest Epinephrine Adrenaline - 3×10 ml
syringe
1:10,000
concentration
Oxygen Oxygen - - 1E
cylinder
Antidysrhythmic Lidocaine Xylocaine Procainamide 1× 5ml
ampule
100 mg
Symptomatic
bradycardia
Atropine Atropine Isoproternol 2×10ml
syringe
1 mg/10 ml
Symptomatic
hypotension
Dopamine Intropin Dobutamine 2×5 ml
ampules
80 mg/ml
Analgesic Morphine Morphine Meperidine 2×2 ml
ampules
10 mg /ml
PSVT Verapamil Isoptin - 1×4 ml
ampules
2.5 mg/ml
79. Drug class: catecholamine
Alternative drug: none
Proprietary name: Ana-guard, Epi-pen,
Twinject,
80. DRUG CLASS: Endogenous catecholamine
ALTERNATIVE DRUG : none
PROPRIETARY: Adrenaline
ACTIONS: Maintains coronary artery blood flow while CPR
in progress- life saving in cardiac arrest
THERAPEUTIC INDICATIONS: Cardiac arrest including
ventricular fibrillation,
pulseless ventricular tachycardia,
asystole, pulseless electrical activity
SIDE EFFECTS: exacerbate ventricular ectopy in patients
receiving Digitalis
AVAILABILITY: 1:10,000 conc in pre-loaded 10 ml syringes
In emergency kit: 2 - 3 pre-loaded syringes
81. Essential in cardiac resuscitation &
emergency cardiac care
Prevents hypoxia
Side effect: toxicity on long term
administration
AVAILABILITY: 1 E-cylinder
82. DRUG CLASS: local anesthetic, anti-dysrhythmic
ALTERNATIVE DRUG: Procainamide
PROPRIETARY: Xylocaine
THERAPEUTIC INDICATIONS:
i. Primary anti-dysrhythmic drug
ii.In premature ventricular contraction ( coupled,
multi-focal
iii.Ventricular tachycardia
iv.Ventricular fibrillation
83. SIDE EFFECTS: myocardial, circulatory & CNS
depression
• Overdose:Drowsiness, paraesthesia, muscle
twitching
• Severe overdose: Tonic clonic seizures
CONTRAINDICATION: Depressed hepatic function
AVAILABILITY:
- as IV injection in 5 ml pre-filled
syringes(50/100mg)
- 5 ml ampules of 100 mg
IN EMERGENCY KIT: 1 -100 mg pre-loaded syringe
1 - 5 ml ampule
84. DRUG CLASS: Parasympatholytic
ALTERNATIVE DRUG: Isoprotrenol
PROPRIETARY: Atropine
THERAPEUTIC INDICATION:
i. haemodynamically significant
bradydysrhythmias
ii.Asystole refractory to epinephrine
ISOPROTRENOL
Synthetic sympathomimetic amine
Increases cardiac output
Increases myocardial oxygen consumption
85. DRUG CLASS: Sympathomimetic amine
ALTERNATIVE DRUG: Dobutamine
PROPRIETARY: Intropin
THERAPEUTIC INDICATION: haemodynamically
significant hypotension in absence of
hypovolemia
MODE OF ACTION: Large doses stimulates both α
& β
adrenergic receptors
• Small doses dialates mesentric, renal & cerebral
arteries
86. SIDE EFFECTS
i. Exacerbate supraventricular or ventricular
dysrhythmias
ii.Exacerbates myocardial ischemia
CONTRAINDICATIONS:In patients receiving
monoamine oxidase
inhibitors
(Isocarboxazid, pargyline, tranyl-cypromine,
phenelzine)
AVAILABILITY: 200, 400 & 800 mg in 5 ml ampules
87. DRUG CLASS: Opioid agonist
ALTERNATIVE DRUG: Meperidine
PROPRIETARY: Morphine
THERAPEUTIC INDICATIONS:Pain & anxiety in
ischemic chest pain
SIDE EFFECTS: potent CNS & respiratory
depressants
CONTRAINDICATIONS: injury & multiple trauma
AVAILABILITY: 10 mg/ml morphine sulfate,
50 mg/ ml Meperidine
88. DRUG CLASS: Calcium channel blockers
ALTERNATIVE DRUG: none
PROPRIETARY: Isoptin
THERAPEUTIC INDICATIONS:Paroxysmal
supraventricular
tachycardia
SIDE EFFECTS: transient decrease in arterial
pressure,
severe hypotension, ventricular
fibrillation
CONTRAINDICATIONS: ventricular tachycardia
AVAILABILITY: 2.5 mg/ml in 2 ml & 4 ml ampules
90. CATEGORY GENERIC
NAME
PROPRIETARY
NAME
ALTERNATIVE QUANTITY AVAILABILTY
Narcotic
antagonist
NALOXONE NARCAN NALBUPHINE 2×1 ml
ampules
0.4 mg/ml
Benzodiazepine
antagonist
FLUMAZENIL MAZICON - 1×10 ml
vial
0.1 mg/ml
Antiemergence
delirium
PHYSOSTIGMINE ANTILIRIUM - 2×2 ml
ampules
1 mg/ml
vasodilator PROCAINE NOVOCAIN - 2×2ml
ampules
10mg/ml
91. DRUG CLASS: Thebaine derivative
ALTERNATIVE DRUG: Nalbuphine
PROPRIETARY: Narcan
THERAPEUTIC INDICATIONS:Opioid induced
depression including respiratory
depression
SIDE EFFECTS: respiratory depression recurs when
administered parenterally
CONTRAINDICATIONS: use with extreme care in
physical
dependance
AVAILABILITY: 0.4 mg/ml in 1 ml ampules & 10 ml vials
PEDIATRIC ADMINISTRATION: 0.02 ml in 2 ml
92. DRUG CLASS: Benzodiazepine antagonist
ALTERNATIVE DRUG: None
PROPRIETARY: Romazicon
MODE OF ACTION:
o Rapid reversal of sedation
o Increased alertness
o Decreased amnesic effect in geriatric population
THERAPEUTIC INDICATIONS:
o Reverse the clinical actions of parenterally administered
Benzodiazepenes
SIDE EFFECTS & CONTRAINDICATIONS:
o Rebound anxiety
AVAILABILITY: 0.1 mg/ml in 5 ml ampules & 10 ml vials
IN EMERGENCY KIT: 1 - 10 ml vial
93. DRUG CLASS: Cholinesterase inhibitor
ALTERNATIVE DRUG: None
PROPRIETARY: Antilirium
THERAPEUTIC INDICATIONS:Reverse emergence delirium
Emergence delirium:
i. loss of contact with reality due to drugs like Scopolamine,benzodiazepenes,
diazepam, midazolam.
ii. Patient makes unintelligible sounds, increased muscular movement
MODE OF ACTION: reversible cholinesterase inhibitor, can cross BBB
94. SIDE EFFECTS
i. Increased salivation
ii. Possible emesis
iii.Involuntary urination & defecation
iv.Bradycardia & hypersalivation
CONTRAINDICATIONS:
i. Asthma
ii. Diabetes
iii.Cardiovascular diseases
iv.Mechanical obstruction of gastrointestinal genito-urinary
tract
AVAILABILITY: 1 mg/ml in 2 ml ampules
IN EMERGENCY KIT: 2-3 ampules
95. DRUG CLASS: Local anesthetic
ALTERNATIVE DRUG: None
THERAPEUTIC INDICATIONS:
i. Vasospasm & compromised circulation following intra-arterial
administration of a drug
ii. Management of pain & vascular compromise following
extravascular administration of irritating drugs
SIDE EFFECTS & CONTRAINDICATIONS:History of local
anesthetic allergy
AVAILABILITY: 1% (10 mg/ml) solution in 2 & 6 ml ampules
IN EMERGENCY KIT: 2 - 2ml ampules
96. Should not be complicated
Only those drugs and equipment which
doctor is familiar should be included
Should be stored in plastic box with several
compartments
Labels should be applied in each
compartment containing generic and
proprietary names and dosage and expiry
dates
