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Emergency drugs used in dental office
- 1.
- 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 acollection 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
- 4. Endotracheal Intravenous Sublingual or intralingual Intramuscular i. Vastus-lateralis ii.Mid-deltoid iii.Gluteal region
- 5. 1) Cleanse thearea 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
- 7. 1) Place thetourniquet 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 anindwelling 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
- 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
- 13. Injectable drugs 1. Epinephrine 2.Anti-histamine Non-injectable drugs 1. Oxygen 2. Vasodialators Emergency equipment 1. Oxygen delivery system 2. Suction & suction tips 3. Tourniquets 4. syringes
- 14.
- 15. Non-injectable drugs 1.Respiratory stimulant 2.Antihypoglycemic 3.bronchodilators Emergencyequipment 1.Device for cricothyrotomy 2.Artificial airways 3.Laryngoscope & endotracheal tubes
- 16. 1. Epinephrine 2. Oxygen 3.Lidocaine 4. Atropine 5. Dopamine 6. Morphine sulfate 7. Verapamil
- 17. Narcotic antagonists Benzodiazepines Antiemergence delerium drug Vasodilator
- 19. Most importantemergency drug Drug of choice in acute allergic reactions DESIRABLE PROPERTIES Rapid onset of action Potent bronchial smooth muscle dilator Histamine blocking properties Vasopressor action Cardiac effects(increased cardiac output)
- 20. Therapeutic indications 1:1000concentration in - Anaphylaxis - Acute ashmatic attack 1:10000 concentration - Cardiac arrest
- 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 Delayedonset 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 - 1mland 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)
- 27.
- 28. DRUG CLASS-NONE ALTERNATIVE DRUG-NONE PROPRIETARY -NONE
- 29. Most usefuldrug in emergency kit THERAPEUTIC INDICATIONS Emergency situations where respiratory distress is evident SIDE EFFECTS-NONE CONTRAINDICATIONS-HYPERVENTILATION
- 30. AVAILABILITY Compressedgas cylinder IN EMERGENCY KIT ONE E CYLINDER
- 31. DRUG CLASS-VASODILATOR ALTERNATIVE DRUG-AMYL NITRITE PROPRIETARY-NITROLINGUALSPRAY -NITROSTAT TABLETS
- 32. THERAPEUTIC INDICATIONS -CHEST PAIN IN In acute myocardial infarction Angina pectoris - Acute hypertensive episodes
- 33. Side Effects -Transient pulsating headache -Facial flushing -Degree of hypotension CONTRAINDICATIONS -In hypotensive patients
- 34. AVAILABILITY -0.3,0.4,0.6mgdoses of sublingual tablets -0.4,0.8mg/dose translingual spray -0.3ml doses of amyl nitrate yellow vaporoles IN EMERGENCY KIT -One bottle of metered trans lingual nitroglycerine spray
- 35. DRUG CLASS-BRONCHODILATOR ALTERNATIVE DRUG-METAPROTERENOL PROPRIETARY-PROVENTIL,VENTONIL
- 36. Drug ofchoice in asthmatic & allergic patients Mode of action: bronchial smooth muscle relaxation Therapeutic indication: bronchospasms, acute asthmatic & allergic reactions Contraindications : pre-existing tachydysrhythmias
- 37. AVAILABILITY: -Albuterol inhalers ( Ventolin, Proventil ) - Metaproterenol inhalers (Alupent) - Epinephrine mistometers (Medihaler- Epi, Primatine Mist) - Isoproterenol mistometers (Medihaler- Iso)
- 38. DRUG CLASS-ANTIHYPOGLYCEMICS DRUG OF CHOICE – ORANGE JUICE ALTERNATIVE DRUG-SOFT DRINKS (NONDIET) PROPRIETARY-NONE
- 39. Drug ofchoice 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
- 40. AVAILABILITY: -Glucola - Gluco-stat - Insta-glucose - nondiet cola beverages - fruit juices - granulated sugar - tubes of decorative icing
- 41. DRUG CLASS-ANTI-PLATELET ALTERNATIVE DRUG-NONE PROPRIETARY-NONE
- 42. Drug ofchoice 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
- 43. AVAILABILITY: -65,81, 162 , 325 mg tablets In emergency kit 3-4 baby chewable aspirin- 162 mg
- 44. Oxygen deliverysystem Automated external defibrillator Syringes Suction & suction tips Tourniquets Magill intubation forceps
- 45. TECHNIQUE PERCENTAGE O2DELIVERED MOUTH-TO-MOUTH 16 MOUTH-TO-MASK 16 BAG-VALVE MASK 21 BAG VALVE MASK+SUPPLEMENTAL O2 >21 - <100 POSITIVE PRESSURE OXYGEN 100
- 46. POSITIVE PRESSURE Adaptableto 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-facedmask 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 PEDIATRICPATIENTS 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 EMERGENCYKIT 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
- 51. Sophisticated,simple,battery operated ,computeriseddevice,reliable &easy to use. Use-to recognise cardiac dysrrythmias- ventricular fibrillation&pulseless ventricular tachycardia. In emergency kit:one automated external defibrillator
- 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 emergencykit: 2 plastic evacuators or tonsil suction tips
- 54. To administerIV drugs For bloodless phlebotomy in acute pulmonary oedema In emergency kit: 3 tourniquets & a sphygmomanometer
- 55. To placeendotracheal 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
- 57.
- 58. DRUG OFCHOICE: Midazolam PROPRIETARY: Versed DRUG CLASS: Benzodiazepine ALTERNATIVE DRUG: Diazepam
- 59. DRUG OFCHOICE: 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 OFCHOICE: 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 OFCHOICE: 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 OFCHOICE: Hydrocortisone sodium succinate PROPRIETARY: Solu-Cortef DRUG CLASS: Adrenal glucocorticosteroid ALTERNATIVE DRUG: none
- 64. THERAPEUTIC INDICATIONS:definitive management of acute allergy, in acute adrenal insufficiency PRECAUTIONS: peptic ulcer, pre-existing infection, hyperglycemia AVAILABILITY: Hydrocortisone sodium succinate 50 mg/ml, (2ml vials) IN EMERGENCY KIT: 1, 2ml vial
- 65. DRUG OFCHOICE: 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 OFCHOICE: 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)
- 67. 1. Respiratory stimulant 2.Antihypertensives
- 68. DRUG OFCHOICE: Aromatic ammonia PROPRIETARY: none DRUG CLASS: Respiratory stimulant ALTERNATIVE DRUG: none
- 69. THERAPEUTIC INDICATIONS:to treat respiratorydepression 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 OFCHOICE: 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
- 71. 1. Scalpel orcricothyrotomy needle 2. Artificial airway 3. Laryngoscope & endotracheal tubes 4. Laryngeal mask airway
- 72. Indicated whenall other noninvasive procedure fail to secure a patent airway In emergency kit: 1 scalpel with a disposable blade 1 cricothyrotomy device
- 73. Plastic orrubber 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
- 75. These areadvanced 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 maskairway 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
- 77. Essential ACLSdrugs include: Epinephrine Oxygen Lidocaine Atropine Dopamine Morphine sulfate Verpamil
- 78. CATEGORY GENERIC NAME PROPRIETARY NAME ALTERNATIVE QUANTITYAVAILABILTY 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 incardiac resuscitation & emergency cardiac care Prevents hypoxia Side effect: toxicity on long term administration AVAILABILITY: 1 E-cylinder
- 82. DRUG CLASS: localanesthetic, 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. Exacerbatesupraventricular 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: Calciumchannel 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
- 89. OPIOID ANTAGONISTS BENZODIAZEPENES ANTIEMERGENCE DELIRIUM DRUG VASODILATOR
- 90. CATEGORY GENERIC NAME PROPRIETARY NAME ALTERNATIVE QUANTITYAVAILABILTY 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. Increasedsalivation 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 notbe 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