Emergency Kit Lecture Notes (Student Notes) | Su24

DH 410 – EMERGENCIES IN DENTAL PRACTICE Lecture 2: Emergency Kit  3 Important Rules #1 Primary management of ALL emergency situations involves BLS  3 Important Rules #2 Drug administration is NOT ne...

DH 410 – EMERGENCIES IN DENTAL PRACTICE Lecture 2: Emergency Kit  3 Important Rules #1 Primary management of ALL emergency situations involves BLS  3 Important Rules #2 Drug administration is NOT necessary for the immediate management of medical emergencies BLS is always implemented first, as needed  You many not need meds… don’t jump the gun  3 Important Rules #3 When in doubt, do NOT medicate  May cause more harm than good  Exception to this rule is in the case of presumed anaphylaxis  Emergency Kit  Custom Designed  Per DDS/Staff training and licensing  Geographic location  Easily Accessible  Everyone in the practice knows where it is  Must be updated (replaced expired meds)  Mobile  Can be moved easily from original/storage location to event  Easily accessible O2  In working order  Full tank  Emergency Kit  Simple and includes only materials with which the dental team is familiar and will use  Based on license status  Must conform to the level of training of the office personnel who will use it  Save all drug/information inserts (quick reference)  Consider location  Urban setting with quick EMS response time – less components  Rural setting – full complement of products Figure 2.1 Emergency drug kit Figure 03-02. STAT KIT 550 Emergency Medical Kit for BLS Figure 03-03. Mobile ACLS V2 Emergency Medical Kit. WLAC EMERGENCY KIT - LOCATION  MSB CLINIC  Front Office  Berenice’s Desk  Upper Left Top Shelf WLAC EMERGENCY KIT - LOCATION ESSENTIAL DRUGS  Essential Drugs  OXYGEN used for all emergencies EXCEPT hyperventilation * Will be discussed in separate Oxygen Administration Chapter Portable size E oxygen cylinder Oxygen = GREEN Portable size E oxygen cylinder WLAC OXYGEN - LOCATION  BACK of MSB CLINIC  Across from the radiology bay  Against the wall WLAC OXYGEN - LOCATION  BACK of MSB CLINIC  Across from the radiology bay  Against the wall WLAC OXYGEN - LOCATION  BACK of MSB CLINIC  Across from the radiology bay  Against the wall WLAC OXYGEN - LOCATION  BACK of MSB CLINIC  Across from the radiology bay  Against the wall  Essential Drugs  Epinephrine  USE: Acute Anaphylaxis  USE: Severe Acute Asthma Attack  LIFE-THREATENING  Counteracts major physiological events in anaphylaxis  Reduces hypotension, bronchospasm, laryngeal edema, prevents additional release of histamine and other chemical mediators  Essential Drugs  Epinephrine  THERAPEUTIC INDICATIONS:  Rapid onset and short duration  Bronchial smooth muscle dilator  More in pharmacology….  CONTRAINDICATIONS:  None; advantages outweigh risks  Essential Drugs  Epinephrine  WHERE:  Intramuscular injection  DOSAGE:  Adult dosage .3 mg of 1:1,000 concentration  Pediatric dosage .15 mg of 1:1,000 concentration .3 mg of 1:2,000 concentration Figure 3.8 Adult and child EpiPens  Essential Drugs  Diphenhydramine or Chlorpheniramine  Moderate allergic reaction with respiratory symptoms  Mild, NON-life-threatening allergic reactions  THERAPUTIC INDICATIONS:  Oral histamine blocker (H1-blocker, antihistamine)  WHERE:  Oral or intramuscular (DDS only)  DOSAGE:  Chlorpheniramine 10 mg  Diphenhydramine 25 – 50 mg Figure 2.5 Chlorpheneramine tablets Diphenhydramine tablets Figure 2.6 Diphenhydramine with disposable syringe  Essential Drugs  Nitroglycerine  Angina pectoris, MI or CHF  Vasodilator; Dilates coronary blood vessels  Rapid onset  Tablet and spray form  Spray shelf life usually 2 years – no special storage  Tablets become ineffective if exposed to light or air  Essential Drugs  Nitroglycerine  Administer sublingually  Administer at 5-minute intervals – up to 3 doses  Should NOT administer if systolic BP < 90 mmHg  Do NOT use in patients taking Erectile Dysfunction medications. Figure 2. 4 Nitroglycerine spray & Tablets  Essential Drugs  Albuterol  Asthma attack or bronchospasm  Inhaler  Dilation of bronchioles - minimal cardiovascular effects  Quick onset  Long duration of action – 30 to 60 seconds – 4 to 6 hours  Adult dose 2 sprays  Can repeat dose if  Pediatric dose 1 spray necessary Albuterol inhaler  Essential Drugs  Aspirin  Reduces overall mortality from acute MI  Prevents progression of cardiac ischemia to cardiac tissue death  Recommended dose 325 mg: 4 baby aspirin (4 tabs @81 mg)  Powder: pour on tongue, follow with water  Tablet: Chew for 30 seconds, then swallow  Rapid and sustained anti-coagulant effect  Essential Drugs  Aspirin  Check medical history for ALLERGY  Check medical history for bleeding disorders or blood thinning medications  Should NOT be used in these cases unless instructed by 911 Powder Aspirin – 325mg Chewable Aspirin – 81mg  Essential Drugs  Oral Carbohydrate (Glucose)  Hypoglycemia (Conscious patient)  Not actually a drug, but inclusion necessary  Paste or tablets do not require refrigeration  Other helpful items:  fruit juice  sodas  hard candies Figure 2.9 Oral glucose: tablets, gel and sugar packet  Essential Drugs  Naloxone  *“Narcan”- proprietary name discontinued use in United States  Opioid antagonist; opioid overdose  Intramuscular, Nasal Spray  New CA bill – will require inclusion in medical emergency kits by the end of 2026 (Jan 2024)  No pharmacological effects for patients who have not received opioids – better to administer than not Naloxone Nasal Spray  Essential Drugs  Ammonia Inhalant  Syncope – general arousal agent  Use supplemental oxygen  Place patient Trendelenburg  Rapid onset  Not to be used in people with the following:  Eye problems Vapor is eye irritant  Respiratory disease or impairments (ie: COPD, Asthma)  Irritates mucosal lining of respiratory tract  Head injury or suspected head injury  Ammonia can cause reflexive jerking – further injurious  Has been controversial, some say yes, some say no  Supplemental Drugs ALL of the following are only administered by DDS with special training  Glucagon  Unconscious hypoglycemic patient  Administered IM  Dextrose  Intravenous  Atropine  Hypotension  Increases heart rate which may also increase BP  Corticosteroid  Prevention of recurrence of anaphylaxis  Adrenal crisis  Injectable Benzodiazepine  Prolonged seizures or hyperventilation  Skeletal muscle relaxation – anticonvulsant Injectable glucagon Injectable Dextrose Atropine Figure 2.13 Injectable Solu-Cortef (hydrocortisone) Figure 2.10 Injectable Lorezepam  Additional Items  BP cuff and stethoscope Pediatric, adult, and large adult blood pressure cuff  Additional Items  Pocket mask with one-way valve  Additional Items  Perioretriever (broken instrument tip)  Additional Items  Bandaids and sterile gauze  Additional Items  Ice pack  Additional Items  AED – Automated External Defibrillator WLAC AED – LOCATION  BACK of MSB CLINIC  Across from the radiology bay  Against the wall WLAC OXYGEN - LOCATION  BACK of MSB CLINIC  Across from the radiology bay  Against the wall WLAC OXYGEN - LOCATION  MSB CLINIC  Across from the radiology bay  Against the wall  Additional Items  Thermometer with sleeves  Syringes  Gloves  Masks  Torniquet  Reference Malamed, S. F. (2022). Medical emergencies in the dental office. Elsevier. Little, J. W., Miller, C., & Rhodus, N. L. (2017). Little and Falace’s dental management of the medically compromised patient. Mosby. Grimes, E. B. (2014). Medical emergencies: Essentials for the Dental Professional. Prentice Hall