First take all your emergency drugs and tape them to 5 by 8 cards with a brief description of what they are, how they are used, how much you give, and can they be repeated. The paragraphs below can be printed then pasted to a 5 by 8 card. Tape a syringe and needle to the card so you are already to use the drug. Place each card in a clear ziplock bag just large enough to hold the card, meds, and syringes. Place all the bags in a brightly colored plastic tool box and label the box “EMERGENCY KIT” in large letters. The kit must be centrally located and visible, so do not place in a cupboard. All staff MUST know where this kit is at all times!
Do not have any drug in your kit you do not know and are comfortable giving. Do have every drug you know how to use and might want. It is too late to order the drug when the patient is having a problem.
Refresh you emergency kit every year at income tax time. You need to bind it to a date or you will put off replacing old drugs. I have been in offices with kits that are over 20 years old and have never had the seal broken.
Realize that we see so few emergencies; it is hard to stay good at handling them. You cannot practice too often. However, the paramedics prefer to be called while the patient is still alive. Their save rate is much greater when treating alive patients. So call them early. They will not hold it against you. It is not good marketing to have an ambulance parked out front with their lights flashing but it is much better than having a coroner’s vehicle out there. So call for help early.
Emergency kit contents, directions and indications.
1. A can of non-diet soda. Have patient drink 5 oz per minute until can is empty. Hypoglycemia in a diabetic patient is best treated with this. The carbonation gets it through the stomach faster than any uncarbonated source of sugar. It is absorbed from the small intestine. This requires a CONSCIOUS and oriented patient.
2. A bottle of Aspirin (325mg tabs). In the case of angina or a heart attack the patient is to chew one tablet while the staff calls 911.
3. One 5cc bottle of Midazolam 1mg/mL. Inject 1-1.5 cc into buccal fold and repeat after a minute or two if the seizure has not stopped. If buccal fold is too difficult due to patient clenching inject IM on upper arm. Use for seizures, since it can be injected IM or subQ or swallowed (orally). Realistically you want to call 911 if the seizure lasts more than a minute or if it is the first seizure for a patient. Beware: Midazolam is also available as a 5mg/mL vial in which case 5cc would be 25mg: too much!!
4. Four Benadryl Capsules 25mg each. TWO capsules (50mg) given orally (ONE for kids age 1-7). Used for mild, slow onset (takes an hour or more) allergic reactions: Skin itching and or hives.
4. Benadryl Injectable 50mg/cc . Inject 1cc (for kids aged 1-7 use 0.5cc) IM in upper arm . Used for moderate, slow onset (takes one hour or more) allergic reaction: Itching throat, swollen tongue, or lip. Be ready for anaphylaxis if breathing difficulty starts..
Observe for 1 hour to ensure recovery
Terminate appointment
Refer to MD for oral antihistamine or steroids for 3 days
5. EpiPen 2-Pak 0.3mg/0.3mL (contains 2 Adult pens) Inject one pen in to front outside of thigh. Ok to repeat if needed after 3-5 minutes. Call 911. Used for anaphylaxis: severe, rapid onset (less than 1 hour) allergic reaction, swollen throat, tongue, or lip or if patient has difficulty breathing allergic reaction. Note that the EpiPen is expensive at $120 for the 2 pens if you see children you must also carry the EpiPen Jr 2-pak 0.15mg/0.3mL.
There is some evidence that epi pens’ needle is too short. They cost over $100 each as opposed to under $5 for ampules of epinephrine. They must be replaced every 2 years.
OR
5. Epi 1:1000 ampule (contains 1mg epinephrine)
Call 911 Call 911 Call 911
Inject into lateral border of the thigh deep near the bone, in the upper arm or floor of the mouth. 0.2cc to 0.5cc repeat every 5 minutes or more often. (USE 0.1 cc for kids each injection to max of 3 injections).
. Used for anaphylaxis: severe, rapid onset (less than 1 hour) allergic reaction swollen throat, tongue, or lip or if patient has difficulty breathing allergic reaction. or if patient has difficulty breathing with slow onset allergic reaction.
Call 911.
6. 2 bottles Flumazenil. Give 1cc in floor of mouth off midline adjacent to bicuspid/cuspid area. Observe effect for 5 minutes. Repeat if needed. Patient must be kept in office for 2 hours to see if they resedate. Used to reverse BZDs including Triazolam , Midazolam , Diazepam, Alprazolam , Lorazepam and at least one non-BZD, Zaleplon.
7. One bottle of nitroglycerine spray. Pump once or twice to prime (you should see a mist come out) then spray 1-2 doses into the floor of mouth. May repeat every 5 minutes up to 3 times. Call 911 if chest pain does not resolve. Used for angina. Prime the pump and check to be sure no Viagra or Levitra within the last 24 hours (48 hours for Cialas) before giving the nitro.
8. One albuterol inhaler. Shake dispenser, have patient exhale, spray as they inhale. May repeat every 30 seconds. Used for asthma, bronchial spasm.
9. O2 portable tank w/mask and ambu bag.
Optional, but highly recommended:
An AED (Automated External Defibrillator). The patient’s chance of leaving the hospital after cardiac arrest drops 10% for every minute the patient is in ventricular fibrillation. You are probably the oldest person in the office so you may be doing this for yourself. It is expected that within a few years AEDs will be mandatory in all dental offices.
A tennis ball - If you think you should give a drug but do not know which one. Give the drug to the tennis ball. The tennis ball has 911 written on all visible surfaces to remind you that should have already called for help. In this way you will do the patient no harm.
