Dental Tribune U.S. Edition

Dental Tribune U.S. Edition | July 2012A4 CLINICAL expiration dates so a reminder is sent to you before the actual expired date. Also, at monthly staff meetings, encour- age emergency medications as a regular topic so that area is covered each month and you can prevent your drugs from be- ing expired. The American Dental Association Council on Scientific Affairs, in its 2002 report in the Journal of the American Dental Association, Vol. 133, No. 3, 364- 365, titled “Office Emergencies and Emer- gency Kits,” states the following: "In designing an emergency drug kit, the Council suggests that the follow- ing drugs be included as a minimum: epinephrine 1:1,000 (injectable), hista- mine-blocker (injectable), oxygen with positive-pressure administration capa- bility, nitroglycerin (sublingual tablet or aerosol spray), bronchodilator (asthma inhaler), sugar and aspirin. Other drugs may be included as the dentist’s training and needs mandate. "It is particularly important that the dentist be knowledgeable about the indi- cations, contraindications, dosages and methods of delivery for all items includ- ed in the emergency kit. Dentists are also urged to perform continual emergency kit maintenance by replacing soon-to-be- outdated drugs before their expiration. "Local anesthesia is the backbone of pain control in dentistry. Dentists realize and know that adverse events can occur before, during or after administration of local anesthesia. Package Insert (PI) of all local anesthetics clearly illustrates the importance of the dental practitioner having the proper equipment and resus- citative drugs prior to administering any local anesthetic." Here is what the "warn- ings" section states: “Dental practitioners who employ local anesthetic agents should be well versed in diagnosis and management of emer- gencies which may arise from their use. Resuscitative equipment, oxygen and other resuscitative drugs should be avail- able for immediate use.” CANAL acronym Medical emergencies happen in dental offices, and we must be ready to respond. Here is an acronym that could assist you in trying to remember the many emergencies, along with the emergency drugs that could potentially be used to treat those emergencies. C = Cardiac • Chest pain: oxygen, nitroglycerin • Myocardial infarction: oxygen, aspirin • Dysrhythmias: ACLS drugs • Sudden cardiac arrest: AED • Ventricular Fibrillation: ACLS drugs A = Airway • Foreign body obstruction: airway techniques • Bronchospasm: albuterol, oxygen, epinephrine • Larygnospasm: oxygen, succinylcholine • Hyperventilation • Aspiration/Emesis: airway techniques N = Neurological • Seizures: anti-convulsant • Transient ischemic attack • Stroke • Panic attack: anti-anxiety agent • Anxiety: anti-anxiety agent A = Allergic and drug reaction • Latex allergy: diphenhydramine • Anaphylaxis: epinephrine, diphenhydramine, albuterol, dexamethasone • Allergic reaction: diphenhydramine • Epinephrine overdose: • Benzodiazepine overdose: flumazenil • Local anesthetic overdose: oxygen • Narcotic overdose: narcan L = Loss of consciousness • Syncope: ammonia • Sudden cardiac arrest: AED • Hypoglycemia: glucose • Stroke Eight CORE drugs Here is a suggested list of the CORE (Criti- cal Office Resuscitative Emergency) eight emergency drugs needed for each dental office, with suggested other emergency medications for those doing advanced an- esthesia. Confirm with your state dental board the mandatory emergency medica- tions you must have in your office. Emergency drugs should be available in all dental offices that are ready to address the medical emergencies for which such drugs would be used. These eight emergency drugs should be the minimum in dental offices. They are: Epinephrine: for anaphylaxis, broncho- spasm. Benadryl: for allergic reactions, anaphy- laxis. Albuterol: for asthmatic attack, bron- chospasm. Nitroglycerin: for angina Aspirin: for suspected myocardial in- farction. Glucose: source for diabetic emergency (hypoglycemia). Ammonia: inhalants for syncope. Oxygen: as supplemental adjunct. Note: Part 2 in this two-part series will cover the eight CORE drugs in more detail. Disclaimer The publisher and author are not respon- sible (as a matter of product liability, negligence or otherwise) for any injury resulting from any material herein. This publication contains information relating to general principles of medical care that should not be construed as spe- cific instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current information, including con- traindications, dosages, and precautions. The purpose of this article is to provide information only, rather than advice or ” See EMERGENCY page A5 “ EMERGENCY, page A3 Ad