Ch. 21 Emergency Drugs

Preparing for an Emergency: General Measures

• Train

  • CPR/BLS

  • ACLS

  • Prevention of emergency situations

• Telephone number

• Emergency kit

• Observe the patient

• Observe and actively listen

• Record BP, pulse rate

• Perform necessary laboratory examination

• Take a complete patient history

• Seek medical consultations

• Prescribe premedication

• Avoid drug interactions

ABCs:

A- airway

B- breathing

C- circulation (chest compressions)

Treatment of an Emergency:

• Recognize the abnormal occurrence

• Make a proper diagnosis

• Locate the AED

• Call 911 or other appropriate emergency number

• Note the time

• Position the patient properly

• Maintain an airway

• Administer oxygen

• Monitor vital signs

• Provide symptomatic treatment

• Administer CPR per AED instructions if there is no pulse

Categories of Emergencies:

• Lost or altered consciousness

• Respiratory emergencies

• Cardiovascular system emergencies

• Other emergency situations

• Drug-related emergencies

Lost or Altered Consciousness:

• Syncope

• Hypoglycemia

• Diabetic coma

• Convulsions or seizures

Respiratory Emergencies:

• Hyperventilation

• Asthma

• Anaphylactic shock

• Acute airway obstruction

Cardiovascular System Emergencies:

• Angina pectoris

• Acute myocardial infarction

• Cardiac arrest

• Other cardiovascular emergencies

Extrapyramidal reactions:

involuntary muscle movements, tremors, muscle contractions caused by antipsychotics

Acute adrenocortical insufficiency:

sudden onset of defective production of adrenal steroids caused by abrupt cessation of treatment with glucocorticoids

Thyroid Storm:

undertreated hyperthyroidism increases blood pressure, heart rate, and body temperature

Malignant Hyperthermia:

muscle rigidity, high fever, fast heart rate during general anesthesia

Drug-Related Emergencies:

• Opioid overdose

• Reaction to local anesthetic agents

• Epinephrine

Emergency Kit for Dental Office: Level 1 (critical) drugs

• Epinephrine: Cardiac arrest, anaphylaxis, or acute asthmatic attack

• Diphenhydramine: Some allergic reactions

• Oxygen: Indicated in most emergencies

• Nitroglycerin: Acute anginal attack

• Glucose: Hypoglycemia

• Albuterol: Bronchodilation

Emergency Kit for Dental Office: Level 2 drugs

• Benzodiazepines: Convulsions

• Aromatic ammonia spirits: Syncope

• Morphine: An acute myocardial infarction

• Methoxamine: Hypotension

• Hydrocortisone: Allergic reactions, anaphylaxis, and adrenal crisis

• Dextrose: Unconscious hypoglycemia

• Glucagon: Severe hypoglycemia

• Atropine: Preoperative antisialagogue and to increase cardiac rate

• β-Blockers: Tachycardia or hypertension

• Naloxone: Opioid antagonist

• Flumazenil: Reversing most effects of benzodiazepines

• Antiarrhythmics: Lidocaine, Aminodarone

Emergency Kit Equipment: Level 1 (critical devices)

• Syringes/needles

• Tourniquets

• System to give oxygen

• Automated external defibrillator (AED)

Emergency Kit Equipment: Level 2 (secondary devices)

• cricothyrotomy device

• endotracheal tube

• laryngoscope

• system to give IV or IO infusions

• Nasal and oral airways

• Endotracheal tubes

• Laryngoscope

• IV solutions, tubing, butterfly needles, and adhesive tape

• Cricothyrotomy kit