3: Emergency Drug Management

The critical care medical assistant also will act as a team lead in the absence of the team lead. The critical care medical assistant has to restock the medications and supplies used during the process, and is responsible for checking both the oxygen tank level and the medication expiration dates on a monthly basis.

Finally, the critical care coordinator will be in charge of coordinating calls and documentation, including tasks such as:

calling EMS (911)

meeting the paramedics

keeping chronological records of all vital signs, medication doses and patient’s response to treatment

The critical care coordinator will act as an emergency team assistant or as a team lead, if needed.

In summary:

Emergency Team Leader takes care of the patient, and stays with the patient at all times.

Critical Care Medical Assistant takes care of the equipment, the medication, and the supplies.

Critical Care Coordinator takes care of the documentation, and the coordination with the emergency medical services.

2 | Emergency Drugs

The ADA Council on Scientific Affairs stated the following in a 2002 report in the Journal of the American Dental Association, Volume 133, No 3, 364-365 titled “Office Emergencies and Emergency Kits”:

“In designing an emergency drug kit, the Council suggests that the following drugs be included as a minimum: epinephrine 1:1,000 (injectable), histamine-blocker (injectable), oxygen with positive-pressure administration capability, nitroglycerin (sublingual tablet or aerosol spray), bronchodilator (asthma inhaler), sugar and aspirin. Other drugs may be included as the doctor’s training and needs mandate. It is particularly important that the dentist be knowledgeable about the indications, contraindications, dosages and methods of delivery for all items included in the emergency kit. Dentists are also urged to perform continual emergency kit maintenance by replacing soon-to-be-outdated drugs before their expiration.”

The flow chart provides a suggested list of the basic emergency drugs that should be present in every dental office for various emergency situations. The choice of drug, its administration and expected effects depend on the symptoms experienced by the patient. The critical care team should monitor vital signs and call the EMS/911 when drug administration fails or symptoms worsen. In addition, medication and equipment must be checked on a monthly basis to ensure that it will be ready to use in an emergency.

Many states also require dental offices to have certain emergency drugs and equipment and most importantly to be prepared for emergency events through certifications and training. For additional information about the safety requirements in your state, consult with your state dental association or your state board of dental practice.

Tables 1a-j | Medication Options for Medical Emergencies

Table 1a. Allergic Reaction

Symptoms

Rash, urticaria, with no evidence of airway obstruction

Drug to Use

Diphenhydramine 50 mg/mL

How to Use

Adults: 50 mg by mouth/1 mL IM

Children: 25 mg by mouth/0.5 mL IM

Expected Effects

Onset of action 15-30 min for by mouth, and <10 min for IM,

Reduction in pruritic, and cholinergic symptoms

Sedation, hypotension

Monitor or Avoid

None

What to do next

If symptoms do not resolve and/or laryngeal edema is suspected, use epinephrine 1 mg/mL, 0.3 mL IM for adults and 0.15 mL IM for children

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Table 1c. Asthmatic Reaction

Symptoms

Shortness of breath or difficulty breathing with no swelling in the throat

Drug to Use

Albuterol 90 mcg inhaler

How to Use

2-3 puffs inhalation every 1-2 min

Repeat 3 times as needed

Expected Effects

Increase in oxygen levels

Reduction in airway resistance

Tachycardia, hypertension, restlessness, nervousness

Monitor or Avoid

Monitor vital signs at all times

Consider using oxygen, especially when the O2 saturation starts dropping

What to do next

If symptoms do not resolve, use methylprednisolone 80 mg/mL, 3 mL intramuscularly as a one-time dose

If symptoms do not resolve, and/or laryngeal edema is suspected, use epinephrine

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Table 1d. Benzodiazepine and Z-drugs Intoxication

Feb 15, 2020 | Posted by in Dental Materials | Comments Off on 3: Emergency Drug Management
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