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Medical Emergency Drugs

EmergenciesEach dental practice must stock a selection of drugs for use in medical emergencies. The Prescription Only Medicines (Human Use) Order 1997 lists injectable drugs that can be administered by anyone for the purpose of saving a life in an emergency; this includes adrenaline and glucagon (see list below). Therefore, all dental team members may administer adrenaline and glucagon, and the non-injectable drugs listed below. However, dental team members must be competent in the use of these drugs, and employers must accept responsibility for the actions of staff.

NB: The list of drugs for use in medical emergencies includes midazolam which is a Schedule 3 controlled drug and therefore its use must comply with relevant legislation. For further information go to:

To enable you to deal with any medical emergency as it arises, ensure that you have immediate access to the following drugs*:

  • Adrenaline, 1-ml ampoules or pre-filled syringes of 0.5 ml 1:1000 solution for intramuscular (i.m.) injection;
  • Aspirin, 300-mg dispersible tablets;
  • Glucagon, for i.m. injection of 1 mg;
  • Glyceryl trinitrate (GTN) spray, 400 micrograms per metered dose;
  • Midazolam oromucosal solution, 5 mg/ml, for topical buccal administration. (Note: Midazolam oromucosal solution is available as pre-filled oral syringes; several sizes are available to allow for exact dosing for different age groups);
  • Oral glucose (there are several alternative forms, including non-diet fizzy drinks, glucose gel, powdered glucose and sugar lumps);
  • Oxygen cylinder (NB: some cylinders have a built-in regulator, whereas others have a bolt-on regulator; these are not interchangeable; ensure you are aware of the type of cylinder you have and that any spare cylinders are useable);
  • Salbutamol inhaler, 100 micrograms per actuation.

In addition, dental practices might wish to stock the following to aid the management of patients with mild allergic reactions:

  • Cetirizine, 10-mg tablets or oral solution (5 mg/5 ml);
  • Chlorphenamine, 4-mg tablets or oral solution (2 mg/5 ml);
    (NB: chlorphenamine can cause drowsiness)
  • Loratidine, 10-mg tablets or syrup (5 mg/5 ml).

NB: Emergency drug boxes that contain recommended drugs can be purchased from suppliers.

*All drugs correct per BNF 83 (March 2022).

Risk assess the number of oxygen cylinders you will need to stock (i.e. two Size D or two Size CD or one Size E*), and ensure you have sufficient supplies to enable adequate flow rates (15 litres/minute) to be maintained until the ambulance arrives or the patient recovers fully.

NB: A full Size D cylinder contains nominally 340 litres of oxygen and therefore should provide oxygen for up to ~22 minutes; a full Size CD cylinder contains nominally 460 litres of oxygen and therefore should provide oxygen for up to ~30 minutes; a full Size E cylinder contains nominally 680 litres of oxygen and therefore should provide oxygen for up to ~45 minutes. The National Dental Advisory Committee (NDAC) advises that every practice should have sufficient oxygen to ensure at least 30 minutes supply at a flow rate of 15 litres/minute and recommends that rural practices stock two size E cylinders to account for potentially prolonged ambulance response times.

*The NDAC refers to one supplier’s codes for cylinder types. Alternative suppliers may use different codes and practices should ensure that cylinders are of an equivalent size.