7.5 Pharmacological Emergency Interventions & Airway Management

7.5 Pharmacological Emergency Interventions & Airway Management

Pharmacological intervention during acute medical emergencies requires an intimate knowledge of emergency drug kit components, mechanisms of action, exact clinical dosages, routes of administration, and absolute contraindications. Furthermore, proficiency in supplemental oxygen administration and airway management modalities is a non-negotiable requirement for dental hygiene practice.

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The Emergency Drug Kit: Core Essential Medications

Every dental practice must maintain an accessible, regularly inspected emergency drug kit containing critical emergency drugs categorized by essential level.

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Critical Emergency Drug Profiles & Protocols

1. Epinephrine 1:1000 (1 mg/mL)

• Epinephrine is the primary life-saving drug in emergency medicine. It acts rapidly on alpha and beta-adrenergic receptors. In severe anaphylaxis, alpha-1 receptor stimulation causes intense vasoconstriction, elevating blood pressure and reversing laryngeal edema. Beta-2 receptor stimulation Relaxes bronchial smooth muscle, relieving life-threatening bronchospasm.

2. Nitroglycerin Sublingual (0.4 mg)

• Administered for chest pain of suspected cardiac origin. The patient must be seated upright. If chest pain is relieved within 3 to 5 minutes, angina is diagnosed. If pain persists, repeat dose every 5 minutes up to a maximum of 3 doses within 15 minutes.
• PDE-5 Inhibitor Warning: Administering nitroglycerin to a patient who has taken PDE-5 inhibitors (e.g., sildenafil [Viagra], tadalafil [Cialis]) within the preceding 24 to 48 hours causes catastrophic, refractory vasodilation resulting in fatal hypotension.

3. Aspirin 325 mg (Antiplatelet Therapy)

• Indicated immediately for any patient presenting with symptoms of acute myocardial infarction. The patient must chew the aspirin prior to swallowing to facilitate rapid buccal mucosal absorption.

4. Naloxone (Narcan) Intranasal Spray (4 mg)

• Indicated when a patient exhibits signs of opioid toxicity: respiratory depression (<8–10 breaths/min), pinpoint pupils (miosis), and unresponsiveness. Administer a single 4 mg spray into one nostril. If no response occurs within 2 to 3 minutes, administer a second dose into the opposite nostril while maintaining CPR.

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Supplemental Oxygen Administration & Flow Rates

Oxygen is indicated for almost all medical emergencies (syncope, angina, MI, anaphylaxis, asthma, seizures) EXCEPT hyperventilation syndrome.

Patient Assessment ➔ Conscious / Mild Distress ➔ Nasal Cannula (2-6 L/min | 24-44% O2)
                   ➔ Conscious / Severe Distress ➔ Non-Rebreather Mask (10-15 L/min | 60-90% O2)
                   ➔ Apneic / Non-Breathing ➔ Bag-Valve-Mask (10-15 L/min | 100% O2)

Oxygen Delivery Modalities

1. Nasal Cannula:

   • Flow Rate: 2 to 6 Liters per minute (L/min).
   • Oxygen Concentration: Delivers 24% to 44% Fraction of Inspired Oxygen (FiO2).
   • Clinical Indication: Conscious, spontaneously breathing patient experiencing mild respiratory or cardiovascular distress (e.g., syncope, mild angina, post-seizure recovery).

2. Non-Rebreather Mask with Reservoir Bag:

   • Flow Rate: 10 to 15 Liters per minute (L/min) (reservoir bag must be pre-inflated before placing on face).
   • Oxygen Concentration: Delivers 60% to 90% FiO2.
   • Clinical Indication: Conscious or spontaneously breathing patient experiencing severe respiratory or cardiovascular distress (e.g., anaphylaxis, acute MI, severe asthma attack, shock).

3. Bag-Valve-Mask (BVM) Resuscitator:

   • Flow Rate: 10 to 15 Liters per minute (L/min) attached to 100% O2 source.
   • Oxygen Concentration: Delivers up to 100% FiO2.
   • Clinical Indication: Apneic (non-breathing) patient or severely hypoventilating patient requiring positive-pressure ventilation. Deliver 1 breath every 6 seconds (10 breaths/min) for adults with a pulse.