8.3 Emergency Drugs & the Resuscitation Kit
Key Takeaways
- SDCEP (Drug Prescribing for Dentistry) recommends a core emergency drug kit for every dental practice: oxygen, adrenaline 1:1000, glucagon, aspirin 300 mg dispersible, GTN spray, midazolam (oromucosal), salbutamol inhaler, and oral glucose
- Oxygen cylinders must hold enough to deliver 15 L/min for at least 30 minutes (e.g., two Size D, two Size CD, or one Size E cylinder)
- Midazolam for emergency buccal use is a Schedule 3 controlled drug; the injection solution (5 mg/mL, 2 mL ampoule) may replace the oromucosal solution where permitted
- Recommended emergency equipment includes an AED, oxygen cylinder, bag-valve-mask, oropharyngeal airways, non-rebreather mask, syringes, and a blood glucose meter
- Dental practitioners do not routinely stock IV emergency drugs; all team members should rehearse the kit annually with BLS/ILS training
The SDCEP Core Emergency Drug Kit
The Scottish Dental Clinical Effectiveness Programme (SDCEP), through its Drug Prescribing for Dentistry guidance and the Practice Support Manual, defines the minimum emergency drugs every dental practice must stock. The kit is deliberately small and designed for use by any trained member of the dental team.
| Drug | Indication | Adult Dose / Form |
|---|---|---|
| Oxygen | Any emergency with hypoxia or shock | 15 L/min via non-rebreather mask |
| Adrenaline 1:1000 (1 mg/mL) | Anaphylaxis | 500 micrograms (0.5 mL) IM |
| Glucagon | Hypoglycaemia (unconscious/uncooperative) | 1 mg IM |
| Aspirin 300 mg dispersible | Acute coronary syndrome (MI) | 300 mg chewed |
| Glyceryl trinitrate (GTN) spray | Angina | 400 micrograms (1 spray) sublingual |
| Midazolam oromucosal solution (5 mg/mL) | Prolonged/repeated seizure (status) | 10 mg (2 mL) buccal |
| Salbutamol inhaler (100 mcg/actuation) | Asthma attack | 2-4 puffs via spacer; 5 mg nebulised if severe |
| Oral glucose (tablets/gel/GlucoGel/sugar) | Hypoglycaemia (conscious) | 15-20 g |
Key Points on the Drug Kit
- Injectable adrenaline and glucagon may be administered by any dental team member under the Prescription Only Medicines (Human Use) Order 1997, provided they are competent to do so.
- Chlorphenamine, hydrocortisone, and IV fluids are not part of the routine dental emergency kit under current RCUK/SDCEP guidance for anaphylaxis, although some practices keep antihistamines (cetirizine, loratadine) for mild allergic reactions.
- Dental practitioners do not routinely stock IV emergency drugs (e.g., IV adrenaline, IV glucose, IV fluids) — these are administered by ambulance or hospital teams.
- Midazolam is a Schedule 3 controlled drug: prescriptions and requisitions must comply with CD regulations, invoices must be retained for two years, and it must be denatured before disposal. It is exempt from safe-custody (CD cabinet) requirements.
Oxygen Supply
SDCEP requires enough oxygen to deliver 15 L/min for at least 30 minutes. Cylinder capacities:
| Cylinder | Capacity | Duration at 15 L/min |
|---|---|---|
| Size D | ~340 litres | ~22 minutes |
| Size CD | ~460 litres | ~30 minutes |
| Size E | ~680 litres | ~45 minutes |
A common compliant configuration is two Size CD cylinders or one Size E. Rural practices are advised to keep two Size E cylinders because ambulance response may be longer.
Emergency Equipment Checklist
In addition to drugs, the practice must hold the equipment to use them and to resuscitate:
- Automated external defibrillator (AED) — the GDC expects every dental practice to have one
- Oxygen cylinder(s) with regulator and flowmeter
- Bag-valve-mask (BVM) with adult and paediatric masks
- Oropharyngeal (Guedel) airways — sizes 2, 3, 4 for adults
- Non-rebreather oxygen mask with reservoir
- Nasal cannulae (optional)
- Syringes and needles (for IM injection of adrenaline/glucagon)
- Blood glucose meter and test strips — essential for the ABCDE 'Disability' step
- Spacer device (for salbutamol inhaler use)
- Single-use suction and Yankauer for airway clearance
Equipment Maintenance
- Check the kit weekly (drug expiry, oxygen pressure, AED battery and pads).
- Replace any used item immediately after an emergency.
- Keep a written log of checks.
Matching Drugs to Emergencies (High-Yield Summary)
| Emergency | Drug | Route |
|---|---|---|
| Syncope | None (legs raised) | Position only |
| Anaphylaxis | Adrenaline 500 mcg | IM (anterolateral thigh) |
| Hypoglycaemia (conscious) | Oral glucose 15-20 g | PO |
| Hypoglycaemia (unconscious) | Glucagon 1 mg | IM |
| Angina | GTN 400 mcg (1 spray) | Sublingual |
| MI / ACS | Aspirin 300 mg | Chewed (PO) |
| Asthma (mild/moderate) | Salbutamol 100 mcg | Inhaled (spacer) |
| Asthma (severe) | Salbutamol 5 mg + O2 | Nebulised; call 999 |
| Prolonged seizure | Midazolam 10 mg | Buccal |
| Cardiac arrest | (AED) | Defibrillation + CPR |
Training Requirements
| Requirement | Frequency / Detail |
|---|---|
| BLS / ILS (Immediate Life Support) | Annual certification for all clinical staff |
| Medical emergency drill | Regular team rehearsals (at least annually) |
| AED use | Included in BLS/ILS training |
| Team roles | Assign and rehearse: caller, CPR, drug admin, timer |
| GDC principle 6 | Practitioners must work within their knowledge and skills and ensure the team is trained to manage emergencies |
The GDC's Standards for the Dental Team (principle 6) requires all dental professionals to be trained to recognise and manage medical emergencies, and to have appropriate equipment and drugs available. Training that is not refreshed annually is treated as lapsing by the GDC.
Sources and Currency
- Resuscitation Council UK 2021 Guidelines (BLS, ALS, Anaphylaxis) — current at the time of writing.
- SDCEP Drug Prescribing for Dentistry — updated to be consistent with BNF 91 (March-September 2026); a broader review of the guidance is underway.
- SDCEP Practice Support Manual — the practical emergency drugs list and equipment guidance for dental practices.
According to SDCEP guidance, what is the minimum oxygen supply a dental practice must hold?
An adult patient has a prolonged seizure lasting more than five minutes in the dental surgery. Which drug, formulation, and dose does SDCEP recommend for emergency use in this setting?
Which of the following is NOT part of the routine SDCEP emergency drug kit for a general dental practice?