For all provinces and territories, check with your regulatory body for the required contents of medical emergency kits in the region where you practice. Use of the Medical Emergency Kit Contents Oxygen may be used in all emergencies except for hyperventilation. Have an E-size oxygen tank on wheels that is separate from your nitrous oxide unit. Have adult and pediatric bag valve masks (for patients not breathing) and adult and pediatric face masks (for patients who are breathing). The masks are single use only so make sure that you have extra masks for replacement. Give 100% oxygen with a flow rate of 6L/minute with a face mask for adult patients who are breathing, and 15L/minute with a bag valve mask for adult patients who are not breathing.2 Nitroglycerin is given to manage chest pain. It is available as oral tablets and as a sublingual spray. It is best to carry the spray bottle as the tablets expire within 3 months of opening the bottle. A maximum of 3 sprays can be administered; however, you must wait 5 minutes before each spray. Nitroglycerin is a vasodilator and will decrease blood pressure, so you must wait 5 minutes before a subsequent spray, and it is contraindicated if the patient’s systolic blood pressure is equal or less than 90 mm Hg, or if they took Viagra or Levitra in the last 24 hours or Cialis or Adcirca in the last 48 hours. Consider myocardial infarction if there is no relief after the third spray of nitroglycerin. Glucose is recommended, but not mandatory in the medical emergency kit in Ontario. Glucose can be given for hypoglycemia, when someone feels faint or after someone regains consciousness after syncope. Another recommended, but not mandatory item is naloxone, which is used for opioid overdose. Dental practices that provide deep sedation or general anaesthesia must have parenteral naloxone. If your office performs these procedures, additional medications are required in your medical emergency kit. Stay Current Syncope is the most common medical emergency in the dental office. Fortunately, my patient and team stepped in to care for me when I fainted during my own medical emergency. Management involves laying the patient flat with legs elevated, administering oxygen by face mask, and offering juice once they’re alert and seated upright. Practice managing scenarios like syncope (and other emergencies) with your team on a regular basis. Consider sharing this article with them and review your medical emergency kit as a group. Establish an office protocol and ensure everyone is familiar with it. Routine review and hands-on practice will help you stay confident and ready when emergencies arise. References: 1. Ontario Information about Medical Emergencies in the Dental Office. Royal College of Dental Surgeons of Ontario; 2025. Available: bit.ly/3LOcOu2 2. How to Use an Oxygen Resuscitator. Mega Medical; 2022. Available: megamedical.com.au/how-to-use-an-oxygen-resuscitator 3. Salbutamol: Uses, Dosage, Side Effects, Warnings. Drugs.com; 2025. Available: drugs.com/salbutamol.html Salbutamol (Ventolin) is used for an acute asthma attack. Adults should inhale 2 puffs of salbutamol (100 micrograms/puff), but children should get 1 puff. Shake the inhaler before use and wait 30-60 seconds between each puff.3 In the case of severe asthma, puffs can be repeated as needed up to 10 puffs. If there is no relief after 10 puffs, consider using epinephrine. Epinephrine has 3 uses: severe asthma, severe allergy and cardiac arrest. For cardiac arrest, the dosage is 1 mg I.V. for adults and 0.01 mg/kg I.V. for children. For severe asthma and severe allergy, the dosage is 0.3–0.5 mg I.M. for adults and 0.01 mg/kg I.M. for children. Keep 2 doses in your kit as epinephrine is short acting and you may have to give an additional dose. Call 911 if you’ve had to administer epinephrine, as symptoms may return. SA (acetylsalicylic acid or Aspirin) is administered when someone is experiencing a myocardial infarction. The dosage is 160-325 mg. The tablets should be chewed, swished with water and swallowed as this will allow faster onset. Use non-enteric coated ASA as it will break down in the stomach instead of the intestines allowing faster onset. Diphenhydramine (Benadryl) is used for a mild allergic reaction. It can also be used after epinephrine is given for a severe allergy to provide long term management as epinephrine is short acting. The dosage is 50 mg I.M. for adults and 1 mg/kg I.M. for children. Watch Dr. Sanjukta Mohanta discuss managing medical emergencies in the dental office on CDA Oasis at: bit.ly/4o9xytM 31 Issue 6 | 2025 | Supporting Your Practice
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