Emergency drugs used in dental office
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Transcript of Emergency drugs used in dental office
KS Harishankar–
Emergency drugs & equipment must be available in every dental office
Life-savingSecondary role to
basic life support in overall management
It is a collection of drugs & equipments highly effective in managing life-threatening situations
Should be as simple to use as possibleShould be intended to use for adult or pediatric patients
They are presented in 4 levels or modules based on level of training & experience of the doctor
Drugs in each modulei. Injectablesii.Non-injectables
Endotracheal IntravenousSublingual or intra lingual Intramusculari. Vastus-lateralisii.Mid-deltoidiii.Gluteal region
1) Cleanse the area of needle insertion 2) Grab the muscle & pull it away from the
bone3) Holding the syringe like a dart, quickly
insert the needle into the muscle mass to a depth of approximately 1 inch
4) Aspirate to ensure nonvascular penetration5) Quickly administer the drugs6) Remove the syringe, placing a dry gauze
under pressure at the injection site for a minimum of 1-2 minutes
7) Rubbing the area may increase vascularity & speed the rate of drug absorption
1) Place the tourniquet above the antecubital fossa
2) If possible have the patient open & close the fist to help distend the veins
3) When the patient cannot open & close his/her fist (unconscious) – place arm below the level of patient’s heart to help distend the veins
4) Cleanse & then dry the area in which the venipuncture is to be placed
5) Use an indwelling catheter , scalp-vein needle or syringe with the bevel of the needle facing up held at about 30 – 45 angle to the vein to be entered
6) Advance the needle into the vein until a return of blood is noted
7) Remove the tourniquet & either start the IV infusion or administer the desired drug
8) Secure the needle with a tape to maintain venous access
MODULE ONE- Basic emergency kit (critical drugs &
equipment)
MODULE TWO – non critical drugs & equipment
MODULE THREE – advanced cardiac life support
MODULE FOUR – antidotal drugs
Injectable drugs1. Epinephrine2. Anti-histamineNon-injectable drugs 1. Oxygen2. Vasodialators Emergency equipment1. Oxygen delivery system2. Suction & suction tips3. Tourniquets4. syringes
Secondary Injectable drugs1.Anticonvulsaunt2.Analgesics3.Vasopressor4.Antihypoglycemics5.Corticosteroids6.Antihypertensive7.anticholinergic
Non-injectable drugs 1.Respiratory stimulant2.Antihypoglycemic3.bronchodilatorsEmergency equipment1.Device for cricothyrotomy2.Artificial airways3.Laryngoscope & endotracheal tubes
1. Epinephrine2. Oxygen3. Lidocaine4. Atropine5. Dopamine6. Morphine sulfate7. Verapamil
Narcotic antagonistsBenzodiazepines Antiemergence delerium drugVasodilator
Most important emergency drug Drug of choice in acute allergic reactions DESIRABLE PROPERTIESRapid onset of actionPotent bronchial smooth muscle dilatorHistamine blocking propertiesVasopressor action Cardiac effects(increased cardiac output)
Therapeutic indications
1:1000 concentration in - Anaphylaxis - Acute ashmatic attack 1:10000 concentration - Cardiac arrest
SIDE EFFECTS Tachydysrhythmias - Supraventricular - Ventricular PRECAUTIONS In pregnancy -decreases placental blood
flow -premature labour NO CONTRA INDICATIONS
AVAILABILITY Preloaded syringes - 1:1000 intramuscular and
subcutaneous -1:10000 intravenous1 ml ampulesDOSEAdult dose 0.3 -0.5 ml intramuscular and subcutaneousPediatric dose 0.15mg
In Emergency kits- 1 preloaded syringe(1 ml of 1:1000
epinephrine)
- 3 or 4 ampules(1:1000 epinephrine)
Drug class - Histamine blockersProprietary - Chlor- TrimetonAlternative drug -DiphenhydramineHistamine blockersDrug of choice - delayed allergic response - definitive management of acute allergyMODE OF ACTIONCompetitive antagonists of histaminePrevent histamine’s access to receptor siteBlocking response of effector to histamine
THERAPEUTIC INDICATIONSDelayed onset allergic reactionsAs local anesthetics in allergic patientDefinitive management of acute allergic
reactionsSide Effects - CNS Depression -Decreased Blood Pressure -Thickening of bronchial secretionsContraindications -Acute asthmatic episodes
AVAILABILITY - 1ml and 2ml ampules(10mg|ml) -1ml pre loaded syringes DIPHENHYDRAMINE -10&30ml multidose vials(10mg\ml) -1ml ampules(50mg\ml) -1ml pre-loaded syringes IN EMERGENCY KITS -Three or Four 1ml ampules Chlorpheniramine(10mg/ml) or Diphenhydramine(50mglml)
1)OXYGEN2)VASODILATOR3)BRONCHODILATOR4)ANTIHYPOGLYCEMIC5)ASPIRIN
DRUG CLASS -NONEALTERNATIVE DRUG-NONEPROPRIETARY -NONE
Most useful drug in emergency kitTHERAPEUTIC INDICATIONS Emergency situations where
respiratory
distress is evident SIDE EFFECTS-NONECONTRAINDICATIONS-
HYPERVENTILATION
AVAILABILITY Compressed gas cylinderIN EMERGENCY KIT ONE E CYLINDER
DRUG CLASS-VASODILATORALTERNATIVE DRUG-AMYL NITRITEPROPRIETARY-NITROLINGUALSPRAY -NITROSTAT
TABLETS
THERAPEUTIC INDICATIONS - CHEST PAIN IN In acute myocardial
infarction Angina pectoris - Acute hypertensive episodes
Side Effects -Transient pulsating headache -Facial flushing -Degree of hypotensionCONTRAINDICATIONS -In hypotensive patients
AVAILABILITY -0.3,0.4,0.6mg doses of sublingual
tablets -0.4,0.8mg/dose translingual spray -0.3ml doses of amyl nitrate yellow
vaporoles IN EMERGENCY KIT -One bottle of metered trans lingual
nitroglycerine spray
DRUG CLASS-BRONCHODILATORALTERNATIVE DRUG-
METAPROTERENOLPROPRIETARY-PROVENTIL,VENTONIL
Drug of choice in asthmatic & allergic patients
Mode of action: bronchial smooth muscle relaxation
Therapeutic indication: bronchospasms, acute asthmatic & allergic reactions
Contraindications : pre-existing tachydysrhythmias
AVAILABILITY: - Albuterol inhalers ( Ventolin,
Proventil ) - Metaproterenol inhalers (Alupent) - Epinephrine mistometers
(Medihaler-Epi,
Primatine Mist) - Isoproterenol mistometers
(Medihaler-Iso)
DRUG CLASS-ANTIHYPOGLYCEMICSDRUG OF CHOICE – ORANGE JUICEALTERNATIVE DRUG-SOFT DRINKS
(NONDIET)PROPRIETARY-NONE
Drug of choice in patients with hypoglycemic reactions in Diabetes mellitus & non-diabetic patients with hypoglycemia
Therapeutic indications: management of unconscious hypoglycemic state
Contraindications : patients without active gag reflex, or unable to drink without assistance
Side effects: none
AVAILABILITY: - Glucola - Gluco-stat - Insta-glucose - nondiet cola beverages - fruit juices - granulated sugar - tubes of decorative icing
DRUG CLASS-ANTI-PLATELETALTERNATIVE DRUG-NONEPROPRIETARY-NONE
Drug of choice in suspected myocardial infarctionMode of action: - irreversibly acetylates the platelet cycloxygense - removes all cycloxygenase activity for the lifespan of platelet - stops production of proaggregatory
thromboxane A2 - non platelet effects: diminishes formation of
prostacyclinesTherapeutic indications: suspected myocardial
infarction unstable anginaContraindications & side effects :life-threatening
haemorrhage (bleeding peptic ulcer), history of aspirin allergy
AVAILABILITY: -65, 81, 162 , 325 mg tablets In emergency kit3-4 baby chewable aspirin- 162 mg
Oxygen delivery systemAutomated external defibrillatorSyringesSuction & suction tipsTourniquetsMagill intubation forceps
TECHNIQUE PERCENTAGE O2 DELIVERED
MOUTH-TO-MOUTH 16
MOUTH-TO-MASK 16
BAG-VALVE MASK 21
BAG VALVE MASK+SUPPLEMENTAL O2
>21 - <100
POSITIVE PRESSURE OXYGEN 100
POSITIVE PRESSUREAdaptable to the E-cylinderDelivers oxygen under positive pressureExamples: Positive pressure or demand valve - Reservoir bagThe devices should be fitted with a clear face
maskEfficient delivery of 100% oxygenPermit the rescuer to inspect the victim’s mouth
for the presence of foreign matter like vomitus, blood, saliva, water
Should be available in child, small adult & large adult sizes
Portable Self-inflating Source of positive pressure oxygen or ambient air or enriched oxygen (>21%, <100%) Attached to oxygen delivery tube Rescuer should be able to maintain an air-
tight seal Should have patent airway with one hand
while using the other hand to activate the device & ventilate the victim
Clear, full-faced maskRescuer applies exhaled air ventilation ( 16%
oxygen) to ventilate the victimExhalation occur through one way valve located
on the side of the maskAlso available with supplemental oxygen port
permitting the attachment of the mask to an oxygen tube & deliver enriched oxygen ventilation
It enables the rescuer to provide mouth to mask ventilation
Advantage: prevention of transmission of disease, low cost
IN PEDIATRIC PATIENTSSimply invert the mask, holding the
narrow nose side of the mask in the cleft of the chin & the wider chin side on the bridge of the child’s nose
IN EMERGENCY KIT One portable oxygen cylinder (E-
cylinder) with positive pressure mask One portable, self-inflating, bag-valve-
mask device One pocket mask for each staff member Sizes: child, small adult, large adult Advanced training for safe &effective
use
Sophisticated,simple,battery operated ,computerised device,reliable &easy to use.
Use-to recognise cardiac dysrrythmias-ventricular fibrillation&pulseless ventricular tachycardia.
In emergency kit:one automated external defibrillator
Plastic , disposable syringes with 18 or 21 gauge needles
2 ml syringes – emergency drug delivery
In emergency kit: 2-4 2 ml disposable syringes
In emergency kit: 2 plastic evacuators or tonsil suction tips
To administer IV drugsFor bloodless phlebotomy in acute
pulmonary oedema In emergency kit: 3 tourniquets & a
sphygmomanometer
To place endotracheal tube during nasal intubation
It is a blunt ended scissor with a right angled bend which permits the forceps to grasp objects deep in the hypopharynx
In emergency kit: one pediatric size Magill intubation forceps
Secondary injectable drugs1.Anticonvulsants2.Analgesics3.Vasopressors4.Antihypoglycemics5.Corticosteroids6.Antihypertensive7.Anticholinergic
DRUG OF CHOICE: MidazolamPROPRIETARY: VersedDRUG CLASS: BenzodiazepineALTERNATIVE DRUG: Diazepam
DRUG OF CHOICE: Morphine sulphate PROPRIETARY: none DRUG CLASS: Opioid agonist ALTERNATIVE DRUG: Meperidine; nitrous oxide & oxygen (N2O-O2) THERAPEUTIC INDICATIONS: Pain & anxiety in ischemic chest
pain SIDE EFFECTS: potent CNS & respiratory depressants CONTRAINDICATIONS: injury & multiple trauma AVAILABILITY: 8,10, 15 mg/ml in 2 ml ampules & 20 ml
vials morphine sulfate, 50, 100 mg/ ml Meperidine in 1 ml ampule & 20,
30 ml vials In emergency kit: 10 mg/ml morphine sulfate (2, 2ml
ampules) 50 mg/ml Meperidine (2, 2ml ampules)
DRUG OF CHOICE: PhenylephrinePROPRIETARY: ManyDRUG CLASS: VasopressorALTERNATIVE DRUG: noneTHERAPEUTIC INDICATIONS: 1.manage hypotension2.Syncopal reactions3.Drug-overdose reactions4.Post-seizure states5.Acute adrenal insufficiency6.allergy
PRECAUTIONS: hyperthyroidism, bradycardia, partial heart block, myocardial disease, severe atherosclerosis
CONTRAINDICATIONS: parenteral administration is contraindiacted in patients with high BP, or ventricular tachycardia
AVAILABILITY: 10 mg/ml in 1 ml ampules IN EMERGENCY KIT: 10 mg/ml 2 – 3, 1 ml
ampules
DRUG OF CHOICE: Dextrose, 50 % solution PROPRIETARY: none DRUG CLASS: Antihypoglycemics ALTERNATIVE DRUG: Glucagon THERAPEUTIC INDICATIONS: treatment of hypoglycemia,
diagnostic aid in unconsciousness or seizures of unknown origin
SIDE EFFECTS: 50% dextrose solution administered IV – tissue necrosis if extravascular infiltration occurs
CONTRAINDICATIONS: IV or IM glucagon in starvation or chronic hypoglycemia
AVAILABILITY: 50 % dextrose in 30 ml glass Glucagon in 1mg of dry powder with 1 ml of diluents IN EMERGENCY KIT: 50% dextrose 1-2 vials (IV) or
1mg/ml glucagon (IV or IM)
DRUG OF CHOICE: Hydrocortisone sodium succinate
PROPRIETARY: Solu-CortefDRUG CLASS: Adrenal
glucocorticosteroidALTERNATIVE DRUG: none
THERAPEUTIC INDICATIONS: definitive management of acute allergy, in acute adrenal insufficiency
PRECAUTIONS: peptic ulcer, pre-existing infection, hyperglycemia
AVAILABILITY: Hydrocortisone sodium succinate 50 mg/ml, (2ml vials)
IN EMERGENCY KIT: 1, 2ml vial
DRUG OF CHOICE: Esmolol PROPRIETARY: Brevibloc DRUG CLASS: β-Adrenergic blocker ALTERNATIVE DRUG: Propanolol THERAPEUTIC INDICATIONS: acute hypertensive
episodes, as antidysrhythmic agent in PSVT, intra-operative & post-operative tachycardia
CONTRAINDICATIONS: sinus bradycardia, heart block greater than 1st degree, cardiogenic shock, overt heart failure
AVAILABILITY: 2.5 g in 10 ml ampule which is diluted to a 10 mg/ml concentration prior to infusion
IN EMERGENCY KIT: 2 ampules (100 mg/ml) with diluents
DRUG OF CHOICE: Atropine PROPRIETARY: none DRUG CLASS: Anticholinergic ALTERNATIVE DRUG: none THERAPEUTIC INDICATIONS:bradycardia,
hemodynamically significant bradydysrhythmias SIDE EFFECTS: hot, dry skin, headache, blurred near-
sightedness , dry mouth throat, disorientation & hallucinations
CONTRAINDICATIONS: glaucoma, prostatic hypertrophy AVAILABILITY:0.5 mg/ml in 1 ml vials 7 1 mg/ml in 10
ml pre-loaded syringes IN EMERGENCY KIT: 2 or 3 ampules of 0.5 mg/ml (IM) or
2, 1o ml syringes (IV)
1. Respiratory stimulant2. Antihypertensives
DRUG OF CHOICE: Aromatic ammonia
PROPRIETARY: noneDRUG CLASS: Respiratory stimulantALTERNATIVE DRUG: none
THERAPEUTIC INDICATIONS:to treat respiratory depression not induced by opioid analgesics ,vasodepressor syncope
SIDE EFFECTS:irritating effects on mucous membrane of upper respiratory tract precipitates bronchospasm
CONTRAINDICATIONS: chronic obstructive pulmonary disease or asthma
Availability :silver grey vaporoles containing 0 .3ml of ammonia
IN EMERGENCY KIT: one or two boxes of vaporoles
DRUG OF CHOICE: NifedipinePROPRIETARY: ProcardiaDRUG CLASS: Calcium channel blockerALTERNATIVE DRUG: NitroglycerinTHERAPEUTIC INDICATIONS:hypertension,acute
anginal painSIDE EFFECTS:excessive hypotension CONTRAINDICATIONS: in patients receiving β-
blockers, patients undergoing anasthesia with high doses of fentanyl
AVAILABILITY:10mg or20 mg capsules IN EMERGENCY KIT: one bottle of 10mg capsules
1. Scalpel or cricothyrotomy needle2. Artificial airway3. Laryngoscope & endotracheal tubes4. Laryngeal mask airway
Indicated when all other noninvasive procedure fail to secure a patent airway
In emergency kit: 1 scalpel with a disposable blade
1 cricothyrotomy device
Plastic or rubber oropharyngeal or nasopharyngeal airways used
Used to assist in maintenance of patent airway in unconscious patient
Act by lifting the base of the tongue off the posterior pharyngeal wall
In patients who are not deeply unconscious – gagging, regurgitation, vomiting
Available in variety of sizes: child, small adult & large adult
In emergency kit: 1 set of each adult & pediatric nasopharyngeal airways
These are advanced airway devicesEndotracheal intubation uses a laryngoscope
to visualize the trachea & an endotracheal tube
Advantages: isolation of the airway preventing aspiration
Facilitation of ventilation & oxygenationFor the easy administration of emergency
drugs In emergency kits: 1 laryngoscope & a set of
spare batteries & assorted adult & pediatric size endotracheal tubes
Laryngeal mask airway maintains airway during anaesthesia
The airway is a tube & a small mask with an inflatable circumferential cuff intended for placement in victim’s posterior pharynx which seals the base of the tongue & laryngeal opening
Very high success rate; low complication rate
Essential ACLS drugs include:EpinephrineOxygenLidocaineAtropineDopamineMorphine sulfateVerpamil
CATEGORY GENERICNAME
PROPRIETARY NAME
ALTERNATIVE QUANTITY AVAILABILTY
Cardiac arrest Epinephrine Adrenaline - 3×10 ml
syringe
1:10,000 concentrati
onOxygen Oxygen - - 1E
cylinder
Antidysrhythmic
Lidocaine Xylocaine Procainamide 1× 5ml ampule
100 mg
Symptomatic bradycardia
Atropine Atropine Isoproternol 2×10ml syringe
1 mg/10 ml
Symptomatic
hypotension
Dopamine Intropin Dobutamine
2×5 ml ampule
s
80 mg/ml
Analgesic Morphine Morphine Meperidine
2×2 ml ampule
s
10 mg /ml
PSVT Verapamil Isoptin - 1×4 ml ampule
s
2.5 mg/ml
Drug class: catecholamine Alternative drug: noneProprietary name: Ana-guard, Epi-
pen, Twinject,
DRUG CLASS: Endogenous catecholamine ALTERNATIVE DRUG : none PROPRIETARY: Adrenaline ACTIONS: Maintains coronary artery blood flow while CPR in progress- life saving in cardiac arrest THERAPEUTIC INDICATIONS: Cardiac arrest including ventricular
fibrillation, pulseless ventricular
tachycardia, asystole, pulseless
electrical activity SIDE EFFECTS: exacerbate ventricular ectopy in patients receiving Digitalis AVAILABILITY: 1:10,000 conc in pre-loaded 10 ml syringes In emergency kit: 2 - 3 pre-loaded syringes
Essential in cardiac resuscitation & emergency cardiac care
Prevents hypoxiaSide effect: toxicity on long term
administrationAVAILABILITY: 1 E-cylinder
DRUG CLASS: local anesthetic, anti-dysrhythmic
ALTERNATIVE DRUG: ProcainamidePROPRIETARY: XylocaineTHERAPEUTIC INDICATIONS: i. Primary anti-dysrhythmic drugii.In premature ventricular contraction ( coupled, multi-focal
iii.Ventricular tachycardiaiv.Ventricular fibrillation
SIDE EFFECTS: myocardial, circulatory & CNS depression
• Overdose:Drowsiness, paraesthesia, muscle twitching • Severe overdose: Tonic clonic seizuresCONTRAINDICATION: Depressed hepatic functionAVAILABILITY: - as IV injection in 5 ml pre-filled syringes(50/100mg)
- 5 ml ampules of 100 mg IN EMERGENCY KIT: 1 -100 mg pre-loaded syringe 1 - 5 ml ampule
DRUG CLASS: ParasympatholyticALTERNATIVE DRUG: IsoprotrenolPROPRIETARY: AtropineTHERAPEUTIC INDICATION: i. haemodynamically significant
bradydysrhythmiasii.Asystole refractory to epinephrine
ISOPROTRENOLSynthetic sympathomimetic amine Increases cardiac output Increases myocardial oxygen consumption
DRUG CLASS: Sympathomimetic amine ALTERNATIVE DRUG: Dobutamine PROPRIETARY: Intropin THERAPEUTIC INDICATION: haemodynamically significant hypotension in absence of
hypovolemia MODE OF ACTION: Large doses stimulates both α & β adrenergic receptors• Small doses dialates mesentric, renal & cerebral
arteries• Also stimulates the release of nor-epinephrine
SIDE EFFECTS i. Exacerbate supraventricular or ventricular dysrhythmias
ii.Exacerbates myocardial ischemiaCONTRAINDICATIONS:In patients receiving monoamine oxidase inhibitors
(Isocarboxazid, pargyline, tranyl-cypromine, phenelzine)
AVAILABILITY: 200, 400 & 800 mg in 5 ml ampules IN EMERGENCY KIT: 1-2 400 mg ampules
DRUG CLASS: Opioid agonist ALTERNATIVE DRUG: Meperidine PROPRIETARY: Morphine THERAPEUTIC INDICATIONS:Pain & anxiety in ischemic
chest pain SIDE EFFECTS: potent CNS & respiratory
depressants CONTRAINDICATIONS: injury & multiple trauma AVAILABILITY: 10 mg/ml morphine sulfate, 50 mg/ ml Meperidine
DRUG CLASS: Calcium channel blockersALTERNATIVE DRUG: nonePROPRIETARY: IsoptinTHERAPEUTIC INDICATIONS:Paroxysmal supraventricular tachycardia
SIDE EFFECTS: transient decrease in arterial pressure, severe hypotension, ventricular fibrillation
CONTRAINDICATIONS: ventricular tachycardiaAVAILABILITY: 2.5 mg/ml in 2 ml & 4 ml ampules IN EMERGENCY KIT: 1-2 4 ml ampules
OPIOID ANTAGONISTSBENZODIAZEPENESANTIEMERGENCE DELIRIUM DRUGVASODILATOR
CATEGORY GENERICNAME
PROPRIETARY NAME
ALTERNATIVE
QUANTITY AVAILABILTY
Narcotic antagonist
NALOXONE NARCAN NALBUPHINE 2×1 ml ampule
s
0.4 mg/ml
Benzodiazepine antagonist
FLUMAZENIL MAZICON - 1×10 ml vial
0.1 mg/ml
Antiemergence delirium
PHYSOSTIGMINE ANTILIRIUM - 2×2 ml ampule
s
1 mg/ml
vasodilator PROCAINE NOVOCAIN - 2×2ml ampule
s
10mg/ml
DRUG CLASS: Thebaine derivativeALTERNATIVE DRUG: NalbuphinePROPRIETARY: NarcanTHERAPEUTIC INDICATIONS:Opioid induced depression including respiratory
depressionSIDE EFFECTS: respiratory depression recurs when administered parenterallyCONTRAINDICATIONS: use with extreme care in
physical dependanceAVAILABILITY: 0.4 mg/ml in 1 ml ampules & 10 ml vialsPEDIATRIC ADMINISTRATION: 0.02 ml in 2 ml ampules IN EMERGENCY KIT: 2 - 1 ml ampules
DRUG CLASS: Benzodiazepine antagonist ALTERNATIVE DRUG: None PROPRIETARY: Romazicon MODE OF ACTION: o Rapid reversal of sedationo Increased alertnesso Decreased amnesic effect in geriatric population THERAPEUTIC INDICATIONS:o Reverse the clinical actions of parenterally
administered Benzodiazepenes SIDE EFFECTS & CONTRAINDICATIONS:o Rebound anxiety AVAILABILITY: 0.1 mg/ml in 5 ml ampules & 10 ml
vials IN EMERGENCY KIT: 1 - 10 ml vial
DRUG CLASS: Cholinesterase inhibitor ALTERNATIVE DRUG: None PROPRIETARY: Antilirium THERAPEUTIC INDICATIONS:Reverse emergence delirium Emergence delirium:i. loss of contact with reality due to drugs like
Scopolamine,benzodiazepenes, diazepam, midazolam.ii. Patient makes unintelligible sounds, increased muscular
movement MODE OF ACTION: reversible cholinesterase inhibitor, can
cross BBB
SIDE EFFECTS i. Increased salivationii.Possible emesisiii.Involuntary urination & defecationiv.Bradycardia & hypersalivation CONTRAINDICATIONS:i. Asthmaii.Diabetesiii.Cardiovascular diseasesiv.Mechanical obstruction of gastrointestinal
genito-urinary tract AVAILABILITY: 1 mg/ml in 2 ml ampules IN EMERGENCY KIT: 2-3 ampules
DRUG CLASS: Local anesthetic ALTERNATIVE DRUG: None THERAPEUTIC INDICATIONS:i. Vasospasm & compromised circulation following
intra-arterial administration of a drugii. Management of pain & vascular compromise
following extravascular administration of irritating drugs
SIDE EFFECTS & CONTRAINDICATIONS:History of local
anesthetic allergy
AVAILABILITY: 1% (10 mg/ml) solution in 2 & 6 ml ampules
IN EMERGENCY KIT: 2 - 2ml ampules
Should not be complicated Only those drugs and equipment which
doctor is familiar should be included Should be stored in plastic box with
several compartments Labels should be applied in each
compartment containing generic and proprietary names and dosage and expiry dates