Medical Emergencies in the Dental Practice: Drugs, Doses & ABCDE (UK)

The ABCDE approach: a systematic first response

When a patient collapses, deteriorates or reports alarming symptoms, use the structured ABCDE assessment recommended by the Resuscitation Council UK. Treat life-threatening problems as you find them before moving on, and reassess from the top after any intervention.

Mandatory emergency drugs and equipment

UK dental practices must hold a defined minimum set of emergency drugs and equipment, check it regularly, and replace items when used or out of date. Note the sourcing: the drugs list (and the exact strengths and forms) comes from the “Medical emergencies” section of SDCEP Drug Prescribing for Dentistry, which draws on the BNF (whose emergency-drug treatment summary is now titled “Medical emergencies in the community”) and the Scottish Government’s 2024 “Emergency drugs and equipment in primary dental care”, while the Resuscitation Council UK Quality Standards: Primary Dental Care deliberately covers cardiorespiratory-arrest equipment and refers readers to the BNF for the emergency drugs.

Emergency drugs (minimum — per the BNF/SDCEP dental emergencies guidance, not the Resuscitation Council UK arrest list):

• Oxygen: two size D or two size CD cylinders, or one size E (SDCEP), with appropriate masks
• Adrenaline (epinephrine) injection 1:1000 (1 mg/mL) for intramuscular use
• Aspirin 300 mg dispersible
• Glucagon injection 1 mg
• Glyceryl trinitrate (GTN) spray (400 micrograms per metered dose)
• Midazolam 10 mg (buccal/oromucosal) for prolonged seizures
• Salbutamol inhaler (100 micrograms per actuation)
• Oral glucose (fast-acting — for example glucose tablets, gel, powder or solution)

Emergency equipment (minimum — arrest equipment per the Resuscitation Council UK, plus a large-volume spacer per the BNF/SDCEP; a blood glucose meter is recommended as helpful rather than an essential minimum item):

• Portable oxygen cylinder with pressure-reduction valve and flowmeter, plus an oxygen mask with tubing
• Pocket mask with oxygen port
• Self-inflating bag with reservoir and tubing — both an adult and a separate child (paediatric) size, as the Resuscitation Council UK equipment list specifies two distinct self-inflating bags — plus a range of well-fitting adult and child masks
• Oropharyngeal (Guedel) airways (Resuscitation Council UK list: sizes 0, 1, 2, 3, 4) and a range of clear face masks (sizes 0–4)
• Automated External Defibrillator (AED)
• Large-volume spacer device for inhaled bronchodilator (BNF/SDCEP dental kit — not on the Resuscitation Council UK arrest-equipment list)
• Single-use sterile syringes and needles
• Portable (battery) suction with appropriate catheters (for example a Yankauer)
• Blood glucose meter (recommended as helpful, not an essential minimum item — SDCEP lists a glucometer as helpful for assessing the patient’s condition; it is not on the Resuscitation Council UK arrest-equipment list)
• Single-use gloves, aprons and a sharps container

Anaphylaxis

Recognise: rapid-onset, life-threatening Airway, Breathing or Circulation problems — stridor, wheeze, hypotension, collapse — usually with skin or mucosal changes (urticaria, angio-oedema).

Management (per the Resuscitation Council UK / BSACI anaphylaxis guideline): remove the trigger, call 999, lie the patient flat (a sitting position may help if breathing is the main problem; do not stand them up or sit them up suddenly) and raise the legs if hypotensive; lie a pregnant patient on her left side; give high-flow oxygen; and give intramuscular adrenaline 1:1000 without delay, into the anterolateral mid-thigh, repeating after 5 minutes if there is no improvement.

Acute asthma

Recognise: breathlessness, wheeze, prolonged expiration and an inability to complete sentences; a “silent chest”, cyanosis or exhaustion signal a life-threatening attack.

Management: sit the patient upright, give salbutamol via a large-volume spacer, give oxygen if hypoxic, and call 999 for any severe or life-threatening features or a poor response.

Hypoglycaemia

Recognise: in a known diabetic, sudden confusion, sweating, tremor, aggression, drowsiness or collapse. Check blood glucose.

Management: if the patient is conscious and able to swallow, give fast-acting oral glucose and recheck; if they are unable to swallow or are unconscious, give intramuscular glucagon and call 999, then give oral carbohydrate once they have recovered and can swallow.

Angina and suspected myocardial infarction (MI)

Recognise: central chest pain or tightness, possibly radiating to the arm or jaw, with sweating, nausea or breathlessness.

Management of angina: stop treatment, sit the patient up, reassure them, and give sublingual GTN spray from the emergency kit (or the patient’s own), 1–2 sprays (400 micrograms per metered dose), repeated at 5-minute intervals if symptoms have not resolved, up to a maximum of 3 sprays in total (BNF); if the pain settles, it is likely angina. If the pain has not resolved 5 minutes after the second dose of GTN, or earlier if it is intensifying or the patient is unwell, treat it as a suspected MI: call 999, give oxygen if hypoxic, and give aspirin 300 mg to chew or dissolve unless contraindicated (for example true aspirin allergy or active significant bleeding).

Seizures (convulsions)

Recognise: tonic-clonic movements, loss of consciousness and possible incontinence.

Management: protect the patient from injury, do not restrain them or put anything in the mouth, time the seizure, and place them in the recovery position once it stops. For a convulsive seizure lasting 5 minutes or longer, or repeated seizures, give buccal (oromucosal) midazolam and call 999.

Syncope (simple faint)

Recognise: the most common dental emergency — a pre-faint of pallor, sweating and nausea, then a brief loss of consciousness.

Management: lay the patient flat and raise the legs, loosen tight clothing and ensure a clear airway; recovery is usually rapid. If recovery is slow or atypical, reassess ABCDE and consider another cause (for example hypoglycaemia or a cardiac event). No drug is routinely required for an uncomplicated faint.

Choking / foreign body airway obstruction

Recognise: sudden difficulty speaking or breathing during or after a procedure, often with the patient clutching the throat.

Management: encourage coughing if the cough is effective; if the cough is ineffective, give up to 5 back blows then up to 5 abdominal thrusts, alternating, and reassess between cycles. Call 999 early — if the obstruction is not relieved after the first set of 5 back blows and 5 abdominal thrusts, call 999 and continue alternating until it clears or the patient becomes unresponsive; if the patient becomes unresponsive, start CPR and ensure 999 has already been called. Good moisture-control and a high-volume aspirator help prevent aspiration during treatment.

Drug doses quick-reference

These are adult-default figures with limited paediatric bands; they are not a complete prescribing resource. Confirm indications, contraindications, age and weight bands and maximum doses in the current BNF/BNFC before use.

Calling for help and escalating

Speed of escalation matters more than perfect drug technique. Build these principles into your practice protocol:

• Shout for help early and delegate clearly: name a person to call 999, a person to fetch the emergency drugs kit, oxygen and AED, and a person to record times.
• Call 999 for anaphylaxis, a suspected MI, a prolonged or repeated seizure, severe or life-threatening asthma, an unconscious patient, or any patient you cannot stabilise.
• Hand over with SBAR (Situation, Background, Assessment, Recommendation) when the ambulance arrives, including the drugs, doses, routes and times you gave.
• Keep the practice’s emergency numbers, the nearest A&E and a clear practice address (and what3words) by the phone, and rehearse who does what.

Documentation: what to record after a medical emergency

A medical emergency must be documented contemporaneously, factually and in full — both for patient safety and for medico-legal defensibility. Record:

• Date, time and location; who was present and their roles.
• The patient’s presenting symptoms and your ABCDE findings, with observations: conscious level (AVPU/GCS), respiratory rate, pulse, blood pressure, SpO₂ and blood glucose.
• A timed sequence of events.
• Every drug given: name, dose, route, time, batch number and expiry, and by whom — plus oxygen and any BLS/AED use, including shock times.
• The patient’s response to each intervention.
• The time 999 was called, ambulance arrival and handover (SBAR), and the outcome or destination.
• Post-event actions: restock and re-check the emergency kit, complete a significant event analysis, consider the professional duty of candour, and make any external reports required (for example an MHRA Yellow Card for a suspected adverse drug reaction, or RIDDOR where applicable).

Good contemporaneous record-keeping here follows the same standards as the rest of the clinical record — the DCP record-keeping and SOAP-format guides linked below cover how to structure a defensible note.

Training and CPD: keep the whole team ready

Equipment and drugs only help if the team can use them under pressure:

• Medical emergencies and CPR/BLS is a recommended GDC enhanced CPD topic; the GDC recommends at least 10 hours of medical-emergencies CPD per five-year cycle, with at least 2 hours every year (GDC recommended CPD topics).
• The Resuscitation Council UK recommends that the whole dental team undertakes practical medical-emergency and resuscitation training at least annually, appropriate to their role.
• Run scenario drills in the practice, keep an emergency-drug and equipment check log, and make sure new and locum staff are inducted on where the kit is and what their role is.

Quick protocols and reference in the Nosht app

Nosht is a structured UK dental clinical-notes tool. Inside the app, subscribed clinicians have an Emergency Protocols quick-reference and a Drug Interactions reference among the clinical aids. These are gated in-app tools and are reference aids only — they do not replace current Resuscitation Council UK guidance, the BNF/BNFC, SDCEP or hands-on training, and the same verification caveat applies to any dose shown in-app.

Nosht uses optional, clinician-reviewed AI (Anthropic’s Claude Haiku 4.5) in two narrow ways: it can turn your shorthand into structured note fields that you review and confirm line by line, and it offers an advisory “Bulletproof” check that flags where a note may be incomplete. The template core is deterministic, and the AI is never trained on your notes. Unlike ambient or voice-based AI scribes that record and transcribe the consultation, Nosht’s structured-notes workflow does not record audio — you type shorthand; there is no voice capture in this workflow, and you confirm every field yourself. Most templates have no patient-identifier fields (referral letters and leaflet sending excepted). You copy the finished note into your own practice-management system, which remains your system of record.

Sources and last checked

• Resuscitation Council UK Guidelines 2025 (Adult and Paediatric Basic Life Support, published 27 October 2025) and Quality Standards: Primary dental care (cardiorespiratory-arrest equipment).
• Resuscitation Council UK / BSACI, Emergency treatment of anaphylaxis (2021).
• SDCEP Drug Prescribing for Dentistry, Medical emergencies section (website edition), including the 10 October 2025 GTN update.
• BNF and BNF for Children, medical emergencies treatment summaries, and NICE/BNF Prescribing in dental practice (Medical emergencies in dental practice).
• CQC, Dental mythbuster 4: Drugs and equipment for a medical emergency (page last updated 5 June 2025).
• GDC, Recommended CPD topics.

Check dates: the salbutamol, oral glucose, oxygen, buccal midazolam and GTN entries and the CQC citation were checked against these sources on 4 October 2026; the rest of the page was checked in June 2026.

Important safety disclaimer