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

In a dental medical emergency, work through ABCDE — Airway, Breathing, Circulation, Disability, Exposure — call for help early, and give the indicated emergency drug while you reassess. UK practices must keep a defined set of emergency drugs and arrest equipment, and the whole dental team must train in their use at least annually.

This guide is written for the whole UK dental team — dentists, therapists, hygienists, nurses and practice managers — as a revision aid and a prompt for protocol review. It sets out, in an answer-first format, the ABCDE approach, the mandatory emergency drugs and equipment, recognition and first-line management of the common in-surgery emergencies, and a consolidated drug-and-dose quick-reference. It is general professional information, not individual clinical advice, and it makes no guarantee of any clinical outcome: every dose, route and guideline reference must be verified against current Resuscitation Council UK, BNF/BNFC, SDCEP and NICE guidance (as of June 2026), and this page is not a substitute for hands-on training. Clinically reviewed by Mohammad Noori, GDC No. 310862. Last reviewed: June 2026.

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.

Step	What you assess	First actions (verify against current Resuscitation Council UK guidance)
A — Airway	Is the airway patent? Look and listen for obstruction (stridor, gurgling, silence).	Open the airway (head-tilt/chin-lift, or jaw thrust if trauma); suction secretions; consider an oropharyngeal (Guedel) airway in an unconscious patient.
B — Breathing	Rate, effort, symmetry, oxygen saturation (SpO₂), wheeze.	Give high-flow oxygen 15 L/min via a non-rebreathe mask to an acutely unwell patient; sit an asthmatic upright; if not breathing normally, start CPR.
C — Circulation	Pulse rate and quality, colour, capillary refill, blood pressure if available.	Lay the patient flat and raise the legs if hypotensive or faint; gain help; prepare drugs as indicated.
D — Disability	Conscious level (AVPU or GCS), pupils, and check blood glucose (“don’t ever forget glucose”).	Treat hypoglycaemia; place an unconscious, breathing patient in the recovery position.
E — Exposure	Look for rashes, urticaria, swelling, bleeding, medication patches, MedicAlert jewellery.	Expose only as needed; preserve dignity and temperature.

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 BNF “Medical emergencies in the dental practice” treatment summary, mirrored by SDCEP, 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. Verify the list below against current BNF/BNFC, SDCEP, Resuscitation Council UK and CQC guidance (as of June 2026).

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

Oxygen (portable cylinder, for example size D, 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. Verify the dose and sequence against the current Resuscitation Council UK / BSACI anaphylaxis guideline and the BNF/BNFC (as of June 2026).

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. Verify against current BNF/BNFC and SDCEP guidance (as of June 2026).

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. Verify against current BNF/BNFC and SDCEP guidance (as of June 2026).

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; if the pain settles, it is likely angina. If the pain persists beyond about 15 minutes, recurs, or is severe, 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). Verify against current Resuscitation Council UK, BNF and SDCEP guidance (as of June 2026).

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. Verify against current BNF/BNFC and SDCEP guidance (as of June 2026).

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. Verify the choking sequence and age bands against current Resuscitation Council UK guidance (as of June 2026).

Drug doses quick-reference

Drug	Indication	Dose & route (verify)	Notes (verify)
Adrenaline (epinephrine) 1:1000 (1 mg/mL)	Anaphylaxis	IM, anterolateral mid-thigh. Adult and child 12–17 yrs: 500 micrograms (0.5 mL); child 6–11 yrs: 300 micrograms (0.3 mL); child 6 months–5 yrs: 150 micrograms (0.15 mL); child under 6 months: 100–150 micrograms. (Mutually exclusive BNFC/RCUK age bands — a 12-year-old gets 500 micrograms; the BNFC adds that a child 12–17 years who is small or prepubertal should be given 300 micrograms / 0.3 mL.)	Repeat after 5 minutes if no improvement. Call 999. Per the Resuscitation Council UK / BSACI anaphylaxis guideline; verify against current RCUK/BSACI guidance (as of June 2026).
Salbutamol 100 micrograms/actuation	Acute asthma / bronchospasm	Inhaled via large-volume spacer: up to 10 actuations (puffs), one puff at a time with tidal breathing; repeat as needed pending help.	Give oxygen if hypoxic; call 999 for severe/life-threatening features or a poor response. Per BNF/SDCEP dental emergencies; verify against current BNF/BNFC/SDCEP guidance (as of June 2026).
GTN spray 400 micrograms/metered dose	Angina	Sublingual: 1–2 sprays (400–800 micrograms); SDCEP: repeat after about 3 minutes if chest pain remains.	If pain persists beyond 15 minutes or recurs, treat as a suspected MI. Caution if hypotensive. Per BNF/SDCEP; verify against current guidance (as of June 2026).
Glucose (oral, fast-acting)	Hypoglycaemia — conscious, able to swallow	Oral: 15–20 g fast-acting carbohydrate (for example glucose tablets, about 150–200 mL of a non-diet sugary drink or juice, or about 1.5–2 tubes of 40% glucose gel). Recheck and repeat after 10–15 minutes if needed; follow with longer-acting carbohydrate.	If unable to swallow or unconscious, use glucagon (below), not oral glucose. Verify the carbohydrate quantity against current BNF / diabetes guidance (as of June 2026).
Glucagon 1 mg injection	Hypoglycaemia — unable to swallow / unconscious	IM: adult and child aged 8 yrs and over (or body-weight 25 kg and over): 1 mg; child under 8 yrs (or body-weight under 25 kg): 500 micrograms.	Call 999. May be ineffective if glycogen stores are depleted; give oral carbohydrate once conscious. Per BNF/BNFC; verify age/weight bands against current BNF/BNFC (as of June 2026).
Midazolam (buccal/oromucosal)	Prolonged or repeated seizure (5 minutes or longer)	Buccal: adult: 10 mg; child age-banded (oromucosal solution), for example 1–5 yrs: 5 mg, 5–10 yrs: 7.5 mg, 10–18 yrs: 10 mg — confirm bands against the BNFC / product.	Single dose; call 999. Monitor airway and breathing for sedation. Buccal bands per BNFC (Buccolam / oromucosal licensing); verify against current BNFC / product information (as of June 2026).
Aspirin 300 mg dispersible	Suspected MI	Oral: 300 mg, chewed or dissolved, single dose.	Omit if true aspirin allergy or active significant bleeding. This is for a suspected MI, not routine angina. Per BNF/SDCEP; verify against current guidance (as of June 2026).
Oxygen	Most acute emergencies	15 L/min via a non-rebreathe mask; titrate to saturations once stable.	Essential adjunct alongside the drugs above. Per SDCEP/RCUK: oxygen at least 15 L/min via a non-rebreathe mask; verify against current RCUK/SDCEP guidance (as of June 2026).

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. Verify these principles against your practice protocol and current guidance:

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 (verify against your governance policy):

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. Verify these expectations against current guidance:

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 (verify against current GDC recommended-CPD guidance, as of June 2026).
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.

Check who can administer emergency drugs

Use the free GDC Scope of Practice Checker to confirm which members of the dental team may administer specific drugs in an emergency, by registered title.

Open the scope checker

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 checker among the clinical aids. These are gated in-app tools and are decision-support 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. You can confirm who in the team may administer specific drugs with the free GDC Scope of Practice Checker.

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. Templates are designed to exclude patient identifiers, and you copy the finished note into your own practice-management system, which remains your system of record.

See it in action

Explore the UK-structured templates and try an emergency or examination note — no account and no card needed.

See the dental notes app

Important safety disclaimer

Frequently asked questions

What is the adrenaline dose for anaphylaxis in dental practice?

Anaphylaxis is treated with intramuscular adrenaline into the anterolateral mid-thigh, repeated after 5 minutes if there is no improvement, alongside calling 999, lying the patient flat (raising the legs if hypotensive) and giving high-flow oxygen. The exact microgram dose is age-banded, so adults and older children differ from younger children and infants — confirm the current adult and paediatric figures against the Resuscitation Council UK / BSACI anaphylaxis guideline and the BNF/BNFC before use (as of June 2026). The dose quick-reference in this guide lists the figures for reference only.

What emergency drugs must a dental practice have?

The minimum emergency-drugs list — from the BNF “Medical emergencies in the dental practice” treatment summary, mirrored by SDCEP — is oxygen, adrenaline (epinephrine) injection for intramuscular use, dispersible aspirin, glucagon injection, a glyceryl trinitrate (GTN) spray, buccal (oromucosal) midazolam, a salbutamol inhaler and fast-acting oral glucose. The Resuscitation Council UK Quality Standards: Primary Dental Care sets the cardiorespiratory-arrest equipment (an AED, oxygen delivery, separate adult and child self-inflating bags, airways and masks, and suction), a large-volume spacer is included per the BNF/SDCEP dental kit, and a blood glucose meter is recommended as helpful rather than an essential minimum item. Stock must be checked regularly and replaced when used or expired — confirm the exact strengths and the current list against the BNF/SDCEP dental emergencies guidance, the Resuscitation Council UK equipment list and the relevant CQC guidance (as of June 2026).

How often must the dental team train in medical emergencies?

Medical emergencies and CPR is a recommended GDC enhanced CPD topic — the GDC recommends at least 10 hours per five-year cycle, with at least 2 hours every year — and the Resuscitation Council UK recommends practical training for the whole team at least annually. Confirm the current GDC hours and the Resuscitation Council UK recommendation (as of June 2026).

Do you give aspirin for angina?

No — aspirin is for a suspected myocardial infarction, not routine angina. Angina is managed with rest, reassurance and sublingual GTN; if chest pain persists beyond about 15 minutes, recurs or is severe, treat it as a suspected MI: call 999, give oxygen if hypoxic, and give aspirin to chew or dissolve unless it is contraindicated (for example true aspirin allergy or active significant bleeding). Verify against current Resuscitation Council UK, BNF and SDCEP guidance (as of June 2026).

Read the full guide