Medical Emergency in the Dental Practice 2025 – Anaphylaxis and Adrenaline

As it progresses other visible signs occur –

Frothy “soap suds” coming out of the mouth originating in the lungs. This is surfactant on the lining lungs mixed with fluid from the inflammatory reaction and this leads to the frothy appearance.

The root cause of Anaphylaxis is Histamine

This substance is released by mast cells in the body to fight the threat of the allergens. These cells are found throughout the body.

Adrenaline also counteracts the effects of histamine that is released by the in a severe irritation causing inflammation.

Here is the amazing property of Adrenaline in a medical emergency. When this hormone reaches the tubes of various sizes in the lungs (called the Bronchus or airways), they actually open up more. The micro muscles in the tube contact to make to tube diameter larger and thereby allowing more oxygen into the lungs.

Adrenaline counteracts the effects of histamine; however, each application only lasts 3-5 minutes. That is why EpiPens are not useful in this situation as it’s a single dose and that’s it.

ADMINISTER ADRENLAINE 1:1000 IM (intra-muscular) IMMEDIATELY 

The red bag emergency kit has glass vials of Adrenaline at 1:1,000 (1mg/ml) concentrations. The Adrenaline is drawn out of the vials with a syringe and injected into the thigh muscle even through clothing.

• ADULT 0.5ML
• CHILD  0.25ML

Repeat dose every 3-5 minutes until signs and symptoms clear up.

Now when we use Adrenaline, we use the thick thigh muscle for an intramuscular injection. This allows the hormone to soak into blood vessels. To ensure this is the case, we draw back on the needle BEFORE we inject; to make we are not in a vein. That means NO BLOOD is drawn up into the needle. Otherwise, the Adrenaline will go straight to the heart and make it beat faster and not be a gradual but effective release over the next 3-5 minutes. Remember the concertation in dental anaesthetic is 1:100,000.

The hormone concentration for Anaphylaxis is 100 times stronger!

Long life Adrenaline 1:1,000 pack to provide 30 minutes cover for adult anaphylaxis and 60 minutes for children.

However, these packs expire in 12 months so this has to be closely monitored.

The vanishing point syringe retracts the needle into the syringe when it is not needed any more, and safely can’t be used again.

The ampoule is broken by holding it away from you and breaking its neck to allow drawing up its contents with the syringe.

The breaking of the ampoule can be made easier with…

SnapIT ampoule opener allows you to open an ampoule while keeping both hands away from the sharp edges.

Injecting

The syringe is used to inject intramuscularly (IM), through clothing, on the side of thigh midway between knee and hip.

Put needle the needle right in to the hub and draw back to check for blood, so as to not be in any blood vessel.

Then inject with the needle all the way in- 0.5ml for an adult and 0.25 for a child.

So as to not cause damage of the muscle with prolonged use of Adrenaline, use the other leg to inject the next dose and then go back to the first leg and use a different site on the thigh.

Care – Adrenaline it can cause severe stinging or burning in your eyes, wash with saline, if possible, immediately.                    

Record the time of each injection and into which thigh it was placed.

DO NOT throw away vials as it is needed to do an audit of the incident.

Also photograph the room where the incident occurred for the authorities.

Remember the use of adrenaline is to be used by trained health professionals.

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