Adverse Drug Reaction
Signs and symptoms#
- agitation
- weakness
- headache
- pallor, tremor, and palpitations
- change - increase or decrease - in blood pressure and heart rate
- muscle twitching and tremors
- light-headiness
- tinnitus
- if too much lidocaine - possible decreased blood pressure, heart rate and respiration
- skin eruption/hives
- seizure activity
Action#
Mild reaction#
- be calm and reassuring
- discontinue dental treatment
- clear the mouth of all foreign objects
- assess responsiveness
- evaluate breathing, airway and circulation
- monitor blood pressure, pulse and respiratory rate every 5 min
- administer supplemental oxygen, 6-8 L/min
- allow for recovery
- discharge only with escort or transport to hospital
Severe overdose#
In addition to what is done during a mild reaction:
- start an IV and administer midazolam 2mg, continue 1mg/min to achieve resolution (monitor respiration!)
- alert emergency medical systems (EMS)
References/Websites#
- References
- Greenwood M, et al. General medicine and surgery for dental practitioners: part 2. Medical emergencies in dental practice: the drug box, equipment and basic principles of management. BDJ. 2014;216(11):633-637.
- Greenwood M. General medicine and surgery for dental practitioners: part 3. Management of specific medical emergencies in dental practice. BDJ. 2014;217(1):21-26.
- Haas DA. Preparing dental office staff members for emergencies. Developing a basic action plan JADA. 2010;141(5 suppl):8S-13S.
- Rosenberg M. Preparing for medical emergencies. The essential drugs and equipment for the dental office. JADA. 2010;141(5 suppl):14S-19S.
- Jevon P. Medical emergencies in the dental practice poster: revised and updated. BDJ. 2020;229(2):97-104.