Epi, Perfusion and the Dental Chair

Should Epinephrine be used during Sudden Cardiac Arrest? (Dental Office)

Since epinephrine increases perfusion, and perfusion is the entire purpose of performing CPR (getting as much oxygenated blood to the brain as possible), I recently asked Dr. Stanley F. Malamed, Professor of Anesthesia & Medicine, University of Southern California, if a dentist should auto-inject a patient suffering from cardiac arrest with epinephrine? And if so, where?

“Intracardiac epinephrine is NO LONGER USED, even in medicine. Too many errors, as in injecting the epi into the myocardium, not into the chamber of the heart. In SCA epinephrine is administered either intravenously or intraosseously (e.g. EZ-IO). Endotracheally administered epinephrine is not longer thought to be the route of choice. Too many problems there too.

Giving the drug IM in the vastus lateralis or mid-deltoid would be of little practical value during SCA as there is no peripheral circulation in the absence of chest compression and having been administered IM even with chest compression the uptake would be entirely too slow.”

In the case of Sudden Cardiac Arrest in a dental chair, we should not use the epinephrine from our Dental Drug Kit. Stick with compressions, respiration's and certainly defibrillation. For more information on Emergency Medical Kits, contact First Responder Educational Services www.FRES-CPR.com

Dr. Stanley F. Malamed is Professor and Chief of Anesthesia & Medicine, University of Southern California, and lectures internationally on Medical Emergencies in the Dental Office.