Dr. Malamed: The Importance of Epinephrine Auto-Injectors

Emergency Medications

Dr. Malamed explaining the importance of epinephrine auto-injectors in the dental setting.


  • Epinephrine comes in an ampule or in an auto-injector.
  • Epinephrine auto-injectors are the most effective, easy-to-administer form that dental offices should have on hand.
  • Emergencies are stressful and are a difficult time to try to remember a skill where time is of the essence.
  • Epinephrine ampules are great in a hospital or an emergency department where the skills of drawing up medications and injecting them is a common practice, but not in a dental office setting.

Video Transcript:

Epinephrine is the most important drug in emergency medicine. Not just in dentistry, but in medicine. It is such an important drug that a layperson – no medical background whatsoever – who is allergic to bee stings or peanuts will actually carry around an auto-injector syringe because if they get stung by that bee and get this anaphylactic reaction they don’t have time to call 911 and wait for them to arrive at the scene they might be dead by that time. That’s how important this drug is. The patient, the person will carry this drug and auto-inject themselves. The three forms are the auto-injector, the preloaded syringe, and then you have the ampule. I would be averse to the ampule. And the reason is it comes in a little glass ampule that, when you’re trained to use it, you crack it open, you load the syringe.

My feeling is that if anaphylaxis ever occurred in my office, or let’s say at home, let’s say I’m more of a normal person, not trained in anesthesia. I would be scared to death. This is my son turning blue in front of me. This is my patient turning blue in front of me. Am I going to be calm and collected enough to casually crack open the ampule and put that needle in? I’m going to be shaking like a leaf.

So I don’t like that.

Again, in a hospital environment, or in an emergency department this is fantastic. I don’t believe in an outpatient department – in a dental office or in private life that the ampule thing is going to work very well at all. I do have a problem with the ampule because I don’t think anybody is going to be clear-headed at that point in time. And because of the nature of what we are dealing with, the dental office, where emergencies are rare, they happen, but they are rare, I really try to stress there is really only one drug that I want to be preloaded and that is my epinephrine.


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