Emergency kit for the orofacial harmonization office: essentials
Almost every serious complication in orofacial harmonization fits into three scenarios: severe allergic reaction, malaise with fainting and vascular occlusion. What they have in common is that all three demand a response within minutes, and none leaves time to look for supplies. The emergency kit exists so that the first minute is spent acting.
This guide covers the content and logic of the kit. It complements two texts: hyaluronidase in the office, on storage and the enzyme protocol, and the emergency checklist for the orofacial harmonization office, a ready-made template for checks and the activation flow. It contains no doses or drug management: those are defined by the licensed professional, based on up-to-date guidelines, the label of each medication and the rules of their professional council.
Why think of the kit by scenario?
The most common mistake is building the kit like a shopping list, item by item, without thinking about when each will be used. The result is a full box that is incomplete in precisely the scenario that happens. Thinking by scenario inverts the logic: first you define what can go wrong in your office, then what needs to be at hand for the first minutes of each situation, until emergency services arrive or the patient is referred.
The kit depends on what you inject, where you work and the distance to a referral service. Someone who injects hyaluronic acid in high-risk areas, uses injectable anesthetic and works far from an emergency room has different needs from someone who only does toxin in a building next to a hospital. The risk map by area is in vascular danger zones of the face.
What does the kit need to cover in each scenario?
| Scenario | Signs that trigger the kit | What needs to be at hand (categories) | Referral |
|---|---|---|---|
| Anaphylaxis | Hives across the body, swelling of lips, tongue or throat, wheezing, shortness of breath, dizziness, drop in blood pressure | First-choice anaphylaxis medication, per guideline; adjunct medications defined by the technical manager; administration supplies; respiratory support resources provided in the protocol; monitoring | Call SAMU 192 (Brazil's emergency medical service) immediately |
| Syncope and drop in blood pressure | Pallor, cold sweat, nausea, darkening vision, brief loss of consciousness | Stretcher or chair that fully reclines; monitoring of blood pressure, pulse and saturation; glucometer to rule out hypoglycemia | If no quick recovery or atypical signs, emergency |
| Vascular occlusion from hyaluronic acid | Disproportionate pain, skin blanching, livedo, slow capillary refill | Hyaluronidase within expiry, diluent, syringes and needles, antisepsis supplies, written protocol, camera for documentation | Per protocol; specialist service when indicated |
| Visual complication | Loss or blurring of vision, eye pain, neurological sign | Contact for the referral ophthalmology service, product information and time of injection | Immediate emergency, without waiting for progression |
| Local anesthetic toxicity | Perioral tingling, metallic taste, ringing in the ears, agitation, altered consciousness | Monitoring and support resources provided in the protocol | Emergency |
Visual complication and occlusion are detailed in visual complication after filler and lip vascular occlusion. Reaction to anesthetic, when injectable lidocaine is used, is rare, but belongs in the plan of those who use it.
Anaphylaxis: what does the kit need to guarantee?
Anaphylaxis is the most severe form of hypersensitivity reaction. It can occur after any injectable, including hyaluronidase itself, as discussed in hyaluronidase: allergy, testing and precautions. Anaphylaxis guidelines point to intramuscular epinephrine (adrenaline) as the first-choice treatment, and the other medications as complementary ones that do not replace it.
For the kit, this means:
- The first-choice medication present, within expiry and in the presentation defined by the technical manager. The dose and method of use follow the adopted guideline and are in the internal protocol, printed in the kit.
- Supplies to administer without assembling anything on the spot, separated and labeled.
- Monitoring: blood pressure cuff, pulse oximeter and a clock to record times.
- Respiratory support resources that the clinic's protocol provides for and that the team knows how to use.
- Immediate activation of the emergency service, because the reaction can recur or worsen after an initial improvement.
The management in detail, at a review level, is in anaphylaxis in the orofacial harmonization office.
Syncope: the most frequent scenario
Vasovagal fainting, triggered by pain, fear of needles, fasting or heat, is usually the most common complication in the office. It is generally benign and resolves with the patient lying down, but it requires attention for two reasons: the fall can cause trauma, and the first signs resemble those of an allergic reaction or hypoglycemia.
For this scenario, the kit is mostly structure: a stretcher or chair that allows the patient to be laid down quickly, monitoring of blood pressure, pulse and saturation, a glucometer and something to offer a conscious patient with hypoglycemia, per the protocol. The differential between syncope, anaphylaxis and other causes is discussed in vasovagal syncope in the office.
Vascular occlusion: what goes in the "necro kit"?
"Necro kit" and "hyaluronidase kit" are nicknames for the part of the kit aimed at filler occlusion. The focus here is that it be complete and separate:
- hyaluronidase within expiry, in the quantity defined by the technical manager, and the indicated diluent;
- syringes and needles suitable for preparation and injection, set aside for the kit;
- antisepsis supplies and gauze;
- other resources provided for in the protocol the technical manager adopts;
- a written protocol, printed inside the kit;
- referral contacts, including ophthalmology;
- a record form with a field for the time of each action and photos.
Storage, expiry and training specific to the enzyme are in hyaluronidase in the office. Remember that hyaluronidase only breaks down hyaluronic acid: with biostimulators or an unknown product, the kit does not reverse the material, and referral carries more weight.
How to physically organize the kit?
| Principle | How to apply it |
|---|---|
| Fixed location | Always in the same place, in the procedure room or next to it, clearly marked |
| Separation by scenario | Labeled compartments or bags: "Severe allergy", "Occlusion", "Monitoring" |
| Seal | Numbered seal after each check; a broken seal means the kit needs to be reviewed |
| Expiry label | The date of the item that expires first written on the outside |
| Printed protocol | One sheet per scenario, inside the matching compartment |
| Exclusivity | Nothing from the kit is used in routine work; what leaves is replaced the same day |
| One kit per site | Anyone who works at more than one address needs a kit at each |
Battery-powered equipment, such as the oximeter and glucometer, is part of the check: equipment without charge is equipment that is missing. Checking the kit within the purchasing routine is covered in injectables inventory in the orofacial harmonization clinic.
What do the rules require?
The requirement for emergency supplies and medications in health services comes from the health surveillance authority (vigilância sanitária in Brazil), which licenses the establishment, and from the professional councils, each with its own rules. The requirements vary between municipalities and states and by type of service, and can change.
Before opening or when reviewing the office, confirm with the local health authority which items are required for your type of service and with your professional council what it recommends. The licensing process is in health license for an orofacial harmonization clinic, and the role of the person responsible for the service is in technical manager of the orofacial harmonization clinic.
How to train the team?
The kit only works if the team has opened it before the day of the emergency. A simple routine:
- Introduction on joining. Every new member learns the location, the compartments and their role.
- Defined roles. Who leads, who calls SAMU 192 and gives the address, who brings the kit, who records times.
- Periodic drills. One scenario at a time, with a stopwatch: anaphylaxis one month, syncope the next, occlusion after that.
- Review after real use. What was missing, what was slow, what to change in the protocol.
After the emergency: record and report
Once the patient has been cared for, record in the patient record the times, signs, actions, medications with lot numbers and the referral. Restock the kit the same day and seal it again. Serious adverse events with medications and products can be reported to ANVISA (Brazil's health regulatory agency), as explained in adverse event reporting (Notivisa).
And in Harmy?
Emergency kit checklist
- Office risks mapped: what you inject, where and how far from the referral service.
- Separate compartments for anaphylaxis, syncope and monitoring, and occlusion.
- First-choice anaphylaxis medication present and within expiry, with a printed protocol.
- Hyaluronidase, diluent and supplies set aside, if you inject hyaluronic acid.
- Oximeter, blood pressure cuff and glucometer charged and working.
- Emergency and ophthalmology contacts up to date, with the clinic's address written down.
- Numbered seal, label with the nearest expiry and record of the last check.
- Team trained, with defined roles and the last drill recorded.
- Requirements of the local health authority and of your professional council checked.
Frequently asked questions
What should be in the emergency kit of a facial harmonization office?
Generally, items for three scenarios: a severe allergic reaction (anaphylaxis), malaise with fainting or a drop in blood pressure, and vascular occlusion, which includes hyaluronidase for those who inject hyaluronic acid. Add monitoring equipment, a phone and emergency contacts, a written protocol and a record form. The exact list is defined by the technical manager, according to what the clinic performs and the rules of the professional council and health authority.
What is a necro kit?
It is the nickname for the set of materials to handle a suspected vascular occlusion from filler, with hyaluronidase, preparation and injection supplies, a protocol and referral contacts. It is only one part of the emergency kit: the office also needs to be ready for anaphylaxis and syncope.
Is a hyaluronidase kit enough as an emergency kit?
No. Hyaluronidase treats hyaluronic acid in an occlusion, but it does not address a severe allergic reaction, a faint or a complication with another product. The kit needs to cover the emergencies possible in your office, and the team needs to know how to use it.
How often should the emergency kit be checked?
On a fixed date, with a person responsible and a record, for example monthly, and always after any use. The check verifies expiry, integrity, equipment charge and restocking. The frequency should follow the clinic's protocol and the requirements of the local health authority.
Harmy images are illustrative simulations generated by AI from the patient's photo to support the conversation between practitioner and patient. They are not a promise of results. Indication, technique, product and volume are solely the decision of the licensed practitioner. This content is for information only and does not replace a clinical assessment.