Post on 30-Dec-2015
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Emergency in Emergency in Dentistry: Part IDentistry: Part I BBasic life support (BLS)asic life support (BLS)
- Sequence of BLS- Sequence of BLS - Equipment- Equipment - Techniques- Techniques
The Sequence of BLS:The Sequence of BLS:
AssessmentAssessment
EMS activationEMS activation
The ABCDs of CPRThe ABCDs of CPR - Airway - Breathing - Cardiac - Defibrillation
Step 1: Check for Step 1: Check for UnresponsivenessUnresponsiveness
Check for unresponsivenessCheck for unresponsiveness---”Are you all right?”---”Are you all right?”
Call for helpCall for help--- “6969”--- “6969”--- “119”--- “119”
UnrespondUnrespond
Step 2: Open Step 2: Open AAirwayirway
Upper airway Upper airway obstruction by the obstruction by the tongue & epiglottistongue & epiglottis
““Head tilt-Head tilt-chin life”chin life”
““Jaw thrust”Jaw thrust”If suspected If suspected head traumahead trauma
Step 2: Step 2: BBreathingreathing--- Assessment--- Assessment
Check for breathing:Check for breathing:
- look for chest movement - listen for air escaping during exhalation - feel for the flow of air
Recovery position:Recovery position:
- responsiveness (-) - breathing (+) - circulation (+)
Step 2: Step 2: BBreathingreathing--- Positive pressure --- Positive pressure ventilationventilation
- Deliver positive pressure Deliver positive pressure ventilationventilation- “ “Leak-proof” sealLeak-proof” seal- “ “OK” signalOK” signal- Squeeze Ambu bag slowly: Squeeze Ambu bag slowly: >2sec>2sec- Observe chest riseObserve chest rise- Deliver 2 initial breathsDeliver 2 initial breaths
- Sellick maneuver (cricoid Sellick maneuver (cricoid pressure)pressure)- Preventing gastric inflationPreventing gastric inflation
Step 3: Step 3: CCirculationirculation--- Assessment (no more --- Assessment (no more than 10sec)than 10sec)
- Locate the Locate the tracheatrachea
- Gently feel the carotid Gently feel the carotid pulsepulse
Keep head tilt Keep head tilt positionposition
Slide to the groove between Slide to the groove between trachea & SCMtrachea & SCM
Step 3: Step 3: CCirculationirculation--- Chest compression--- Chest compression
Locate the margin of Locate the margin of the ribthe rib
- Follow the rib Follow the rib margin to margin to xiphoid xiphoid processprocess- Put hand above Put hand above fingersfingers
Put another Put another hand directly hand directly over the handover the hand
Step 3: Step 3: CCirculationirculation--- Chest compression--- Chest compression
- Lock the elbow in position, with the Lock the elbow in position, with the arms straightenedarms straightened- “ “Shoulder over hand” positionShoulder over hand” position- Depress the sternum about 4~5cmDepress the sternum about 4~5cm- Complete release the pressure but Complete release the pressure but keep in contact with the victim’sternkeep in contact with the victim’sternumum- Rate: 100/minRate: 100/min- Compression : Ventilation = 15 : 2Compression : Ventilation = 15 : 2
Foreign body aspirationForeign body aspiration
Heimlich maneuver:Heimlich maneuver:- for responsive victim, standing or sittingfor responsive victim, standing or sitting- give subdiaphragmatic abdominal thrusgive subdiaphragmatic abdominal thrustt- direction: inward & upward- direction: inward & upward
Chest thrust:Chest thrust:- for responsive pregnant or obese for responsive pregnant or obese victimvictim- hand position and technique: same hand position and technique: same as as chest compressionchest compression
Foreign body aspirationForeign body aspiration
Finger sweep & tongue-jaw lift:Finger sweep & tongue-jaw lift:- for unresponsive/unconscious victim for unresponsive/unconscious victim - not indicated for responsive or not indicated for responsive or seizure seizure patientpatient-““tongue-jaw lift” maneuver tongue-jaw lift” maneuver
Check for Check for unresponsivenessunresponsiveness
Access Access airwayairway
Signs of airway Signs of airway obstruction?obstruction?
Access Access breathingbreathing
Signs of inadequate Signs of inadequate breathing?breathing?
Access Access pulsepulse
Pulse Pulse absent?absent?
Open Open airwayairway
Positive ventilationPositive ventilationAdministration Administration oxygenoxygen
Chest compressionChest compressionReady for Ready for defibrillationdefibrillationFollow ACLS protocolFollow ACLS protocol
YesYes
YesYes
YesYes
NoNo
NoNo
Check BPCheck BPRecovery Recovery positionposition
NoNo
Initial Initial assessmentassessment
Emergency cart:Emergency cart:
EKG monitor and defibrillatorEKG monitor and defibrillator
Drugs, laryngoscope, light, oral or Drugs, laryngoscope, light, oral or nasal airwaysnasal airways
Oxygen therapy:Oxygen therapy:
Nasal cannulaNasal cannula Simple Simple maskmask Ventri Ventri
maskmaskNon-Non-
rebreathing rebreathing maskmask
FiOFiO22
24%24% 100100%%
Endotracheal tube Endotracheal tube intubation:intubation:
LayngoscopLayngoscope:e:Check lightCheck light
Endotracheal tube:Endotracheal tube:Male: 7.0, 7.5, 8.0Male: 7.0, 7.5, 8.0Female: 6.5, 7.0, Female: 6.5, 7.0, 7.57.5Test cuffTest cuff
““sniffing” positionsniffing” positionOral-pharyngeal-tracheal Oral-pharyngeal-tracheal axisaxis
Endotracheal tube Endotracheal tube intubation:intubation:
Vocal cordVocal cordLift forward & upwardLift forward & upwardSellick maneuverSellick maneuverLength: 19~23cmLength: 19~23cmCuffCuffCheck position: stethoscope, CXCheck position: stethoscope, CXRR