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

Airways:Airways:OropharyngealOropharyngealairwayairway

Nasopharyngeal Nasopharyngeal airwayairway

Ambu bag:Ambu bag:

““E-C” techniqueE-C” technique

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

Thanks for Your Thanks for Your Attention !!!Attention !!!