Emergency In Dentistry Part 1

Emergency in Dentistry: Part I

B asic life support (BLS)

- Sequence of BLS

- Equipment

- Techniques

The Sequence of BLS:

Assessment

EMS activation

The ABCDs of CPR

- A irway

- B reathing

- C ardiac

- D efibrillation

Step 1: Check for Unresponsiveness Check for unresponsiveness ---”Are you all right?” Call for help --- “6969” --- “119” Unrespond

Step 2: Open A irway Upper airway obstruction by the tongue & epiglottis “ Head tilt- chin life” “ Jaw thrust” If suspected head trauma

Step 2: B reathing --- Assessment

Check for breathing:

- look for chest movement

- listen for air escaping during exhalation

- feel for the flow of air

Recovery position:

- responsiveness (-)

- breathing (+)

- circulation (+)

Step 2: B reathing --- Positive pressure ventilation

Deliver positive pressure ventilation

“ Leak-proof” seal

“ OK” signal

Squeeze Ambu bag slowly: >2sec

Observe chest rise

Deliver 2 initial breaths

Sellick maneuver (cricoid pressure)

Preventing gastric inflation

Step 3: C irculation --- Assessment (no more than 10sec)

Locate the trachea

Gently feel the carotid pulse

Keep head tilt position Slide to the groove between trachea & SCM

Step 3: C irculation --- Chest compression Locate the margin of the rib

Follow the rib

margin to xiphoid

process

Put hand above

fingers

Put another hand directly over the hand

Step 3: C irculation --- Chest compression

Lock the elbow in position, with the

arms straightened

“ Shoulder over hand” position

Depress the sternum about 4~5cm

Complete release the pressure but

keep in contact with the victim’sternum

Rate: 100/min

Compression : Ventilation = 15 : 2

Foreign body aspiration

Heimlich maneuver:

for responsive victim, standing or sitting

give subdiaphragmatic abdominal thrust

- direction: inward & upward

Chest thrust:

for responsive pregnant or obese victim

hand position and technique: same as

chest compression

Foreign body aspiration

Finger sweep & tongue-jaw lift:

for unresponsive/unconscious victim

not indicated for responsive or seizure

patient

“ tongue-jaw lift” maneuver

Check for unresponsiveness Access airway Signs of airway obstruction? Access breathing Signs of inadequate breathing? Access pulse Pulse absent? Open airway Positive ventilation Administration oxygen Chest compression Ready for defibrillation Follow ACLS protocol Yes Yes Yes No No Check BP Recovery position No Initial assessment

Emergency cart: EKG monitor and defibrillator Drugs, laryngoscope, light, oral or nasal airways

Airways: Oropharyngeal airway Nasopharyngeal airway

Ambu bag: “ E-C” technique

Oxygen therapy: Nasal cannula Simple mask Ventri mask Non-rebreathing mask FiO 2 24% 100%

Endotracheal tube intubation: Layngoscope: Check light Endotracheal tube: Male: 7.0, 7.5, 8.0 Female: 6.5, 7.0, 7.5 Test cuff “ sniffing” position Oral-pharyngeal-tracheal axis

Endotracheal tube intubation: Vocal cord Lift forward & upward Sellick maneuver Length: 19~23cm Cuff Check position: stethoscope, CXR

Thanks for Your Attention !!!