PBLS for Paediatric dental surgeons

1. Paediatric Basic Life Support
DR. DEEPASHREE PAUL

2. What is BLS?

3. Definition
• Paediatric Basic Life Support (PBLS) is a rescue
procedure which has purpose of preventing the anoxic
brain damage by promoting the return of spontaneous
circulation and breathing.
AHA

4. Introduction
• Dentistry is a surgical specialty` often associated with
high levels of patient anxiety, that may be conducive to
medical emergencies.
• Highly vasoactive drugs like LAs, vasoconstrictors etc
and drugs like antibiotics, sedatives, analgesics carry
potential for producing acute life threatening reactions.
• It should be appreciated that the role of a dental surgeon
in the management of a medical emergency is to stabilize
the patient until transferred to emergency Medical
Services (EMS) personnel.

5. Prevention is better than
Cure!
Prevention of Medical Emergencies
• Thorough medical history
• Physical Examination
• Medical Consultation (as and when required)
• Vigilant patient monitoring

6. Patient Monitoring for a
pediatric patient
• Observe general appearance from time to time
• Level of consciousness
• Level of comfort
• Muscle tonicity
• Colour of skin and mucosa
• Respiratory pattern

7. When moderate sedation is used especially in a child with
narrow safety margin due to smaller degree of respiratory
and cardiovascular reserve, additional monitoring should
routinely be employed.
• Continual monitoring of B.P via automated B.P cuff.
• Oxygenation and pulse rate via pulse oximetry.
• Ventilation via pretracheal/ pre chordial stethoscope or a
capnograph.
In case of deep sedation / GA more sophisticated
monitoring is required.

8. Preparation For Emergencies
• Personal Preparation
• Staff preparation
• Back-up medical assistance
• Office preparation
 Emergency equipment
 Emergency drugs

9. • A practicing dental surgeon cannot be expected to be able
to diagnose and manage every possible medical
emergency.
• However, can prepare to deal with the most likely
emergencies in a dental office and those with greater
potential to cause morbidity or mortality.
A. Syncope
B. Hyperventilation
C. Seizures
D. Hypoglycemia
E. Acute Asthmatic attack
F. Allergic reactions
G. Airway obstruction

10. • Knowledge of signs and symptoms, course and therapy of
common emergencies.
• Training in basic life support at health care provider level.
• Intramuscular injection techniques (most common
method of emergency drug delivery).
• Deltoid of U/arm and Vastus lateralis of thigh.

11. Staff preparation
• Desirable to keep certified BLS-HCP clinical staff.
• Pre assign and organize individual roles.
• Run mock drill to keep team protocol run smoothly.

12. Back-up medical
assistance
• Arrangements with nearest physician (arranged not
assumed!)
• Current EMS telephone no. conveniently displayed.

13. Office preparation
• Emergency equipment
• Correct sized equipment for infants and adolescents.
• Oxygen is the primary emergency drug in the dental
office.
• >90% O2 at 10 L/min for minimum 1 hour source should
be available. Therefore minimum “E” cylinder should be
available.

14. Non
rebreathing
face mask
for
spontaneous
breather
• Since pediatric dental patients very rarely suffer MI or
cardiac arrest as initiating medical events and drug
induced respiratory depression and loss of patent airway
during unconsciousness much more likely.
• The primary goal of BLS is to maintain proper respiratory
function. Hypoxemia ( low arterial blood O2) leads to
morbidity and mortality in majority of patients.
Bag valve
mask device
connected to
high flow
O2 essential
for apneic
patientsRobertshaw demand
valve device

15. • Next, essential equipment is a high volume suction
device, esp in those obtunded patients in whom vomiting
is induced. Aspiration of vomitus can be dangerous.
Prevented by positioning and suctioning.
• Yankaeur type suction can be connected to dental high
volm evacuation dental suction unit.
• Syringes and needles for IM drug administration.
• Automated external defibrillator. (AED)

16. Emergency Drugs
• Most medical emergencies in dental office do not require
drugs. Practitioner’s thought should primarily directed
towards BLS and drug therapy only when clearly
indicated.

17. Epinephrine
• Second most important after oxygen in emergency
armamentarium.
• Drug of choice for life threatening anaphylactic reactions and
severe asthmatic attacks unresponsive to salbutamol/ albuterol.
• It is early advanced cardiac life support drug for cardiac arrest.
• EpiPen 0.3mg per dose, EpiPen Jr 0.15mg per dose (Dey
Pharma LP)
• Pediatric Doses: 0.01mg/kg IM
• Side effects: hypertension, tachycardia, arrythmia, chest pain,
anxiety, headache.

18. Albuterol
• Use : acute asthmatic attack
• Doses: two puffs with deep inspiration
• SE: tachycardia, anxiety.

19. Nitroglycerine
• Chest pain due to stable/unstable angina pectoris/
evolving MI. Unlikely in pediatric patients.
• Dose: 0.4 mg, every 5 mins until chest pain subsides or
<100mm Hg B.P. max 3 sprays.
• SE: hypotension, headache.

20. Diphenhydramine
(Benadryl)
• Use: allergic reactions
• 1-2mg/kg IM, upto 50mg.
• SE: Sedation, dry mouth.

21. Midazolam
• Use: Anticonvulsant in Status epilepticus or seizures from
LA over dose.
• 0.15 mg/kg IM.
• SE: sedation, respiratory depression.

22. Sugar
• Source of simple sugars to manage hypoglycaemic
shocks.

23. Difference of etiology of cardiac arrest.
Anatomical difference between infants,
children & adults.

24. Highlight
the major
consideratio
ns in
Paediatric
Basic Life
Support

25. AIRWAY
BREATHING
CHEST
COMPRESSION
BLS

26. ABC OR CAB?

27. The 2010 AHA
Guidelines for
CPR and ECC
recommend a
CAB
sequence

28. Paediatric BLS at a
glance……….
Check for Response
No
Response
Shout for Help
Responds
Allow most comfortable
position
Safety of the Rescuer & Victim

29. BLS cont…
Check Breathing
Regular Breathing
Recovery Position
No breathing/ Gasping
Check Pulse ( <10 sec)
Carotid artery in Children
Brachial artery in infant

30. BLS cont…
Check Pulse
Palpable Pulse
( >60/min)
Rescue Breathing
(12-20/ min i.e.1 breath every
3-5 seconds until spontaneous
breathing resumes)
No Pulse / Bradycardia with
poor perfusion
Chest Compression

31. PUSH HARD compress 1/3rd of A-P dia of
sternum .
1.5 inch infant
2 inch children
PUSH FAST at least 100/min
Allow COMPLETE RECOIL of Chest.
CHEST COMPRESSION

35. 30 Compression for 1 rescuer & 15 for 2 rescuer
Open Airway

36. NO BLIND FINGER
SWEEP
1. Head Tilt/Chin Lift
2. Jaw Thurst

37. 1. Head Tilt/Chin Lift
NEUTRAL POSITION
SNIFFING POSITION

38. 2. Jaw Thurst
INFANT CHILDRE
N

39. After chest compression (C) and opening
airway (A) give 2 Breaths (B)
Each Breath should be of 1 Sec
Mouth to Mouth
Mouth to Mouth & Nose
Mouth to Mask
Bag valve mask (BVM)

40. FOR 1 RESCUER COMPRESSION : VENTILATION IS
30 :2 & FOR 2 OR MORE RESCUERS RATIO IS 15
:2
CONTINUE 5 CYCLES (2 MINS) BEFORE ACTIVATING
EMERGENCY SYSTEM OR SWITCHING TO OTHER
RESCUER

41. Duration of CPR
• Signs of life return
• Qualified help arrives to assist you
• It is impossible to continue (e.g.exhaustion)
• An authorised person pronounces life extinct.