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Chapter 12- CPR
1.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Chapter 12 CPR
2.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Objectives • Upon completion of this chapter, you will be able to: – Explain the CABs of CPR – Explain the purpose of the Automated External Defibrillator (AED) – Demonstrate how to determine consciousness – Describe the technique for administering rescue breathing 2
3.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Objectives (cont’d.) – Demonstrate how to check the carotid pulse – Explain the technique for administering external compressions – Explain when CPR should be started and stopped – Explain the technique of two-person CPR – Explain how to open the airway in a child or infant 3
4.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Objectives (cont’d.) – Explain how to provide rescue breathing for infants and children – Explain how to check an infant’s pulse at the brachial artery – Explain how to administer external compressions for infants and children – Describe two of the dangers associated with administering CPR 4
5.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Introduction • All dental team members should maintain a CPR certification that is offered by the American Heart Association or the American Red Cross – Renew on a regular basis to ensure you are using the most up-to-date techniques 5
6.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cardiac Arrest • Exists when the circulation of blood either is absent or is inadequate to maintain life – May be the result of myocardial infarction or angina – May occur without previous signs or symptoms 6
7.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cardiac Arrest (cont’d.) • Presents as one of three conditions: – Cardiovascular collapse – Ventricular fibrillation – Cardiac standstill • Cardiopulmonary resuscitation (CPR) improves chances for survival – Combines rescue breathing with cardiac compressions 7
8.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cardiac Arrest (cont’d.) • Automated external defibrillator (AED): – Portable, computerized device that automatically diagnoses a potentially life threatening cardiac arrhythmia – Computerized program determines whether shock is necessary 8
9.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cardiac Arrest (cont’d.) Figure12-1: Automated external defibrillator 9
10.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cardiac Arrest (cont’d.) • CPR is effective because of the location of the heart – Force applied to the lower sternum creates a pressure that drives the blood through the aorta and pulmonary artery – Blood is oxygenated by rescue breathing with compressions 10
11.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Cardiac Arrest (cont’d.) • Many lives are saved each year due to the number of people trained in CPR 11
12.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. CPR Technique • Order of the steps to perform CPR: – C: Circulation restored – A: Airway opened – B: Breathing 12
13.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Determining Consciousness • When an endangered person is discovered, need to determine consciousness: – Tap patient’s shoulder – Shout in patient’s ear: “Are you all right? Are you all right?” – Make sure the patient is not asleep or in a drug-induced stupor 13
14.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Checking the Pulse • Cardiac arrest: no pulse in the large arteries • Use the first two fingers to check pulse of patient’s carotid artery – Place fingers on the person’s larynx and slide them into the groove between the trachea and the muscles on the side of the neck – Do not press too hard 14
15.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Checking the Pulse (cont’d.) • Check pulse for at least six seconds but not more than 10 seconds • If pulse is present, administer rescue breathing • No pulse, activate EMS and retrieve AED 15
16.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. External Compression • Applying rhythmic pressure over the lower sternum, raising thoracic pressure and forcing blood out of the heart • Chest compressions do not have to be accompanied by rescue breathing – Important to have high quality compressions 16
17.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. External Compression (cont’d.) Figure12-3: Chest compressions 17
18.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. External Compression (cont’d.) • Patient must: – Always be in a horizontal position • Compressions cannot overcome the force of gravity – Be on a firm surface (floor or with board between the patient and the chair) • Contoured dental chair will absorb the force of the compressions 18
19.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Technique • Position self close to the patient’s chest • Locate the proper hand position for administering the compressions • Slide your fingers up the rib cage to the area where the ribs meet the sternum • Place the heel of your hand on the lower part of the sternum 19
20.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Technique (cont’d.) • Place other hand on top of the hand resting on the sternum • Interlock fingers to keep them off the chest during compression • Lock elbows and position shoulders over hands – Compressions are performed with body weight rather than arm muscle 20
21.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Technique (cont’d.) • Depth of the compression depends on patient’s body size: – Adult sternum should be compressed two inches • Immediately after compression, release sternum – Do not remove hands from sternum 21
22.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Technique (cont’d.) • Compressions should be smooth and rhythmic • In one-person CPR, maintain a ratio of 100 compressions in 60 seconds • After the 30th compression, administer two full slow breaths, then continue compressions 22
23.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Technique (cont’d.) • AED should be used as soon as possible • If no pulse, resume CPR • If pulse/breathing present, monitor patient 23
24.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Opening the Airway • Open the airway if rescue breathing is required – Tongue is most often the obstruction – Use head tilt-chin lift to lift the tongue from the airway • If patient is not breathing, rescuer needs to breathe for the patient 24
25.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Opening the Airway (cont’d.) Figure 12-5: Head-tilt, chin-lift 25
26.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Rescue Breathing • Seal the nose by pinching the person’s nostrils between the thumb and forefinger • Take a deep breath, open your mouth very wide, and place it around the outside of the patient’s mouth • Blow air into the patient’s mouth – Watch to see if the patient’s chest rises and falls 26
27.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Rescue Breathing (cont’d.) • First breathing sequence should consist of two breaths with 1-1.5 seconds allowed for each breath – Allow lungs to deflate between breaths • If rescuer cannot get breath into the patient’s lungs, reposition the patient 27
28.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Mouth-to-Nose Respiration • May need to use mouth-to-nose technique if a good seal cannot be achieved • Keep the patient’s head tilted back – Use your hand to close the patient’s mouth • Make a seal with your mouth around the patient’s nose and administer the two slow breaths 28
29.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Mouth-to-Stoma Respiration • For patients with a laryngectomy: – Administer ventilations directly to the person’s stoma • Stoma: an opening that connects the trachea directly to an opening in the skin 29
30.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Gastric Distention • Seen most frequently in children – Occurs when the rescuer uses too much air to ventilate the person or when the airway is partially or completely blocked – Air is forced into the stomach rather than the lungs – Can be dangerous to the patient 30
31.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Starting and Stopping CPR • CPR should be started immediately upon recognition of cardiac arrest • Should be continued until one of the following is met: – The patient recovers – CPR efforts are transferred to another qualified person trained in CPR 31
32.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Starting and Stopping CPR (cont’d.) – A physician assumes responsibility for the person • Should be continued until one of the following is met: – EMS personnel assume responsibility for the person – The rescuer is exhausted and physically unable to continue CPR 32
33.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Two-Person CPR • One person administers compressions and the second person administers respiration • The second rescuer can retrieve the AED as well as notify EMS personnel 33
34.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. CPR for Infants and Children • Cardiac arrest does not occur often in children • Principles of CPR are the same • Require adjustments due to anatomical size differences 34
35.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Categorizing Infants and Children • Infant: – Any child under one year of age • Child: – Any child ages one to eight • Over eight years, child is treated as an adult 35
36.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Determining Consciousness in the Infant or Child • Tap and shout method still appropriate for the child • For an infant, thump the bottom of the infant’s foot while shouting the baby’s name 36
37.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Positioning the Infant/Child • Place supine on a hard flat surface • For better access to an infant, place the infant on a countertop or table rather than the floor 37
38.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. External Compressions • Child: – Heel of the hand used to compress sternum two inches – 100 compressions per minute – Ratio of breaths/compressions • Single rescuer: 30:2 • Two rescuers: 15:2 38
39.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. External Compressions (cont’d.) • Infant: – Hand position is midsternum (between the nipples) – Index and middle finger used to compress sternum 1.5 inches – 100 compressions per minute 39
40.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. External Compressions (cont’d.) – Ratio of breaths/compressions: • Single rescuer: 30:2 • Two rescuers: 15:2 40
41.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Automated External Defibrillator • Must use an AED that is calibrated for use with infants and children 41
42.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Opening the Airway • Use the head-tilt/chin-lift technique • Do not overextend the child’s or infant’s neck – May damage the neck or close the airway 42
43.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Checking for Air Exchange • Check to see if the infant or child is breathing: – Place an ear close to the person’s nose or mouth – Look for rise and fall of the chest – Feel for air against the cheek 43
44.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Breathing • Child: – If a good seal can be formed around the mouth, air may be provided with the same technique as with adults • Infant: – Form a seal by placing mouth over the infant’s mouth and nose 44
45.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Breathing (cont’d.) – Administer two slow breaths – The amount of air administered must be adjusted according to the size of the child – If unable to get air into the lungs, reposition – If still unable, assume an airway obstruction 45
46.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Checking the Pulse • Child: – Palpate the carotid artery • Infant: – Palpate the brachial artery • Inside the infant’s arm midway between the elbow and the shoulder • Place thumb on the outside of the person’s arm and index and middle finger over the brachial artery and press lightly 46
47.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Checking the Pulse (cont’d.) • If a pulse is present but breathing is absent: – Provide rescue breathing only: • Infant: one puff every three seconds • Child: one breath every four seconds • If no pulse, provide external compressions 47
48.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Dangers of CPR • Injuries may occur during CPR: – Incorrect hand position or excessive force can result in broken ribs – Placing the hands too low on the sternum can lacerate the liver 48
49.
©2013 Delmar, Cengage
Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. Summary • Thousands of Americans die from cardiac arrest each year • Auxiliaries can master the skills of CPR and make efforts to save lives in the dental setting as well as everyday life 49
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