Chapter 12- CPR

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Chapter 12
CPR

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

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

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

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

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

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

• Automated external defibrillator (AED):
– Portable, computerized device that
automatically diagnoses a potentially life
threatening cardiac arrhythmia
– Computerized program determines whether
shock is necessary
8

Figure12-1: Automated external defibrillator
9

• 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

• Many lives are saved each year due to the
number of people trained in CPR
11

CPR Technique
• Order of the steps to perform CPR:
– C: Circulation restored
– A: Airway opened
– B: Breathing
12

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

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

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

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

External Compression (cont’d.)
Figure12-3: Chest compressions
17

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

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

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

• 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

• 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

• AED should be used as soon as possible
• If no pulse, resume CPR
• If pulse/breathing present, monitor patient
23

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

Opening the Airway (cont’d.)
Figure 12-5: Head-tilt, chin-lift
25

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

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

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

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

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

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

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

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

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

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

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

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

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

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

External Compressions (cont’d.)
– Ratio of breaths/compressions:
• Single rescuer: 30:2
• Two rescuers: 15:2
40

Automated External Defibrillator
• Must use an AED that is calibrated for use
with infants and children
41

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

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

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

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

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

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

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

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

Chapter 12- CPR

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