©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

©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 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. 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 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. Cardiac Arrest 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 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. Cardiac Arrest Automated external defibrillator (AED): –Portable, computerized device that automatically diagnoses a potentially life threatening cardiac arrhythmia –Computerized program determines whether shock is necessary 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. Cardiac Arrest (cont’d.) 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 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 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. CPR Technique Order of the steps to perform CPR: –C: Circulation restored –A: Airway opened –B: Breathing 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. 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 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. 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 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. Checking the Pulse 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 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. 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 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 and AED

©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. New CPR Sequence

©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. Compressions A compression is the act of pushing on the chest People often don’t push hard enough because they’re afraid of hurting the victim An injury is unlikely, but it is better than death It is better to push too hard than not hard enough

©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. Compressions

©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. Give Breaths Compressions are the most important part of CPR If you are also able to give breaths, you will help even more Your breaths need to make the chest rise When the chest rises, you know the person has taken in enough air

©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. Open the Airway

©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. Give Breaths

©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. Use an AED If you start CPR and then use an AED within a few minutes, you will have the best chance of saving a life AEDs are safe, accurate, and easy to use

©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. AED Programs – Why? 294,000 cases of EMS-treated out-of-hospital sudden cardiac arrest (SCA) each year in the U.S. Less than one-third receive bystander CPR; even fewer receive bystander defibrillation Bystander CPR and time to defibrillation are key

©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 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 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. 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 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. 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 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. 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 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. 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 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. 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 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. 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 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. 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 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. 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 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. 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 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. 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 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. External Compressions (cont’d.) –Ratio of breaths/compressions: Single rescuer: 30:2 Two rescuers: 15:2 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. Automated External Defibrillator Must use an AED that is calibrated for use with infants and children 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. 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 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. 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 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. 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 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. Breathing –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 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. 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 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. 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 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. 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 41