Emergency in Dentistry: Part I B asic life support (BLS) - Sequence of BLS - Sequence of BLS - Equipment - Equipment - Techniques - 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 Airway Upper airway obstruction by the tongue & epiglottis “Head tilt- chin life” “Jaw thrust” If suspected head trauma

Step 2: Breathing --- 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: Breathing --- 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: Circulation --- 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: Circulation --- Chest compression Locate the margin of the rib - Follow the rib margin to xiphoid margin to xiphoid process process - Put hand above fingers fingers Put another hand directly over the hand

Step 3: Circulation --- Chest compression - Lock the elbow in position, with the arms straightened arms straightened - “Shoulder over hand” position - Depress the sternum about 4~5cm - Complete release the pressure but keep in contact with the victim’sternum 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 chest compression

Foreign body aspiration Finger sweep & tongue-jaw lift: - for unresponsive/unconscious victim - not indicated for responsive or seizure patient 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: Oropharyngealairway Nasopharyngealairway

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 !!!