Emergency in Dentistry:Part IEmergency in Dentistry:Part I
Basic life support (BLS) Basic life support (BLS)
- Sequence of BLS - Sequence of BLS
- Equipment - Equipment
- Techniques - Techniques
The Sequence of BLS:The Sequence of BLS:
AssessmentAssessment
EMS activationEMS activation
The ABCDs of CPRThe ABCDs of CPR
- Airway
- Breathing
- Cardiac
- Defibrillation
Step 1: Check for UnresponsivenessStep 1: Check for Unresponsiveness
Check for unresponsivenessCheck for unresponsiveness
---”Are you all right?”---”Are you all right?”
Call for helpCall for help
--- “6969”--- “6969”
--- “119”--- “119”
UnrespondUnrespond
Step 2: Open AirwayStep 2: Open Airway
Upper airway obstructionby the tongue & epiglottisUpper airway obstructionby the tongue & epiglottis
“Head tilt-“Head tilt-
chin life”chin life”
“Jaw thrust”“Jaw thrust”
If suspectedIf suspected
head traumahead trauma
Step 2: Breathing--- AssessmentStep 2: Breathing--- Assessment
Check for breathing:Check for breathing:
- look for chest movement
- listen for air escaping during exhalation
- feel for the flow of air
Recovery position:Recovery position:
- responsiveness (-)
- breathing (+)
- circulation (+)
Step 2: Breathing--- Positive pressure ventilationStep 2: Breathing--- Positive pressure ventilation
- Deliver positive pressure ventilation- Deliver positive pressure ventilation
- “Leak-proof” seal- “Leak-proof” seal
- “OK” signal- “OK” signal
- Squeeze Ambu bag slowly: >2sec- Squeeze Ambu bag slowly: >2sec
- Observe chest rise- Observe chest rise
- Deliver 2 initial breaths- Deliver 2 initial breaths
- Sellick maneuver (cricoid pressure)- Sellick maneuver (cricoid pressure)
- Preventing gastric inflation- Preventing gastric inflation
Step 3: Circulation--- Assessment (no more than 10sec)Step 3: Circulation--- Assessment (no more than 10sec)
- Locate the trachea- Locate the trachea
- Gently feel the carotid pulse- Gently feel the carotid pulse
Keep head tiltKeep head tilt
positionposition
Slide to the groove betweenSlide to the groove between
trachea & SCMtrachea & SCM
Step 3: Circulation--- Chest compressionStep 3: Circulation--- Chest compression
Locate the margin of theribLocate the margin of therib
- Follow the rib- Follow the rib
margin to xiphoid margin to xiphoid
process process
- Put hand above- Put hand above
fingers fingers
Put another handdirectly over thehandPut another handdirectly over thehand
Step 3: Circulation--- Chest compressionStep 3: Circulation--- Chest compression
- Lock the elbow in position, with the- Lock the elbow in position, with the
arms straightened arms straightened
- “Shoulder over hand” position- “Shoulder over hand” position
- Depress the sternum about 4~5cm- Depress the sternum about 4~5cm
- Complete release the pressure but- Complete release the pressure but
keep in contact with the victim’sternum keep in contact with the victim’sternum
- Rate: 100/min- Rate: 100/min
- Compression : Ventilation = 15 : 2- Compression : Ventilation = 15 : 2
Foreign body aspirationForeign body aspiration
Heimlich maneuver:Heimlich maneuver:
- for responsive victim, standing or sitting- for responsive victim, standing or sitting
- give subdiaphragmatic abdominal thrust- give subdiaphragmatic abdominal thrust
- direction: inward & upward- direction: inward & upward
Chest thrust:Chest thrust:
- for responsive pregnant or obese victim- for responsive pregnant or obese victim
- hand position and technique: same as- hand position and technique: same as
chest compression chest compression
Foreign body aspirationForeign body aspiration
Finger sweep & tongue-jaw lift:Finger sweep & tongue-jaw lift:
- for unresponsive/unconscious victim- for unresponsive/unconscious victim
- not indicated for responsive or seizure- not indicated for responsive or seizure
patient patient
-“tongue-jaw lift” maneuver-“tongue-jaw lift” maneuver
Check for unresponsivenessCheck for unresponsiveness
Access airwayAccess airway
Signs of airway obstruction?Signs of airway obstruction?
Access breathingAccess breathing
Signs of inadequate breathing?Signs of inadequate breathing?
Access pulseAccess pulse
Pulse absent?Pulse absent?
Open airwayOpen airway
Positive ventilationPositive ventilation
Administration oxygenAdministration oxygen
Chest compressionChest compression
Ready for defibrillationReady for defibrillation
Follow ACLS protocolFollow ACLS protocol
YesYes
YesYes
YesYes
NoNo
NoNo
Check BPCheck BP
Recovery positionRecovery position
NoNo
Initial assessmentInitial assessment
Emergency cart:Emergency cart:
EKG monitor and defibrillatorEKG monitor and defibrillator
Drugs, laryngoscope, light, oral orDrugs, laryngoscope, light, oral or
nasal airwaysnasal airways
Airways:Airways:
OropharyngealOropharyngeal
airwayairway
NasopharyngealNasopharyngeal
airwayairway
Ambu bag:Ambu bag:
“E-C” technique“E-C” technique
Oxygen therapy:Oxygen therapy:
Nasal cannulaNasal cannula
SimplemaskSimplemask
VentrimaskVentrimask
Non-rebreathingmaskNon-rebreathingmask
FiO2FiO2
24%24%
100%100%
Endotracheal tube intubation:Endotracheal tube intubation:
Layngoscope:Layngoscope:
Check lightCheck light
Endotracheal tube:Endotracheal tube:
Male: 7.0, 7.5, 8.0Male: 7.0, 7.5, 8.0
Female: 6.5, 7.0, 7.5Female: 6.5, 7.0, 7.5
Test cuffTest cuff
“sniffing” position“sniffing” position
Oral-pharyngeal-tracheal axisOral-pharyngeal-tracheal axis
Endotracheal tube intubation:Endotracheal tube intubation:
Vocal cordVocal cord
Lift forward & upwardLift forward & upward
Sellick maneuverSellick maneuver
Length: 19~23cmLength: 19~23cm
CuffCuff
Check position: stethoscope, CXRCheck position: stethoscope, CXR
Thanks for YourThanks for Your
Attention !!!Attention !!!