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Emergency in Dentistry: Part I

Emergency in Dentistry: Part I. B asic life support (BLS) - Sequence of BLS - Equipment - Techniques. The Sequence of BLS:. Assessment EMS activation The ABCDs of CPR - A irway - B reathing - C ardiac - D efibrillation.

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Emergency in Dentistry: Part I

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  1. Emergency in Dentistry: Part I Basic life support (BLS) - Sequence of BLS - Equipment - Techniques

  2. The Sequence of BLS: • Assessment • EMS activation • The ABCDs of CPR - Airway - Breathing - Cardiac - Defibrillation

  3. Step 1: Check for Unresponsiveness Unrespond Call for help --- “6969” --- “119” Check for unresponsiveness ---”Are you all right?”

  4. Step 2: Open Airway “Head tilt- chin life” If suspected head trauma Upper airway obstruction by the tongue & epiglottis “Jaw thrust”

  5. 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 (+)

  6. 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

  7. Step 3: Circulation--- Assessment (no more than 10sec) Slide to the groove between trachea & SCM Keep head tilt position • Locate the trachea • Gently feel the carotid pulse

  8. Step 3: Circulation--- Chest compression • Follow the rib • margin to xiphoid • process • Put hand above • fingers Locate the margin of the rib Put another hand directly over the hand

  9. Step 3: Circulation--- Chest compression • Lock the elbow in position, with the • arms straightened • “Shoulder over hand” position • Depress the sternum about 4~5cm • Complete release the pressure but • keep in contact with the victim’sternum • Rate: 100/min • Compression : Ventilation = 15 : 2

  10. Foreign body aspiration • Chest thrust: • for responsive pregnant or obese victim • hand position and technique: same as • chest compression • Heimlich maneuver: • for responsive victim, standing or sitting • give subdiaphragmatic abdominal thrust • - direction: inward & upward

  11. Foreign body aspiration • Finger sweep & tongue-jaw lift: • for unresponsive/unconscious victim • not indicated for responsive or seizure • patient • “tongue-jaw lift” maneuver

  12. Initial assessment Check for unresponsiveness Access airway Yes Open airway Signs of airway obstruction? No Access breathing Yes Positive ventilation Administration oxygen Signs of inadequate breathing? No Access pulse Chest compression Ready for defibrillation Follow ACLS protocol Check BP Recovery position No Yes Pulse absent?

  13. Emergency cart: EKG monitor and defibrillator Drugs, laryngoscope, light, oral or nasal airways

  14. Airways: Oropharyngeal airway Nasopharyngeal airway

  15. Ambu bag: “E-C” technique

  16. Oxygen therapy: Simple mask Nasal cannula Ventri mask Non-rebreathing mask FiO2 24% 100%

  17. Endotracheal tube intubation: Layngoscope: Check light “sniffing” position Oral-pharyngeal-tracheal axis Endotracheal tube: Male: 7.0, 7.5, 8.0 Female: 6.5, 7.0, 7.5 Test cuff

  18. Endotracheal tube intubation: Vocal cord Lift forward & upward Sellick maneuver Length: 19~23cm Cuff Check position: stethoscope, CXR

  19. Thanks for Your Attention !!!

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