This article is related to the presentation that I have given in my university. Here, I will be describing in detail the latest 2015 AHA (American Heart Association) guidelines along with comparisons from the previous 2010 AHA guidelines.
First let me start briefly explaining CPR.
Cardiopulmonary resuscitation, commonly known as CPR, is an emergency procedure that combines chest compression often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest. It is indicated in those who are unresponsive with no breathing or abnormal breathing.¹
CPR is given to victims who became suddenly unresponsive, unable to breath and has no pulse in the dental office. When this occurs, the HCP (Health Care Personnel) should immediately follow the chain of survival provided by the AHA. If the patient is wearing a bracelet or any sort of medical tag, make sure to look for it as it might contain important information about the nature of the patient’s medical illness.
The steps above should be followed in order. Before giving CPR, make sure that the scene is safe for you and your victim. If not, try to bring the patient to a safe scene if possible. Your safety is your 1st priority. Do not approach the victim if the scene is dangerous; for example, presence of fire, toxic gases, a building about to collapse in any second, etc. Otherwise we will be losing 2 lives instead of one.
The first step is to activate the Emergency response system by calling 999 or 911 depending on your country’s emergency numbers. Have them stored on your phone and placed on the wall of your clinic near the landline. You will realize how useful and practical they are with time.
Next, is to provide immediate, effective, and high quality CPR which comprises of 30 chest compressions and 2 rescue breaths. Make sure to interlace your hands and give chest compressions in the middle of the patient’s chest. Minimizing interruptions during chest compressions is crucial for effective CPR. After 30 compressions, give 2 full breaths into the patient’s mouth. Make sure to seal your mouth over the victim’s mouth and the nostrils pinched to avoid escaping of air. Repeat this for 2 minutes which is around 5 cycles and then check for signs of life.
3rd, use a defibrillator or AED (Automated External Defibrillator) immediately when its available, if not, keep giving CPR. The AED will guide you of what to do next so listen and follow its instructions carefully.
The 4th and 5th steps are related to the hospital setting. There is no major role for you here other than to respond to calls from the emergency department when necessary.
Every dentist should take a CPR course provided that its approved by the AHA. Every HCP should keep his knowledge updated with the latest guidelines.
If you don’t know this but the sequence of A-B-C (Airway, Breathing, & Circulation) have been changed to C-A-B and they now stand for (Compressions, Airway, & Breathing) to minimize the delay given to the first compression.
The recommended chest compression rate has been changed to 100-120/min (updated from at least 100/min). The reason to this change is the result of 1 major study associating extremely rapid compression rates with inadequate compression depth. You should allow for the heart to recoil before giving the other compression. Giving it too fast or too slow is not recommended.
The chest compression depth has also been changed and its now should be at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm) in adults.
For patients with known or suspected opioid addiction and who has a definitive pulse but no normal breathing or only gasping, administering Naloxone IM (Intramuscularly) or IN (Intranasally) is recommended. Naloxone will reverse or blocks the effect of opioid medications and its used in emergency situations.
After 5 cycles of CPR, check for signs of life by the method, Look – Listen – And Feel.
- Look: for the chest to rise and fall
- Listen: for the escape of air during exhalation
- Feel: the flow of air on your cheek
Check for the pulse simultaneously and take no more than 10 seconds.
To achieve this, you will have to place your cheek above the victim’s mouth, and your fingers at the carotid pulse.
Stop giving CPR when you see these signs of life, otherwise continue giving until emergency arrives. It shall be noted that whenever the emergency personnel are onsite, the victim shall be handed over to them and you should stop giving CPR.
For children and infants, its the same procedure with some notable differences. Chest compressions depth in infants (younger than age of 1 year) should be 1.5 inches (4 cm) and 2 inches (5 cm) in children (older than age of 1 year). Of course, you should not use the same amount of force as with adults to reduce the possibility of damaging the victim’s internal organs.
The following algorithms should be useful in handling any situation. Keep them in a safe and accessible place and insure that you inform all your staff at the clinic about it. Having AED in your office is essential and will increase the chances of survival of the victim.
And for Pedo patients:
Now its your time to hear your stories. Have you ever had an emergency situation where a patient suddenly collapsed in your clinic? Be sure to take the patient’s consent before sharing it with us.
I read each and every comment.
Haider Maitham, DDS / Bondistry