Basic life support€¦ · Basic life support A collaborative project from 3M ESPE and Dr. med. Sönke Müller, Lead emergency doctor for the Rhine-Neckar region/Germany Guide for

Basic lifesupport

A collaborative project from 3M ESPE and Dr. med. Sönke Müller, Lead emergency doctor for the Rhine-Neckar region/Germany

Guide for the dental practiceEmergency management Part I

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Address:

Dr. med. Sönke Müller

Lead emergency doctor

Fischersberg 26

D-69245 Bammental

E-Mail: [email protected]

Internet: www.notfallseminare.de

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Foreword ................................................................................ 5Realistic emergency managementin the dental practice ............................................................. 6Chain of survival .................................................................. 10Emergency call ..................................................................... 12Checking for vital signs ....................................................... 14Vital signs ............................................................................... 14State of consciousness .......................................................... 16Breathing ................................................................................17Opening airway ...................................................................... 18Pulse ...................................................................................... 20Pupils ......................................................................................21Summary of the check for vital signs ..................................... 22Rescuing and positioning .................................................... 24Rautek grip ............................................................................ 24Recovery position ................................................................... 26Horizontal position / shock position ........................................ 28Raised upper body position .................................................... 29Overview of positions ............................................................. 30Opening airway .................................................................... 32Head-tilt, chin-lift-maneuver .................................................. 32Clearing the airway ................................................................ 33Rescue breathing ................................................................. 34Mouth-to-nose rescue breathing ............................................ 36Mouth-to-mouth rescue breathing ......................................... 38Respiratory resuscitation with equipment .............................. 40Life Key® (from Ambu) .............................................................41Soft cushion mask (e. g. Seal-Easy) ........................................ 42Resuscitation bag................................................................... 43Double-C grip ......................................................................... 46Oropharyngeal airway (Guedel pattern airway-OPA) ................47Oxygen therapy ...................................................................... 48Cardiopulmonary resuscitation (CPR) ................................ 50Chest compressions ............................................................... 50Basic life support ................................................................. 54Basic life support (BLS, adult) ................................................. 54Basic life support algorithm .................................................... 55Finding a lifeless person ......................................................... 56Bibliography ........................................................................... 58Notes ..................................................................................... 59

Cont

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Contents

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EmergencyEmergency

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Fore

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Emergencies will certainly never become routine in the dental practice. On the one hand, emergency situations are – thank-fully – far too rare and, on the other, the dentist usually does not have the opportunity of gathering experience and of training the relevant measures through regular practice.

What must the dentist be able to do as an emergency doctor?

From the forensic perspective, he should at least “master” the emergencies that may be directly caused by his dental-medical actions. Here one of the main legal consider-ations is allergic reaction to drugs administered during dental treatment, for example. Others sure to be included would be isolated cases of asthma or angina attack triggered by anxiety, stress and pain. It is generally expected from you, as a medic – at least in your practice, where you have under-taken a special duty of caring for your patients – that you have the basic knowledge and skills for carrying out immediate life-saving measures.

Acting in emergency situations is really not difficult. If in doubt, stick to basic, but also life-saving, things, free your-self and your emergency bag of unnecessary ballast and take the courage to do what is right:How and what – that is what this compendium is designed to teach you.

Foreword

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A dentist cannot and does not need to have the knowledge and skills of an emergency doctor. From experience, the knowledge of how to gain venous access is limited to “inserting a cannula” once or twice into a patient and healthy fellow student at university. The subject of intubation – at best attempted on a dummy in a crash course on emergency medicine – should also remain an alien concept for the dentist.

For those who really master these invasive measures – great, but dentists so versed in emergency medicine are just as rare as emergency doctors who can carry out professional dental treatment.

However, putting a patient into the recovery position, clearing the airway, recognising a foreign body as such in the airway and, in the extreme event, carrying out cardiopulmonary resuscitation, are things every dentist should master, and of course somewhat more professionally than the “man in the street”.

Whether the patient’s thoracic pain is angina or cardiac arrest or just an acute thoracic spine syndrome is something the dentist will be just as unable to diagnose as any other

Realistic emergency management in the dental practice

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doctor without access to diagnostic equipment. But the fact that he should position this patient with his upper body raised, that he can give oxygen and has to call for (emergen-cy) medical assistance should be obvious to every dentist. The knowledge can be learned by reading, but preferably also acquired and practiced in practically based emergency courses.

Which emergency situations are to be expected in the dental practice?

Statistically, 7 times in your professional career you will be faced with a patient who does not tolerate the local anaes-thetic in one form or another, 1.5 times a patient in your practice will have a grand mal epileptic fi t, one will suffer an angina attack. An anaphylactic shock – the most severe scenario among allergic reactions, e. g. to local anaesthetic – will only have to be experienced by every sixteenth dentist in his practice, a severe asthma attack by only one in three dentists. Only every thirteenth of you will have to endure a resuscitation or acute myocardial infarct, whereas half of you will experience a case of hypoglycaemia.

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Complications induced by dental treatment:

• Orthostatic syndrome, triggered by anxiety, pain

• Hyperventilation tetany, triggered by anxiety, pain

• Allergic reaction to local anaesthetic or other substances

• Intoxication due to local anaesthetic or other substances

Complications induced by the patient’s preexisting diseases:

• Angina attack, heart attack given coronary disease

• Hypertonic crisis given hypertension

• Respiratory distress due to cardiovascular complications (e. g. acute pulmonary oedema given heart failure)

• Respiratory distress due to aspiration (choking), bronchospastic, asthma

• Hypoglycaemia with diabetes mellitus

• Allergic reaction through to anaphylactic shock

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The chain of survival refers to a series of actions that, when put into motion, reduce the mortality associated with cardiac arrest. Like any chain, the chain of survival is only as strong as its weakest link. The four interdependent links in the chain of survival are early access, early CPR, early defibrillation and early advanced care.

Early accessSomeone must witness the cardiac arrest and activate the emergency medical service (EMS) system with an immediate call to 1-1-2 (or your local emergency number).

Early cardiopulmonary resuscitation (CPR)In order to be most effective, bystander CPR should be provided immediately after collapse of the patient. Properly performed CPR can keep the heart in ventricular fi brillation for 10–12 minutes longer.

Early defibrillationMost adults who can be saved from cardiac arrest are in ventricular fibrillation or pulseless ventricular tachycardia. Early defibrillation is the link in the chain most likely to improve survival. Public access defibrillation may be the key to improving survival rates in out-of-hospital cardiac arrest, but is of the greatest value when the other links in the chain do not fail.

Early advanced careEarly advanced cardiac life support by paramedics is another critical link in the chain of survival. In communities with survival rates > 20%, a minimum of two of the rescuers are trained to the advanced level. In some countries, EMS delivery may be performed by ambulancemen, nurses, or doctors.

Chain of survival

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Chai

n of

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earlyaccess

early CPR

earlydefibrilation

early ACLS

to get help

to buy time

to restart heart

to stabilize

early access

to buy time

to restartheart

to stabilize

to get help

early CPR

early defi brillation

early ACLS

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The most common European emergency number is 112. In all European Union countries it is also the emergency telephone number for both mobile and fixedline telephones. Most GSM mobile phones can dial 112 calls even when the phone keyboard is locked, the phone is without a SIM card, or instead of the PIN.

112 is used in Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Republic of Macedo-nia, Malta, Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland and the United Kingdom in addition to their other emergency numbers.

Emergency call

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Emer

genc

y ca

llCountryEmergency Med. Services

Police

Austria 144 and 112 133 and 112

Belarus 103 102

Belgium 112 112

Bulgaria 150 and 112 166 and 112

Croatia 94 and 112 92 and 112

Cyprus 112 112

Czech Republic 155 and 112 158 and 112

Denmark 112 112

Estonia 112 112

Finland 112 112

France 15 and 112 17 and 112

Germany 112 110

Great Britain 999 and 112 999 and 112

Greece 166 and 112 100 and 112

Hungary 104 and 112 107 and 112

Iceland 112 112

Ireland 999 and 112 999 and 112

Italy 118 112 and 113

Latvia 03 and 112 02 and 112

Liechtenstein 144 and 112 117

Lithuania 03 and 112 02 and 112

Luxembourg 112 113 and 112

Macedonia 194 and 112 192 and 112

Malta 112 112

Moldava 903 902

Netherlands 112 112

Norway 113 112

Poland 999 and 112 997 and 112

Portugal 112 112

Romania 112 112

Russia 03 02

Serbia/Montenegro 94 and 112 92 and 112

Slovakia 155 and 112 158 and 112

Slovenia 112 113

Spain 61 and 112 091 and 112

Sweden 112 112

Switzerland 144 and 112 117 and 112

Turkey 112 155

Ukraine 03 and 103 02 and 102

• Consciousness (C)

• Breathing (B)

• Pulse (P)

• Pupils (P)

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Bewusstsein Atmung Puls

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Pupillen, Atemwege freimachen, stabile Seitenlage

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Checking for vital signsVital signs:

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This check allows a very quick and relatively safe assess-ment of whether a patient only has a slight impairment of their general condition, whether a serious threat exists or even an acute danger to life.

The vital signs can be checked without equipment anywhere from anyone and help the fi rst aid provider to keep calm themselves and to follow a plan of action.

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State of consciousness

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Check Result Conclusion Action

Reaction: Protective refl exes, defensive move-ments, wakable, answers

Not unconscious Poss. shock position, try to fi nd out what is wrong with him

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Shake his shoul-ders, ask loudly “Are you alright?”

No reaction: not responsive, unconscious, no protective refl exes

Unconscious-ness

Immediately check breathingSeite 10


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Chec

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Listen to breath sounds, feel expired air, look or feel for chest movements

No visible and palpable respiratory movements, no audible breath sounds

Respiratory arrest

Immediately clear the airway

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Visible and palpable respiratory movements, breath sounds

No respiratory arrest

Recovery position

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Breathing

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Tilt head, lift chin maneuver

Result Conclusion Action



Recovery position

Tilt head, lift chin maneuver


No breathing Airway blocked? Clear the airway

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Atemwege blockiert

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Atemspende ein / aus

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Kopf überstrecken, Atemwege freimachen

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Opening airway

• Tilt head, lift chin maneuver

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Chec

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Clearing the airway




Recovery position

Clearing the airway


No breathing Respiratory arrest

Feel pulse

Chest compressions

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• Clearing the airway

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Herzdruckmassage und Mund-zu-Mund – jeweils separat und kombiniert

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Pulse

How? Result Conclusion Action

Feel pulse on wrist or neck

No pulse palpable on either side

Cardiac arrest • Cardiopulmo-nary resuscitation

Pulse reliably palpable

No cardiac arrest

• Check breathing again

• Clear airway again

• Rescue breathing

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Chec

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Pupils

How? Result Conclusion Action

Pull the eyelids up, shine light into the eyes, if possible

Dilated pupils, no contraction when exposed to light

Cardiac arrest • Cardiopulmo-nary resuscitation

Pupils contract equally

Cardiac arrest unlikely

• Check breathing again

• Clear airway again

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Summary of the check for vital signs

Check How? Result Conclusion Action

Consciousness Shake his shoulders, ask loudly “Are you alright?”

Not responsive, motionless

Unconsciousness• Check breathing

Recovery position,

check for continous breathing

Breathing Listen to breath sounds, feel expired air, see or feel for chest movements

No visible and palpable respiratory move-ments, no audible breath sounds

Respiratory arrest• Immediately check

pulse, only with certain signs of pulse

• Not possible to check the pulse or no signs of circulation

Rescue breathing: Mouth-to-nose or mouth-to-mouth

Pulse Feel pulse on wrist or neck


Cardiac arrest • Cardiopulmonary resuscitation

Pupils Pull the eyelids up, shine light into the eyes, if possible

Dilated pupils, no con-traction when exposed to light


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Chec

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Check How? Result Conclusion Action

Consciousness Shake his shoulders, ask loudly “Are you alright?”

Not responsive, motionless

Unconsciousness• Check breathing

Recovery position,

check for continous breathing

Breathing Listen to breath sounds, feel expired air, see or feel for chest movements

No visible and palpable respiratory move-ments, no audible breath sounds

Respiratory arrest• Immediately check

pulse, only with certain signs of pulse

• Not possible to check the pulse or no signs of circulation

Rescue breathing: Mouth-to-nose or mouth-to-mouth

Pulse Feel pulse on wrist or neck



Pupils Pull the eyelids up, shine light into the eyes, if possible

Dilated pupils, no con-traction when exposed to light


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It is generally not possible to adequately carry out measures to safeguard the vital functions or resuscitate while the acutely ill person is in a sitting position, e. g. on the dentist’s chair. Therefore put always the person on his back on a firm surface.

Method:Try to get behind the victim’s back. Pull the victim outwards with a forceful movement of the hips. Grasp the victim from the back with both arms passing under his armpits. Bend one of the victim’s arms at a right angle at the elbow, then grip his lower arm with both hands from above and press the arm against his body at the upper abdomen.

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Rautek-Griff (A, B)

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Rautek-Griff (A, B)

Rescuing and positioningRautek grip

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Resc

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Pull the victim on your own thigh. This distributes the weight fa-vourably and you can then pull the victim from the chair back-wards.

You can also use the Rautek rescue grip to pick the victim up from the ground and e. g. remove him from a danger zone: Approach the head end of the victim, place both hands fl at beneath the back of his head. Now carefully lift the upper body from the back and bend him forwards. Support the victim’s body with your own knee from behind. Then you can apply the Rautek grip and pull the victim away backwards.

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Rautek-Griff (C, D)

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Rautek-Griff (C, D)

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Every unconscious person with suffi cient spontaneous breathing must be placed in the recovery position. This position is intended to avoid aspiration by preventing the casualty’s tongue from block-ing the airway and by promoting drainage of fl uids, such as blood or romit from the mouth.

Recovery position

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Method:Kneel beside the unconscious person. Place the unconscious person’s arm nearest you at right angles to casualty’s body with palm facing upwards.

Bring casualty’s far arm across his chest and hold back of casualty’s hand against opposite cheek.

Grab and bend the person’s far knee.Gently roll the person toward you by pulling the far knee over and to the ground.

Tilt back the head slightly so that the airway is open.

Check for breathing.

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Horizontal position

If there is a respiratory or cardiac arrest, the casualty must be posi-tioned on his back on a fi rm sur-face, most simply on the fl oor. Only in this position you can per-form further measures, such as chest compression and rescue breathing, to the best effect. Choose a place where you have suffi cient space around the casualty for your supporting measures.

Shock positionThe shock position should be adopted in the case of injuries or disorders which lead to major blood loss or reduce blood fl ow (e. g. with vasovagal syndrome or with anaphylaxis). The improvement of circulation especially to the brain and the heart by the additional blood from the legs can delay, reduce or eliminate the effects of shock as unconsciousness.

Horizontal position / shock positionSeite 24

Flachlage, Schocklage

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Resc

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Method:Either move the upper body of the casualty to a low position, e. g. by lowering the dentist’s chair into the shock position, or lay the victim on the fl oor and raise his legs.If the casualty is unconscious, the recovery position obviously takes priority over the shock position!

Raised upper body positionA conscious patient with breath-ing diffi culties with heart disease or injuries to the upper body or head should be positioned with the upper body raised.

Method:Raise the upper body of the casualty by 15– 45° or depending on their preference.

Raised upper body positionSeite 25

auf Zahnarztstuhl, Oberkörper-Hochlage

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Overview of positions

Consciousness Breathing Circulation Type of positioning Action

Present Present, but respiratory distress

Present Raised upper body position

Oxygen administration Monitoring

Present Present Present, but shock symptoms

Shock position

Disturbed Present Present Recovery position

Disturbed Disturbed Present Horizontal position Clear the airway: choking?• back blows• Heimlich maneuver

Disturbed Present Disturbed Horizontal position, poss. shock position

Check for continious normal breathing, if it stops.• Cardiopulmonary

resuscitation

Disturbed Disturbed Disturbed Horizontal position • Cardiopulmonary resuscitation

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Resc

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Consciousness Breathing Circulation Type of positioning Action

Present Present, but respiratory distress

Present Raised upper body position

Oxygen administration Monitoring

Present Present Present, but shock symptoms

Shock position

Disturbed Present Present Recovery position

Disturbed Disturbed Present Horizontal position Clear the airway: choking?• back blows• Heimlich maneuver

Disturbed Present Disturbed Horizontal position, poss. shock position

Check for continious normal breathing, if it stops.• Cardiopulmonary

resuscitation

Disturbed Disturbed Disturbed Horizontal position • Cardiopulmonary resuscitation

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If a casualty looses conscious-ness, the tongue may fall back into the throat and block the pas-sage of air from the mouth into the lungs. Ensuring the airway is open, is vital to the casualty’s survival.Tilting the head and lifting the chin may reestablish normal breathing in such cases.

Method:Pur the victim into the horizontal position.

Kneel on the side of casualty’s head.

Place one hand on the casualty’s forehead and the other under the chin.

Gently tilt back the head and lift the chin. Check for normal breathing again.

Opening airwayTilt head, lift chin

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Kopf überstrecken, Atemtätigkeit wiederherstellen

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Open

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The mouth and throat of every unconscious person and especially every patient with irregular breathing must be inspected to exclude blockage due to any foreign bodies (vomit, saliva, blood, loose dental prosthetics etc.).

Method:Pull the lower jaw forward by holding the angles of the lower jaw with your fi ngers and the lower jaw on both sides and then by applying pressure, push the mouth forward and open at the same time (Esmarch grip). Press the casualty’s cheek with one thumb between the rows of teeth to keep the mouth open. It is best to turn the patient’s head to the side.

Clear the mouth and throat either by suction or manually by clearing or wiping out. If there is still disor-dered breathing or respiratory ar-rest after tilting the head and clearing the airway, the circulation must be checked immediately and CPR started if necessary.

Clearing the airway

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Freimachen der Atemwege

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The aim of every form of rescue breathing is optimal oxygenisation of the casualty. The rescuer must, of course, also act according to the circumstances, i.e. the breathing frequency and tidal volume, above all, must be matched to the age group of the patient. If it is not possible to restore adequate breathing through simple measures, such as tilting the head and clearing the airway, resuscitation should be indicated without delay.

Age group Respiratory frequency (min) Breath volume (ml)

Newborn 40 – 50 20 – 35

Infant 30 – 40 40 – 100

Small child 20 – 30 150 – 200

School child 16 – 20 300 – 400

Adolescent 14 – 16 300 – 500

Adult 10 – 14 500 – 1000

Rescue breathing

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The breath volume should be about 500– 600 ml (6 – 7 ml/kg) for mouth-to-nose / mouth-to-mouth rescue breathing and 400 – 600 ml for mask bag resuscitation. Higher volumes or an excessive breathing frequency not only cause signifi cantly more pronounced bloating of the stomach, but even reduce the venous return to the heart due to increasing the intrathoracic pressure: the survival rate declines as a result.

Rescue breathing is possible with or without equipment.• Without equipment:

- mouth-to-mouth- mouth-to-nose

• With equipment:- mouth-to-equipment (protective mask)- breathing bag to mask

The simplest form of respiratory resuscitation which can be carried out without any equipment in every situation is mouth-to-nose resuscitation.

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Mouth-to-nose rescue breathing is the method of choice, as it is safer and more effective to perform than mouth-to-mouth resuscitation.

Method:Put the unconscious patient into the horizontal position.

Kneel to the side of the head, open the mouth and look to see whether foreign bodies are in the mouth or pharynx. If so, remove them.

Tilt the head. Keep the mouth of the unconscious person closed by pushing with your hand on the region between the upper lip and tip of the chin.

Mouth-to-nose rescue breathing

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Breath in normally and place your opened mouth over the nostrils of the unconscious person such that your lips seal tightly around the nose. Blow your expired air quickly in approx. 1 second into the patient’s nose.Draw breath on the side, at the same time observing whether the thorax excursions are visible and whether expired air escapes from the patient’s nose.Repeat rescue breathing a sec-ond time and either continue chest compressions or – if the pulse is clearly present – go on with rescue breathing with a respiratory frequency of approx. 10 – 14 times a minute.

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Atemwege blockiert

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Mund-zu-Nase, Mund-zu-Mund

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Atemwege blockiert

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Especially if mouth-to-nose rescue breathing is impossible, e. g. due to blockage or injury to the nose, mouth-to-mouth rescue breathing is applied.

Method:Put the unconscious patient on to his back on a fi rm fl at surface.

Kneel next to the person close to his head and open the mouth. Look and remove any obvious obstructions.

Tilt the head back. Open the patient’s mouth.

Mouth-to-mouth rescue breathing

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The thumb and forefi nger of the hand, placed on the patient’s forehead, hold the nostrils from above and close them with gentle pressure.

Take a normal breath and place your mouth over the patient’s mouth. Blow your exhaled air into the person’s mouth for one second.

Draw breath on the side, at the same time watching whether the person’s chest rises and whether air escapes. Repeat rescue breat-hing for a second time and either start chest compressions or – if the pulse is clearly present – go on with rescue breathing with a respiratory frequency of approx. 10 – 14 times a minute.

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Atemwege blockiert

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Respiratory resuscitation with equipment

Wherever possible, respiratory resuscitation should be carried out using equipment. This saves the helper over-coming the aversion that may exist or fear of infections.The simplest, cheapest equipment available include the Life Key® and the soft cushion masks; the breathing bag with breathing mask is not quite so cheap and not quite so simple to use.

Advantages of respiratory resuscitation with equipment:• No direct helper-patient contact required – better infection

control• Not an invasive measure• Enrichment of the breathing air with oxygen may

be possible

Disadvantages of respiratory resuscitation with equipment:• Diffi culty of ventilation, especially with the breathing bag is

underestimated; there is the risk of incorrect resuscitation (e. g. bloating of the stomach).

Therefore, familiarise yourself suffi ciently with the correct use of your equipment!

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The Life Key – semi-transparent face should packed in soft woven case, carried on a key chain and therefore generally available and deployable every where – is relatively easy to handle. In an emergency, the mask is removed from the case, unfolded, placed over the patient’s face and fi xed behind his ears. You can then use standard mouth-to-mouth or mouth-to-nose resuscitation via the one way valve without modifi cation.

Life Key® (from Ambu)

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Life Key

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Life Key

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Life Key

Mouth-to-nose

Mouth-to-mouth

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The advantage of the soft cush-ion mask is that it fi ts for small children over 18 months through for adolescents and adults ir-respective of their size. It is also easy to use with bearded or den-tureless patients or those with facial trauma. The mask can be used with the valve for direct mouth-to-mask resuscitation or without the valve for bag-to-mask resuscitation.

To use in the one helper method, the helper kneels beside the casualty, in the two-helper method preferably behind the casualty. Tilt the head and lift the chin. At the same time, the mask opening is placed over the casualty’s nose. Now the mask is gently pressed on the face and air insuffl ated through the valve attachment. Any air escaping from the side can be eliminated by gently correcting the pressure on the soft cushion mask.

Soft cushion mask (e. g. Seal-Easy)

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Weichkissenmaske

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Weichkissenmaske

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Resuscitation bag

Although the use of resuscita-tion bags is a standard for resuscitation in the dental practice, the diffi culty and risk of incorrect usage should not be underestimated.

The advantages of avoiding direct contact with the patient and the possibility of enriching the breathing air with additional oxygen are countered by defective material (e. g. porous resuscitation masks) and the dentist’s lack of prac-tice and lack of experience. Especially the insuffi cient “seal” of the mask, the inadequate reclining of the head and the associated “bloating of the stomach” can make the use of the breathing bag diffi cult.

Resuscitation with the breathing bag must be a “matter for the boss”. The responsibility must not be passed to a less experienced employee (e. g. assistant).

MaterialVarious breathing bags and breathing masks can be used depending on the age and size of the patient.

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Mask sizes• Size 5 for adults• Size 3 for children / adolescents• Size 1 for infants

Generally, a standard adult bag combined with e. g. two common mask sizes (size 5 for adults, size 3 for children/adolescents) should be suffi cient.

Different types of resuscitation bags

Adult bagOver 30 kg

Child bag7 – 30 kg

Baby bag Under 7 kg

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Method:Place the mask with your left hand over the mouth and nose and fi x it using the C-grip: Thumbs and forefi ngers form a C over the casualty’s face, the other fi ngers tilt the head and left the chin. The correct use of the C-grip ensures an adequate seal given the correct choice of mask. Now compress the breathing bag with the right hand. The rising and falling of the thorax indicates effective breathing.

During resuscitation, generally make sure that the air is not expelled too strongly, as otherwise there are pressure peaks in the upper airway that can cause the oesophagus to open and the stomach to be bloated.

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Beatmungsbeutel / C-Griff

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The most common problem with mask resuscitation is the leakage between the mask and patient, whereby the attempt is often made to counter this with too fast and forceful air insuf-fl ation, which often causes the opposite, i.e. bloating of the stomach and even worse quality of breathing. In this case you should fi x the mask on from behind or from the side using a double C-grip to completely seal the mask with compression of the breathing bag taken over by the second helper. Then it should be possible in most of the cases to achieve a good seal and effi cient resuscitation.

Double C-grip

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Oropharyngeal airway (Guedel pattern airway-OPA)

Oropharyngeal airways can keep the airway open by pre-venting the tongue from covering the epiglottis. They are mainly used for facilitating the insuffl ations with any kinds of resucitation masks.

The precondition for precise posi-tioning of the airway is the selec-tion of the correct size; here the distance from the earlobe to the corner of the oral opening should be taken as a guide. The airway is inserted into the mouth upside down. Once contact is made with the back of the throat, the airway in rotated 180°.The OPA does not prevent suffocation by liquid or the closing of the glottis, but it facilitates the insuffl ations.

Age group Oropharyngeal airway size

Adult (man) 4

Adult (large) 5

Rule of thumb for oropharyngeal airway:Length = approx. distance corner of the mouth – earlobe Seite 43

Guedeltubus

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Oxygen therapy

Every patient with respiratory distress, heart complaints and of course every resuscitated patient should always be given additional oxygen as a simple, effective and low risk medica-tion. Depending on the type of oxygen s upply, up to 100 % oxygen concentration can be achieved for the air breathed by the patient!

Resuscitation technique Inspiratory O2 concentration

Mouth-to-nose ventilation (expired air)

17 %

Spontaneous and bag mask ventilation (room air)

21 %

Bag-mask ventilation with 10 l/min oxygen supply

up to 40 %

Bag-mask ventilation using a reservoir bag, 10 – 15 l/min O2

up to 95 %

49

Resc

ue b

reat

hing

For example, a 1 l oxygen cylinder (200 bar) would be useful for the dental practice either with a set pressure regulator (e. g. 4 l/min) or better still, a fl exible pressure regulator (e. g. 1 – 15 l/min). It is best to connect a breathing mask ready at hand.

50

The updated guidelines of the European Resuscitation Council (ERC) of 2005 call for 30 chest compressions, delivered hard and fast. Especially in the early phase of resuscitation and before any ventilation breaths the oxygen supply to the brain can be re-established very effectively through distribution of the residual oxygen from blood that is still well oxygenated. The death of brain cells due to lack of oxygen can be delayed by several minutes as a result and, if effective resuscitation is also performed, for a very much longer period.

Evidence did show, that multiple interruptions to chest com-pressions reduces the chances of survival, pausing compres-sions means blood fl ow stops within a couple of seconds.

Chest compressions is therefore the fi rst and most important part of CPR and should be applied without any delay to an unconscious and non-breathing patient.

Chest compressions is a skill, which must be practiced and mastered by every employee in the practice.

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Cardiopulmonary resuscitation (CPR)Chest compressions

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Card

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resu

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Principle:Two mechanisms are viewed as signifi cant in the blood fl ow generated by chest compression:• The compression of the heart

between the sternum and the spine

• Generation of thoracic pressure fl uctuations

Even with the best possible chest compression technique, the generated stroke volume is still only approx. 20 – 40 % of the normal resting value!

Method:Immediately put the patient onto a firm surface in the horizontal position. Undo the clothing over the rib cage and kneel by the side of the patient. Feel the patient’s rib cage and search for the pressure point in the centre of the victim’s chest.

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Place the heel of one hand in the centre of the chest.Place the heel of your other hand on top of the fi rst hand interlock fi ngers.

Position yourself vertically above the victim’s chest and, with your arms straight, press down on the sternum 4 – 5 cm.

After each compression, release all the pressure on the chest without losing contact between your hands and the sternum.Repeat at a rate of about 100/min. (a little less than 2 compres-sions/sec.).

If possible change CPR-operator every 2 min.!

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Card

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resu

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54

Check Response• Shake gently• Shout loudly

Shout for help

If not responsiveOpen airwayCheck breathing• Tilt head back and lift chin• Look• Listen• Feel• Take no more than 10s

If not breathing normallyCall 112Hands in the centre of the chest

Deliver 30 chest compressions

Frequency of chest compres-sions: 100/min.

Deliver 2 rescue breaths:• Seal your lips around the

mouth• Blow steadily until chest rises• Give next breath when the

chest falls

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Basic Life Support

55

Basi

c lif

e su

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Basic life support algorithm

Continue CPR 30 : 2 until qualifi ed help arrives

The algorithm applies the same for the one helper as well as the two-helper method!

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Unresponsive?

Shout for help

Open airway

Breathing normally?

Always make emergency call

30 chest compressions

2 rescue breaths 30 chest compressions

56

Finding a lifeless person

Consciousness?Talk loudly Shake gently on the shoulder

Look out for visible injuries when touching/shaking!

If responsive: help as required

If unconscious: immediate emergency call

Emergency numbers see page 13.

In most European countries 112

Breathing?See: chest movementsHear: breat soundsFeel: fl ow of air on the helper’s cheek

Clear airwayRemove any visible foreign bodies from the oropharynx

If breathing is normal:Recovery posi-tion, monitor breathing

If no breathing:if possible check circulation, otherwise immediately

Circulation? Look for signs of circulation

Signs of circulation are:normal breathing, coughing or movements

If there are certain signs of circulation:check breathing, signs of circulation every 60 sec.

If there are no signs of circulation: start cardiopulmonary resuscitation

Lay victim on a fi rm surface, ex-pose rib cage, perform 30 chest compressions alternated with 2 rescue breaths

30 : 2

57

Basi

c lif

e su

ppor

t

Finding a lifeless person

Consciousness?Talk loudly Shake gently on the shoulder

Look out for visible injuries when touching/shaking!

If responsive: help as required

If unconscious: immediate emergency call

Emergency numbers see page 13.

In most European countries 112

Breathing?See: chest movementsHear: breat soundsFeel: fl ow of air on the helper’s cheek

Clear airwayRemove any visible foreign bodies from the oropharynx

If breathing is normal:Recovery posi-tion, monitor breathing

If no breathing:if possible check circulation, otherwise immediately

Circulation? Look for signs of circulation

Signs of circulation are:normal breathing, coughing or movements

If there are certain signs of circulation:check breathing, signs of circulation every 60 sec.

If there are no signs of circulation: start cardiopulmonary resuscitation

Lay victim on a fi rm surface, ex-pose rib cage, perform 30 chest compressions alternated with 2 rescue breaths

30 : 2

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58

Anthony J. Handley, Rudolph Koster, Koen Monsieurs,Gavin D. Perkins, Sian Davies, Leo BossaertEuropean Resuscitation Council Guidelinesfor Resuscitation 2005Section 2. Adult basic life support and useof automated external defi brillatorsResuscitation (2005), 67 p.1, p. 7 – p. 23

Jerry P. NolanEuropean Resuscitation Council Guidelinesfor Resuscitation 2005Section 1. IntroductionResuscitation (2005), 67 p.1, p. 7 – p. 23

Jerry P. Nolan, Charles D. Deakin, Jasmeet Soar,Bernd W. Böttiger, Gary SmithEuropean Resuscitation Council Guidelinesfor Resuscitation 2005Section 4. Adult advanced life supportResuscitation (2005), 67 p.1, p. 7 – p. 23

BÄKReanimation: Nationaler KonsensDeutsches Ärzteblatt 103, Issue 34 – 35 of 28.8.2006,Page A-22 08

ERC-Leitlinien für die Wiederbelebung 2005,Stand: 24.03.2006Deutsches Ärzteblatt 103, Issue 14 of 7.4.2006,Page A-960 / B-813 / C-785

Bibliography

59

Notes

3M ESPE AGESPE PlatzD-82229 Seefeld Freecall: 0800 - 2 75 37 73Freefax: 0800 - 3 29 37 73e-Mail: [email protected]: www.3mespe.de 70

2009

5589

9/01

(7.2

008)

Basic life support€¦ · Basic life support A collaborative project from 3M ESPE and Dr. med. Sönke Müller, Lead emergency doctor for the Rhine-Neckar region/Germany Guide for

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