#8 – Basic Life Support (CPR)

Everyone must be CPR certified.  We are a health facility.  You never know when an emergency could occur. You must be ready and trained to help.  Several conditions make it more likely that we will have an emergency:

  • More elderly and chronically ill people are requested dental care.
  • Recent medical advances keep very sick people alive longer and they are able to get our office.
  • People are on more drugs.

On a more personal note, when you are trained in CPR, you could also save the life of a family member or friend.  These are important skills!

The fire department is located: ___________________.  They will be here in about 5 minutes.  Our responsibility is to help maintain the distressed patient until the emergency squad arrives.  Also we can call the dentist who has extra emergency training.  With all this support, only 6% of people that have cardiac arrest survive when given CPR.  One of the problems has been how complicated the instructions were (1 or 2 rescuers, age of victim, etc.).  Today, the critical factor is the defibrillator.

Every other year, all of us will either certify or recertify.  Usually this occurs in October.  Keep your CPR card. We will all meet one evening in the office for our recertification.  There is no cost to you.  Expect the meeting to last at least 2 hours. Here are several situations and how to treat them:

Hyperventilation: Usually caused by anxiety in people under the age of 40.  Person will feel anxious, light headed and breathing will be rapid, deep, and labored.

Treatment –  Reduce anxiety,  Have person sit upright and  Breath into paper bag  to Slow down rate of breathing

Allergic reaction: Feels “funny”, dizzy, faint after drug administration, itching, redness, wheezing ‑ call for emergency squad, give O2 under positive pressure

Heart attack: If heart beating, leave alone and monitor ‑CPR if no pulse, call emergency squad

Choking: Use technique learned in CPR class (Heimlich Maneuver)

Seizures: May experience prodromal sensations (smell, taste, sound) before seizure ‑ usually only last 2‑5 minutes (Have client take usual medications before appointment)

Treatment –  Contact EMS immediately!  On back, if breathing a problem turn on side   Don’t worry if 30‑40 seconds between breaths-maintain airway, give oxygen if possible.  Put pillow under head – nothing in the mouth!   Get as many vital signs (blood pressure, pulse, respirations) as possible and all the medications the client was given    Full recovery may take three hours

Asthma: Make sure client takes medication before appointment, Have them bring in their inhalers and place on doctor’s chart.  If an attack occurs (wheezing, anxiety, sweating, red faced) stop treatment.  Bring the client to a sitting position.  Have client use his bronchodilator.   Administer oxygen.  If no bronchodilator available, call EMS.

Angina, chest, back, shoulder, jaw pains, or difficult breathing: Stop dental work immediately, place the chair at a 45 degree angle, oxygen, nitroglycerine under tongue, oxygen, 1 tablet every 5 minutes ( up to a maximum of 3 tablets) –place client’s tablets on doctor’s cart ‑If a client still has pain five minutes after second tablet, call emergency squad.  If pain leaves, continue dental treatment.

Hypoglycemia: Client confused, may seem ‘drunk”, cool moist skin, hungry, slurred speech.  Ask “when did you last eat or take your insulin?” Give some sugar (soda is available from the machine in the lounge), support with 02 (emergency squad if client doesn’t respond in 5-6 minutes)

Falls: Have a physician examine for liability protection

Burns: If the skin isn’t broken and no blisters apply ice for pain, and cover with a plain, sterile gauze pad

Fainting: When client becomes weak, dizzy, pale, sweating, have lay on floor with knees elevated or lay down in dental chair with feet up.  Stop treatment.  Place a cold compress on forehead and loosen tight clothing. Use ammonia ampoule.  If not regain consciousness within one minute, call emergency squad.  Have client sit up for 5 minutes before trying to stand.  Client should be driven home.

Stroke:  Test: Look for bilateral symmetry; smile lift hands  Say short sentence  First, be sure you recognize quickly when a client is in trouble.  Here are some signs:

  • More than 20 or less than 10 breaths per minute
  • Pulse rate greater than 120 or less than 55 (average is 72) 3.  A blood pressure 25% higher or lower than  normal
  • Shortness of breath or hard to breath
  • A wheezing sound when breath
  • Profuse sweating, wet, clammy skin
  • White or gray complexion
  • Bluish color to lips, tongue, nails
  • Swelling rash
  • Unexplained pain (particularly in chest)
  • Shaking

Second, know where our emergency equipment is located and how to use it.

  1. Oxygen tank on rollers – Located: _________________
  2. Tongue blades aid kit – Located: _________________
  3. Ammonia capsules –in each op
  4. Blood pressure cuff –hygiene rooms
  5. Stethoscope – Located: _________________
  6. Ambu bag kit with airways – Located: _________________
  7. Oral Pharyngeal Airways – Located: _________________
  8. AED – Located: _________________

Okay, let’s put what you’ve learned into practice.  Here’s how the system works.

When a Client has an Emergency

  1. Client has a problem
    1. Back staff ‑ immediately notify your doctor of a possible emergency.
    2. Have dentist evaluate the client’s medical status and record
      1. Blood pressure
      2. Pulse
      3. Breathing
      4. Client history
      5. Any drugs given
      6. Doctor announces emergency exists and stays with the client
    3. Emergency situation exists
      1. Dentist makes diagnosis
      2. Ask closest Physician in the building to evaluate
      3. Call 911
        1. Identify our office/location
        2. Name of client and nature of problem
        3. What happened and current status of client
        4. How long till they arrive
        5. Time of call
        6. Dentist determines appropriate treatment (EMS prefers we give no medications.  There is too great a possibility that we would give the wrong medication and complicate treatment.)
        7. Staff prepares for treatment (emergency drug kit, O2 – portable or in N20 delivery system, defibrillator)
        8. Start Oxygen (100%)
          1. Positive pressure using pump masks and oxygen from portable tank
            1. 1 person holds mask in position
            2. 2nd person squeezes bag
  2. CPR ‑ The first four minutes are critical
  3. Automated External Defibrillator (AED)
    1. Located: __________________

b.   Defibrillation (not CPR) must be applied as quickly as possible (survival from cardiac arrest declines 10% for each minute without defibrillation.  After 10 minutes the survival rate is 0%)

c.   Only use the AED if all the following are present

  1. Unresponsive
  2. No breathing
  3. No pulse
  4. No movement

d. Only place patches on dry, clean skin

  1. Secretary contacts the client’s family
    1. Staff person waits at door for emergency squad
    2. Document time of their arrival and departure

Secretary say to the family: “Mrs. Green, your husband is having chest pains and trouble breathing. I’ve called the emergency rescue service.  They will be here within 2‑3 minutes.  Our staff is keeping him/her comfortable. Would you like one of us to drive you to the hospital?”

Keep the relative calm and in the reception room if possible.  If the relative insists in coming back, allow it.  Don’t keep a crying relative forcefully out of the operatory. When there is a medical emergency, don’t run around and panic. Your job is to remain calm, do as you’re told and keep from scaring the patients in the building. When the emergency squad arrives, the secretary that is waiting to meet them at the front door should tell the other patients in the reception room that a client has had a medical emergency and everything is being done for his comfort and safety.  Other staff should continue to take telephone calls and work normally. Don’t announce to each caller that there’s been an office emergency.  Just do business as usual.

  1. Staff records in chart exact time, sequence of events, and what we did ‑ minute by minute.
  2. The secretary should stay by the front door to conduct the EMR crew to the operatory.

Office policy for renewing CPR certification:

We pay for your CPR certification if you take the class with our group. We normally schedule the class on an evening after patients leave and the instructor comes to the practice. We usually have a good time together and this is a great way to make sure we are all safe. Who knows? The emergency could happen to you – and you want your team members to know what to do.

Automated External Defibrillators (AED)

Although CPR can save a client’s life, the AED is easier and better to use.  If the AED is used within 8 minutes of the even, the client has a 3 time increase in the chance of survival. To get checked off in this section, you must get CPR certified by passing the course.

Emergency Drug Kit

 

Although the following is the standard drug kit, since our emergency squad is so close (less than five minutes response time), they have requested we do nothing more than CPR.  They believe that them needing to treat a medical condition caused by us administering a wrong medication is a greater problem than the client’s initial emergency.

 

 

 Standard Emergency Drug Kit (­ * indicates what we should have)

(Based on article by John Roberson, DMD

Basic Drugs

  1. Epinephrine  1:1000  – Use of drug (bronchospasm, allergic reaction, anaphalaxis) and How to administer (injectable)
  2. Histamine-blocker – Use of drug and  How to administer (injectable)
  3.  * Oxygen with positive-pressure administration capability – Use of drug (Bronchospasm Laryngospasm, local Anes. Overdose/injection into vein) and  How to administer
  4. * ­ Nitroglycerin (If client has own prescription, put client’s bottle on tray) – Use of drug (chest pain/angina) and  How to administer (sublingual tablet or aerosol spray)  and  relief of pain 2 – 5 minutes
  5. Bronchodilator  (asthma inhaler) – Use of drug (Bronchospasm) and How to administer (inhaler)
  6. * Sugar – Use of drug (Hypoglycemia or diabetic emergency – orange juice or cola best and How to administer (oral)
  7.  * Aspirin –   Heart attack (aspirin),   How to administer (oral) 325 mg aspirin
  8. Benedryl – itching, rash after drug administration –  Use of drug (allergic reaction, anaphylixis) and How to administer (oral) – 50mg tablet
  9. * Ammonia –  Use of drug (light headed) and How to administer (break capsule and smell)

 Emergencies listed by physical problem and drug that emergency squad may use

Cardiac

a. Angina, chest, back, shoulder, jaw pains, or difficult breathing – stop dental work immediately,  place the chair at a 45 degree angle, oxygen, nitroglycerine under tongue, oxygen, one tablet every five minutes (up to a maximum of three tablets) – place client’s tablets on doctor’s cart – If a client still has pain five minutes after second tablet, call emergency squad.  If pain leaves, continue dental treatment.

b.Myocardial infarction: oxygen, aspirin

c. Dysrhythmias: ACLS drugs

d.Sudden cardiac arrest: AED

e. Ventricular Fibrillation:  ACLS drugs

Airway

a. Choking – foreign body obstruction: Heimlich maneuver

b.Bronchospasm: albuterol, oxygen, epinephrine

c. Larygnospasm: oxygen, saccinylcholine

d.Aspiration/Emesis: airway techniques

e. Asthma – make sure client takes medication before appointment.  Have them bring in their inhalers and place on doctor’s chart.  If an attack occurs (wheezing, anxiety, sweating, red faced) stop treatment.  Bring the client to a sitting position.  Have client use his bronchodilator.  Administer oxygen.  If no bronchodilator available, call EMS.

Neurological

a. Seizures: client notice unusual smell, taste, sounds differently (take usual medications if appropriate)

  1. Contact EMS immediately!
  2. On back, if breathing a problem turn on side
  3. Don’t worry if 30-40 seconds between breaths – maintain airway, give oxygen if possible
  4. Pillow under head – nothing in the mouth!
  5. Get as many vital signs (blood pressure, pulse, respirations) as possible and all the medications the client was given
  6. Full recovery may take three hours

b.Transient ischemic attack

c. Stroke

  1. Look for bilateral symmetry; smile lift hands
  2. Say short sentence

d.Panic attack: anti-anxiety agent

e. Anxiety: anti-anxiety agent

Allergic and drug reaction

a. Feels ”funny”, dizzy, faint after drug administration, itching, redness, wheezing, give

O2 under positive pressure

b.Latex allergy: diphenhydramine

c. Anaphylaxis: epinephrine, diphenhydramine, albuterol, dexamethasone

d.Allergic reaction: diphenhydramine

e. Epinephrine overdose:

  1. Benzodiazepine overdose: flumazenil

g. Local anesthetic overdose: oxygen

h. Narcotic overdose: narcan

Loss of Consciousness

a. Fainting ‑ when client becomes weak, dizzy, pale, sweating, have lay on floor with knees   elevated or lay down in dental chair with feet up.  Stop treatment.  Place a cold compress on forehead and loosen tight clothing. Use ammonia ampoule.  If not regain consciousness within one minute, call emergency squad.  Have client sit up for 5 minutes  before trying to stand.  Client should be driven home.

b.Sudden cardiac arrest: AED

c. Hypoglycemia: Hypoglycemia – client confused, may seem “drunk”, cool moist skin, hungry, slurred speech.  Ask “when did you last eat or take your insulin?”  Give some sugar (soda is available from Pepsi machine), support with O2 (emergency squad if client doesn’t respond in 5-6 minutes)

d.Stroke

Hyperventilation – Usually caused by anxiety in people under the age of 40.  Person will feel anxious, light headed, and breathing will be rapid, deep, and labored.

Treatment

  1. Reduce anxiety
  2. Have person sit upright
  3. Breathe into a paper bag
  4. Slow down rate of breathing

 

Falls – have a physician examine for liability protection
Burns ‑ is the skin isn’t broken and no blisters apply ice for pain, and cover with a plain, sterile gauze pad

 

Steps to Review with advanced (lev 2+) chairside

  1. Develop a log book with list of drugs and when they expire
  2. Put each drug in a plastic container or zip lock bag labeled for easy identification