Basic Life Support &

Medical Emergencies
 Basic Life Support
Cardiopulmonary Resuscitation (CPR) involves Basic
Life Support (BLS) and Advanced Life Support (ALS)

BLS series of manoeuvres initiated by rescuers at the scene

2010 American Heart Association Guidelines ; C-A-B
(circulation-airway-breathing) replaces conventional A-B-C
(airway-breathing-circulation)
 Circulation
1. Activate emergency medical services (EMS)

2. Check pulse 5-10 seconds; if not sure of palpable pulse within 10 seconds, presume no
pulse

(adults; carotid artery // children; carotid/femoral artery // infants; brachial artery)

3. Location : Ensure location is safe

4. Position : Place victim on their back over a hard, firm surface

5. Rescuer position : Kneel beside victims chest

6. Correct technique : Place the heel of 1 hand on the center of victims bare chest & heel
of the other hand on top of the first hand with the fingers interlocking (fingers not in
contact w victims body). Arms straight at the elbow, shoulders directly above hands.

7. Depth of compressions : 5cm / 2 inches

8. Rate of compressions : at least 100 compressions/min

* In smaller children 1 hand,

* Infants two fingers / two-thumb encircling hands, 4cm / 1.5 inches

 Airway
Head tilt-chin lift manoeuvre recommended method to
open airway if no head or neck trauma

- Palm of one hand placed over victims forehead and head

tilted back

- Jaw lifted w fingers of the other hand placed under bony part
of chin

Position of rescuer : either side of victim (single) head end of

victim (multiple)

Spinal injury jaw thrust manoeuvre

 Breathing
Every set of 30 compressions should be followed by 2
breaths
Each breath delivered over 1 second
Volume delivered should be just enough to produce visible
chest rise
1. Mouth-to-mouth : victims nose should be pinched w
thumb & index finger, rescuer should cover victims mouth
w own mouth, forming an air-tight seal, barrier device may
be used (ie: napkin)
2. Bag-mask ventilation : self-inflating bag may be used,
along w face mask
Adult CPR
Infant CPR
Automated External
Defibrillator ( AED )
What is AED ?

A lightweight, portable device that delivers an

electric shock through the chest to the heart.
AED delivers the shock which can potentially
stop an irregular heart beat (arrhythmia) and
restore a normal heart rhythm following sudden
cardiac arrest (SCA).
Indication :

It is used on a person who is having sudden cardiac arrest

(SCA) .
On children over one year old and adults.

Most common cause of SCA is an arrhythmia called ventricular

fibrillation .
VF is a rapid and unsynchronized heart rhythm that originates
from the ventricles.

The heart must be defibrillated as quickly as possible in order

to increase the victims chances of survival.
Why are AEDs important?
Duration for defibrillation are only optimal for a very few
minutes after the onset of VF
The victims chance of survival falls by around 7 - 10% with
every minute that defibrillation is delayed.
Best way of ensuring prompt defibrillation is to use an AED
by someone to deliver the shock that can often save a life.

Who can use an AED ?

Safe and easy to use by the general public or the laymen
who have no formal training before.

Guided by verbal instructions and visual prompts.

Where can I find a defibrillator (AED)?
They are placed or stored where they are most likely to be needed
shopping centres, sports facility, train stations, airports, offices and in
schools.
How do I use a
defibrillator/AED?

1. Make sure an ambulance is called, and, if an

AED isnt immediately available, give CPR
until AED is available.
2. Switch it on. Follow a series of visual and
verbal prompts as guidance.
3. Take the pads out of the sealed pack. Remove
or cut through any clothing and wipe away any
sweat from the chest
4. Attach the pads to their chest
Place the first pad on their upper right side.
Place the econd pad on their left side, just below
the armpit.
5. Make sure no one is, including you, is
touching the person .
6. Push the "analyze" button (if necessary) and
allow the AED to analyze the person's heart
rhythm.
7. If a shock is recommended to the person,
tell everyone to "stand clear." Once clear,
press the "shock" button.
8. Begin CPR after delivering the shock.
Or, if no shock is advised, begin CPR.
Perform 2 minutes (about 5 cycles) of CPR
and continue to follow the AED's prompts.
Foreign Body Airway
Obstruction (FBAO)
 FBAO occurs acutely and causes asphyxia
If severe- rapid loss of consciousness and death if first
aid is not undertaken quickly

Choking is the physiological response to sudden

obstruction of airways.

PARTIAL or a COMPLETE airway obstruction.

PARTIAL airway obstruction COMPLETE airway obstruction

Signs and Symptoms Signs and Symptoms

Victim remains conscious "Universal Choking Sign"

Can cough forcefully and usually can speak Victim cannot speak or cough forcefully.
Breath sounds may be noisy Victim cannot breathe
Cyanosis
Loss of consciousness if
not treated immediately
*Do not interfere with the victims attempts to
cough, because a strong cough is the most
effective way to expel a foreign body.

Stay with the victim and monitor his or her

condition.
 Choking Adult and Child

Stand behind the victim.

Make a fist with one hand and place the

thumb side of the fist on the Victims
abdomen, well below the xyphoid or
breastbone.

Grasp the fist with the other hand and

deliver quick inward and upward thrusts into
the victims abdomen.

Repeat thrusts and continue until object is

expelled or the victim becomes unconscious
Abdominal thrusts ( Heimlich Maneuver )
Choking Infant (less than 1 year)

Deliver 5 Back Blows

Support infants head and neck with one

hand, straddle infant on your forearm with
infant face down,
Head lower than body and supported on
your thigh.
Deliver 5 back blows forcefully between the
shoulder blades with the heel of one hand.

Deliver 5 chest thrusts

If the foreign object is not expelled,

continue to support the head, turn the infant
on his back, head lower than body.

Deliver 5 chest thrusts using 2 fingers

positioned over the sternum.
Unconscious Victim

For Adult, Child and

Infant:
 Anaphylactic Shock
A serious hypersensitivity of the immune system to something in
the environment that usually causes little or no problem in most
people reaction that is rapid in onset and may cause death

Causes:
Common anaphylaxis triggers in children are food allergies, such as to
peanuts, tree nuts, fish, shellfish and milk
Certain medications, including antibiotics, aspirin and other over-the-
counter pain relievers, and the intravenous (IV) contrast used in some
imaging tests
Stings from bees, yellow jackets, wasps, hornets and fire ants
Latex
 Clinical features
Most commonly affects the Cutaneous, Respiratory,
Cardiovascular, and Gastrointestinal Systems
Dermatologic/ocular: Flushing, urticaria, angioedema, cutaneous and/or
conjunctival injection or pruritus, warmth, and swelling

Respiratory: Nasal congestion, coryza, rhinorrhea, sneezing, throat

tightness, wheezing, shortness of breath, cough, hoarseness, dyspnea

Cardiovascular: Dizziness, weakness, syncope, chest pain, palpitations

Gastrointestinal: Dysphagia, nausea, vomiting, diarrhea, bloating, cramps
Neurologic: Headache, dizziness, blurred vision, and seizure (very rare
and often associated with hypotension)

Other: Metallic taste, feeling of impending doom

 Treatment and Management
What to do? if someone shows signs and symptoms of allergic reaction such as pale,
cold and clammy skin, weak and rapid pulse, troubled breathing, confusion and loss of
consciousness

1. Call for emergency medical help

2. Patient is laid supine

3. check the airway closely. If needed, establish and maintain an airway and/or provide
ventilatory assistance

4. Assess the level of consciousness and obtain blood pressure, pulse, and oximetry
values

5. Place the patient in the supine position with legs elevated, and begin supplemental
oxygen

6. Adrenaline 1:1000 with a dose of 0.001 ml/kg intramuscullar repeat 3 times for
every 15-20 mins until symptom resolve
 Drugs
Beta adrenergic blocker : epinephrine (drug of choice)
Antihistamine H1 blockers
Diphenhydramine - Adults: 25 mg PO q6h for 2-5 d; Children:
1 mg/kg PO q6h for 2-5 d
Hydroxyzine - Adults: 25 mg PO q8h for 2-5 d; Children: 1
mg/kg PO q8h for 2-5 d

Corticosteroid : Hydrocortisone
adults, a dose of 1 mg/kg/d in divided doses is probably
adequate
children, a dose of 0.5-1 mg/kg/d in divided doses is
appropriate
 Complications
Complications include :
brain damage
kidney damage
obstructed airway
cardiogenic shock
Arrhythmias
heart attack
death

Pre-existing medical disorders of the respiratory system or

multiple sclerosis can worsen due to the anaphylactic
reaction.
 Acute Angina & Myocardial
Infarction
Angina: is the result of myocardial ischemia caused by
imbalanced between myocardial blood and oxygen demand.
There is narrowed or blocked coronary arteries supplying the
cardiac muscles

Common presenting symptom is chest pain among patients

with coronary artery diseases

The chest pain can be pressure or discomfort

Types of IHD: stable angina, unstable angina, NSTEMI,
STEMI
 Unstable angina: angina at rest or sudden onset with rapid
increase of severity an acute coronary syndrome and a
medical emergency that requires immediate attention

Myocardial infarction: necrosis of heart muscle resulting

from a sudden absolute or relative reduction in the coronary
blood supply. Commonest cause is thrombosis superimposed
on, or haemorrhage within, an atheromatous plaque in an
epicardial coronary artery
 Management
For acute attack of angina:

- Drug: nitroglycerin 0.5 mg sublingual or 0.4mg lingual

spray
- 0.5mg nitroglycerin placed sublingually which relieves pain
in 2-3 min. Patient is advised to spit out the tablet as soon as
pain is relieved to avoid side effects (hypotension and
headache). If the pain is not relieved, the tablet can be
repeated after 5 min; but not more than 3 tablets in 15 min.
 For unstable angina or NSTEMI:

* rest and assure

* emergency hospitalization
* oxygen therapy
* PHYSICAL EXAMINATIONS:
- checking BP
- blood test (for creatine kinase and troponin as cardiac markers)
- electrocardiogram ECG (to check heart rhythm)
- echocardiography
- stress test (for easier detection of angina)
- computed tomography angiography
- coronary angiography and heart catheterization (angiography visualizes any artery
narrowing and blockages)

1) Antiplatelet drugs: aspirin 162 mg or 325 mg orally (chewed and swallowed),clopidogrel 300
mg

2) Nitrates: GTN, isosorbide dinitrate may not always be effective for UA

3) other drugs: anticoagulants, Beta blockers, calcium channel blockers, statins

* further procedures depending on results of coronary angiography

- angioplasty (open a blocked coronary artery, insertion of stent to keep the artery open)
- heart bypass surgery
 For acute Myocardial Infarction:
* rest and assure
* emergency hospitalization
* oxygen therapy
1) Nitrates: sublingual nitroglycerin 0.5 mg not more than 3 tabs in 15 min; for recurrent or
persistent pain i.v GTN is used

2) Antiplatelet agent: aspirin 162 mg or 325 mg orally (chewed and swallowed) in pt. with
suspected or definite MI. Clopidogrel 300 mg is also administered. Antiplatelet agent should
be continued

3) Opiod analgesic (morphine or pethidine) to relieve pain

4) Reperfusion therapy: Thrombolytic therapy or primary percutaneous coronary intervention

(PCI) to restore coronary patency and reperfusion of infarcted area

5) Anticoagulants: heparin is given to prevent reinfarction and thromboembolic complications

6) other drugs: B blockers (eg metoprolol), ACE inhibitors (eg ramipril) or angiotensin-
receptor blockers (eg valsartan)
 Complications
Sudden death
Arrhythmias
Heart attack
Heart failure
 Syncope/ Fainting
1. Syncope is defined as a faint, temporary loss of consciousness due to generalized cerebral
ischemia.

2. In Greek: to- interrupt

3. Syncope is a SYMPTOM not a disease.

4. Predisposing factors:-

a) Psychogenic factors: fright, anxiety, emotional stress, pain especially sudden and
unexpected, sight of blood/ surgical/ other dental instruments.

b) Non psychogenic factors: erect sitting or standing position, hunger from dieting or
skipping meals, exhaustion, poor physical condition, hot humid crowded environment.

5. Clinical manifestation:-

a. Early: Feeling of warmth, heavy perspiration, nausea, tachycardia, loss of skin color; pale
or ashen- grey skin

b. Late: pupillary dilation, yawning, cold hands & feet, hypotension, bradycardia, dizziness,
visual disturbances, loss of consciousness
 Management
PRESYNCOPE
1. Stop the procedure.
2. Position the patient in supine position with the legs are slightly
elevated to increase the venous return to the head.
3. Do the:
A: Airways; check the airways and remove any obstruction to the airways
B: Breathing; check the breathing of the patient by looking at the chest
movement
C: Circulation
D: Drugs
 SYNCOPE
- The steps:-
1. Assess consciousness
2. Call for assistance
3. Position the patient: place the patient in supine position
4. Assess and open the airways
5. Assess airways potency and breathing
6. Assess circulation
7. If the patient remains unconscious, immediately reach for medical assistance!
(activate EMS)
8. Administer oxygen
9. Monitor vital signs
10. Provide definitive management:
: Loosening of tight clothes, use respiratory stimulant; aromatic ammonia vapouroles,
: If bradycardia persist, give I.V Atropine 6 mg OR give I.M Mephentramine 10-30mg
11. If delayed patient recovery : proceed by activating EMS
 Complications
Reduced level of consciousness: profound state of
unconsciousness associated with depressed cerebral activity
from which the individual cannot be aroused; coma generally
occurs when there is dysfunction or injury involving both
cerebral hemispheres or the brain stem.

Falls
DENTAL EMERGENCY
TRAY
 DRUG
Inj. Adrenaline (1:1000)
Inj. Hydrocortisone
50% Dextrose
Inj. Diazepam
Inj. Diphenhydramine
Nitroglycerin (sublingual)
Salbutamol metered dose inhaler (MDI)
Inj. Morphine
Tab. Aspirin (low dose)
Haemocoagulase
10% calcium gluconate
Aromatic ammonia vapouroles
Polyethene/ paper bag
Oxygen
USES
Anaphylactic shock
Anaphylactic shock, adrenal crisis, acute severe
asthma
Hypoglycemia (if the patient is unconscious)
Seizures (epileptic/ drug induced)
Allergic reactions
Acute angina attack, myocardial infarction
Acute bronchial asthma
Myocardial infarction
Myocardial infarction, angina
To control bleeding following dental procedures
Tetany
Fainting attacks/ syncope
Hyperventilation
Essential in every clinic
 Reference
Davidsons Principles & Practice of Medicine
Manipal Handbook of Resuscitation, Basic Life Support, 2nd Edition
Pharmacology for Dentistry - Tara Shanbag
Underwoods Pathology 6th Edition
https://www.heart.org/idc/groups/heart-
public/@wcm/@hcm/documents/downloadable/ucm_300340.pdf
http://www.sja.org.uk/sja/first-aid-advice/first-aid-techniques/using-a--
defibrillator-aed.aspx
http://firstaidlesson.blogspot.my/2013/02/foreign-body-airway-
obstruction-choking.html