Medical Emergencies
Cardio-Pulmonary Resuscitation - CPR
If a patient suffers a cardiac arrest, that is, their heart is not beating effectively, the dental team must start CPR (Cardio-Pulmonary Resuscitation).
CPR requires hands-on team training, using a mannequin designed for CPR teaching.
Because of the heightened awareness of the possibility that the victim may have COVID-19, Resuscitation Council UK offers this advice:
- Recognise cardiac arrest by looking for the absence of signs of life and the absence of normal breathing. Do not listen or feel for breathing by placing your ear and cheek close to the patient’s mouth. If you are in any doubt about confirming cardiac arrest, the default position is to start chest compressions until help arrives.
- Make sure an ambulance is on its way. If COVID 19 is suspected, tell them when you call 999.
- If there is a perceived risk of infection, rescuers should place a cloth/towel over the victims mouth and nose and attempt compression only CPR and early defibrillation until the ambulance (or advanced care team) arrives. Put hands together in the middle of the chest and push hard and fast.
- Early use of a defibrillator significantly increases the person’s chances of survival and does not increase risk of infection.
- If the rescuer has access to any form of personal protective equipment (PPE) this should be worn.
- After performing compression-only CPR, all rescuers should wash their hands thoroughly with soap and water; alcohol-based hand gel is a convenient alternative. They should also seek advice from the NHS 111 coronavirus advice service or medical adviser.
Adult CPR Video
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The video provides a step-by-step guide on how to perform CPR (Cardiopulmonary Resuscitation) on adults aged 12 and older. It begins with important safety checks upon arrival at the scene, emphasising the need to ensure both the rescuer and the victim are safe. The first action is to assess the victim's responsiveness by gently tapping their shoulder and shouting to see if they are okay. If there is no response, the video instructs the viewer to call emergency services immediately.
Next, if the adult is lying face down, the video advises turning them onto their back onto a hard, flat surface. An assessment of breathing and signs of life is conducted, where the rescuer is encouraged to watch for any chest movement or other signs for no more than 10 seconds. If the victim shows no signs of breathing or life, the rescuer is prompted to begin CPR.
The video details the proper hand positioning for chest compressions, instructing viewers to place the heel of one hand in the centre of the chest and stack the other hand on top. The elbows should remain locked and arms straight while leaning over the chest to provide compressions at a depth of 2 inches. The recommended compression cycle is 30 compressions followed by two rescue breaths. The technique for giving breaths includes tilting the victim's head back, lifting their chin, pinching the nose, and sealing the mouth over theirs to ensure the chest rises.
The video emphasises the importance of maintaining a continuous cycle of 30 compressions followed by 2 breaths until the victim shows signs of life, another rescuer takes over, or professional help arrives. This practical training is very important for first responders in any emergency situation, including those in the dental field.
Child CPR Video
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The video provides essential guidance on how to perform CPR on a child in the event of an emergency. It begins by emphasising the importance of calling for help if a child is found unresponsive and not breathing normally. Viewers are instructed to ask someone to call emergency services (999 or 112) and request an AED if one is available, while they begin CPR immediately.
For those alone without a speakerphone, the video recommends starting CPR with five initial rescue breaths, followed by 30 chest compressions and two more rescue breaths after one minute of continuous effort before calling for help. Instructions for giving rescue breaths are detailed, including how to open the airway correctly and eliminate any visible obstructions. The sequence of providing five steady rescue breaths, each lasting about a second, is outlined, emphasising the importance of watching for the chest rising and falling.
Next, the video explains how to perform chest compressions properly, advising viewers to kneel beside the child and use one hand to press down in the centre of the chest at a depth of one-third, following the rhythm of 100 to 120 beats per minute. It suggests using the song “Nellie the Elephant” to maintain the correct tempo.
The process continues with alternating 30 chest compressions and two rescue breaths until professional help arrives or the child begins to show signs of responsiveness. If alone, the video instructs to stop after one minute to call for emergency assistance. In scenarios where a helper is present, they can take over the AED and assist with CPR, allowing for brief switches without interruption in compressions.
Finally, the video underscores the importance of remaining with the child and not leaving to seek an AED independently. If the child regains normal breathing, they should be placed in the recovery position. The video concludes with a reminder of the key steps involved in performing CPR on a child. Throughout, the message emphasises the critical nature of acting swiftly and effectively in emergencies to save a child's life.
Baby CPR Video Click here
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The video provides critical information on how to perform CPR on an unresponsive baby who is not breathing normally. It emphasises the importance of acting swiftly to give the baby the best chance of survival. The first step is to call for emergency assistance by dialling 999 or 112. If you are alone, you should use a mobile speakerphone to call for help while starting CPR immediately. In the absence of a speakerphone, the guidance is to perform CPR for a minute before making the emergency call.
To perform baby CPR, begin by placing the baby on a firm surface and opening their airway. This involves tilting their head back gently with one hand on the forehead while using your fingertip to lift the chin. Any visible obstructions should be cleared from the mouth and nose.
The CPR process consists of two main actions: "puff" and "pump." For the 'puff' step, cover the baby's mouth and nose with your lips, and deliver gentle and steady breaths. You should provide five rescue breaths, watching for the chest to rise and fall. Following this, move on to the 'pump' step, which involves giving 30 chest compressions using two fingers positioned in the centre of the chest. The compressions should be about a third the depth of the chest and performed at a rate of 100-120 per minute. After every 30 pumps, re-open the airway and give an additional two breaths.
Continue alternating between 30 chest compressions and two breaths until professional help arrives or the baby becomes responsive. The video reiterates the key steps and instructions, ensuring that viewers remember the urgency and the method to follow in such critical situations.
If you prefer to view this page as didactic information, rather than as a self assessment, click the arrow below.
Didactic Information: Click here
A diagnosis of Cardiac Arrest is made when there are no “signs of life”, the patient is not breathing, and there is no pulse. (The occasional gasp should be ignored.)
Many authorities recommend that CPR should be started simply if a patient is not breathing, and is unresponsive, as checking for a pulse on a collapsed patient can be unreliable.
If you are going through the ABCDE assessment, you may diagnose cardiac arrest before the assessment is complete. You should immediately start CPR, and finish the assessment later.
All UK Dental Practices should have an Automated External Defibrillator (AED) as part of their emergency equipment. This device will automatically detect what type of Cardiac Arrest is present, and if a shock is needed, will tell the clinician so. It will also tell you if the heart rhythm is normal. AEDs require minimal training, and are suitable for use by any of the dental team.
Procedure for Cardiac Arrest: AED Present.
If the patient is unresponsive, has an open airway, and is not breathing normally:
- Call for an Ambulance, and get the AED
- Give chest compressions and breaths in the ratio 30:2 until the AED is attached
See if the AED advises a shock:
If not, continue CPR 30:2 for 2 minutes, then check the AED advice again. Continue this cycle, checking the AED every two minutes, or until the patient is breathing again.
If the AED does advise a shock, apply one shock, then resume CPR 30:2 for 2 minutes.
Continue checking the AED every 2 minutes to see if another shock is needed, or until the patient starts breathing.
Why is rapid access to a defibrillator necessary?
When the heart is fibrillating ("quivering"), it is using lots of energy, but because there is no effective circulation to bring fresh oxygen, it starts creating lactic acid. This slowly poisons the heart muscle, eventually bringing it to a complete stop (asystole). At this stage, a defibrillator will be pointless.
Chest compressions help to wash away some of the lactic acid build-up in the heart muscle, but not enough to prevent eventual asystole.
The sooner a fibrillating heart is defibrillated with an AED, the less acidosis will have occurred, and the more likely the heart is to recover. Every minute matters, and this is why the UK intends to provide AEDs in as many places as possible, including shopping malls, airports, railway stations, and all health centres (including dental practices).
Self Assessment
What are the signs and symptoms of Cardiac Arrest?
If you are going through an ABCDE assessment of a collapsed patient, and you suspect Cardiac Arrest, should you complete the assessment before starting CPR?
What is an AED? What does it do? Should you have one?
What is the procedure for a Cardiac Arrest? What is the ratio of chest compressions to breaths? Where does the AED fit in?
Why is rapid access to a defibrillator necessary?