We have talked about emergency team, primary survey, and recovery position till now.
Today we will talk about cardiopulmonary resuscitation.
If any patient collapse in clinic and you come to the conclusion after primary survey that patient is unresponsive and he is facing difficulties in breathing. Call immediately ambulance and start CPR.
Let’s know some basics before knowing the procedure of CPR.
AED – Automated External Defibrillation
Restarting heart from only CPR is difficult. You can keep the patient alive from CPR until the medical help brings AED.
Most important thing is AED should be used as soon as possible.
Ventricular fibrillation is the commonest primary arrhythmia at the onset of an adult cardiac arrest.
Means the lower part of heart is beating very fast. These fast heart rhythms are half-unfinished. And these ventricular fibrillations are very dangerous. These situations demand immediate actions like within few minutes. If patient gets immediate shock then chances of survival becomes 75% but chances of success declines with each passing minutes. We can slow this process by CPR but we can’t stop this.
So, AED should be used as quickly as possible. AED is an user friendly medical device which even a lay man can also use.
AED diagnoses the problem automatically due to which heart attack has come. And this AED gives the right shock to cardiac arrest which is called as defibrillation. The abnormal heart activity of heart stops from this and gives the chance to the heart to work once again in a proper manner.
Now, the question comes how does it work?
When we put the electrode of AED on chest then AED analyses the heart activity.
AED, which provides defibrillation, is very accurate.
Modern AED also contains GPR Feedback Technology which tells us that
We have to continue CPR or not.
We are curing CPR or not. Like if we are not compressing the chest in a right way then it will tell us that we have to do hard push.
AED real time tells us about the guide of depth and rate of heart compression.
Now, let’s see procedure to use AED –
Assistant should switch on AED and dentist should continue AED.
Remove the clothes from patient’s chest.
You should keep doing CPR; assistant will install AED on chest.
AED will tell you every step through speaking.
One electrode is to be pasted on the upper chest.
And the other electrode is to be pasted on the lower chest.
Then AED will evaluate heart rhythm.
Now, if AED judges that shock is to be given then we should leave the patient and stand 1m back.
We have to start CPR and rescue breath again after shock.
We have to follow instructions of AED until patient becomes responsive.
Once patient becomes conscious lay the patient in recovery position.
AED leaves attach until help comes.
Now we will talk about safer technique of chest compression.
The correct location of compression is on middle of lower half of sternum.
We should take care during compression that pressure should not be on lower end of sternum or abdomen. Our pressure is not on the ribs also.
Your elbow should not bend during CPR and your back should be straight. The movement should be near hips only during compression.
Chest compression in CPR should be 100-120/minute which is very fast means two compression per minute and two breaths in 30 compressions.
So that team does not become fatigue and keep on rotating chest compression.
And last basic is maintaining breathing.
We don’t expect mouth to mouth breathing in a dental clinic. So, ambu bag and self-inflating mask in clinic.
Dentist has to stand for CPR and if CPR has to be done on the floor then you have to sit on the knees and do it.
Now, take your shoulder above the patient’s sternum and keep the arms straight.
Now, keep one hand on the chest of the patient, other hand on his hand and interlock the fingers.
Remember that pressure should only be on sternum.
Now compress sternum 5-6 cm or 2 inches. And then give time to chest to come back.
Compression should not be jerky.
Now count every compression till 30 then stop giving two ventilations breathe with ambu bag or mouth to mouth.
You have to repeat this procedure until help comes or patient becomes better.
MOUTH TO MOUTH VENTILATION
This step is not necessary in the clinic but incase if you don’t have ambu bag or pocket mask then there are something which you have to take care of let’s talk about that.
You have to ensure that patient should be laid in supine position.
If patient is on dental chair and then you sit on a comfortable stool and if patient is on floor then sit on knees.
You have to lift his chin maintaining head tilt so that the mouth of the patient can open. Then press the nose of the patient and take normal deep breath.
Now, you have to make a good seal from your lips on patient’s mouth and blow air for 1 min. Then see the rising of the chest.
If ventilation does not rise the chest then check for obstruction, ensure adequate head tilt and chin lift and check mouth to mouth seal.
Gastric inflation is a common problem in mouth to mouth respiration. It means once air goes into the lungs it does not come back from mouth and due to again and again forceful mouth to mouth breathing air goes into esophagus from pharynx.