ARE YOU PREPARED? 2012 Heaven Can Wait Emergency First Aid Inc.

Transcription

1 ARE YOU PREPARED? 2012 Heaven Can Wait Emergency First Aid Inc. 1

2 Who We Are Heaven Can Wait is a Paramedic-Run, First Aid, CPR/AED Training Provider ü We provide, tailored, dental-specific CPR/AED/Medical Emergencies Training for Dental Offices ü Exceptional savings on our certification programs and AEDs for dentists ü Partners with the Toronto Academy of Dentistry as their preferred Training Provider ü All Programs Approved by the WSIB, Federal Government and Heart and Stroke Foundation ü All in one provider for AEDs, AED maintenance, medical direction and much more ü All instructors are paramedics who provide in-office training or in group settings For More information on our courses and AEDs, please call Heaven Can Wait Emergency First Aid Inc. 2

3 Winter Clinic 2012 Medical Emergencies in the Dental Office and the Impact of BLS for Patients in SCA Mr. David Goodman (BSc, AEMCA, Paramedic) CEO, Heaven Can Wait Emergency First Aid Inc. 50 Holly St, Suite 303, Toronto, Ontario, M4S 3E

4 It s Not a Matter of if, it s a Matter of When Ø In 2007, 7400 dentists in Ontario experienced a medical emergency Ø In 2007, a total of 18,861 dentists in Canada ² -In Ontario, approximately dentists will experience an in-office medical emergency in any given year. ² -In Canada, approximately dentists will experience an in-office emergency in any given year. (CDA, JADA) 4

5 It Will Happen to You. No One is Immune! Syncope-accounted for 50% of all emergencies (causes?) Common Medical Emergencies Ø Ø Ø Ø Ø Ø Ø -Allergic Reactions -Angina/MI -Sudden Cardiac Arrest -Postural Hypotension -Seizures -Respiratory Emergencies -Diabetic Emergencies 5

6 Syncope Definition: A transient loss of consciousness due to a decrease of blood and oxygen to the brain, followed by a recovery to previous mental status. Common Causes 1. Response to emotional stress 2. Heart Problems 3. While assuming an upright position 4. Hyperventilation 5. Drugs/Toxins 6. Decrease blood sugar 7. Heat Stroke 6

7 What You Know Or Don t Know Can Change Lives Forever True or False 1. Anaphylaxis is rare? 2. Severe reactions are avoidable if you know the culprit(s)? 3. Epinephrine is the front-line medication for anaphylactic reactions? 4. Epinephrine is dangerous? 5. Anaphylactic reactions can be triggered by exercise? 6. Anaphylactic reactions only last for an hour or two? 7. Anaphylaxis always presents with hives? 8. Prior anaphylactic episodes are predictors of future attacks? 7

8 Emergency Medications (RCDSO) 1. Oxygen 2. Epinephrine 3. Nitroglycerine (SL) 4. Diphenhydramine 5. Salbutamol (MDI) 6. ASA 8

9 History Taking as a Means of Prevention Past Medical History ü General health of the patient? ü Any diagnosed medical conditions and if so, are they being treated? ü Does the patient have any allergies? ü Does the patient have a primary care physician? ü Has the patient ever been hospitalized and if so, when and why? ü Has the patient had any past and or recent surgical procedures? ü Does the patient have any implantable devices? Patient s Personal Habits ü Smoke, drink, drug? ü Immunizations? ü Occupation (exposure to env. agents)? ü Travel (exposure to contagious disease)? ü Living conditions (house, apartment, cleanliness, pets)? 9

10 Sick or Not Sick??? The Look Test 10

11 Typical Questions you will be Asked by a Call Taker ü Location of the emergency ( number,floor etc ) ü Nearest main intersection ü Building information (house, apartment, business, etc ) ü Phone number ü What is the nature of the emergency (e.g. stroke) ü Number of casualties who require assistance ü Any safety concerns/issues (environment) ü Age of the casualty ü Gender of the casualty ü Are they breathing? Sick or Not Sick? $$ Avg EMS 9-11 mins 11

12 CPR 12

13 Cardiopulmonary Resuscitation (CPR) Common Causes of Cardiac Arrest ü Irregular heart beats ü Structural abnormalities ü Cancer ü Lack of oxygen ü Trauma ü Drug overdose/intoxication ü Electrocution ü Hypothermia Statistics ü 40,000 Canadians/year ü 12,000 in Ontario alone ü < 5 % chance of survival ü CPR can triple survival rates ü 80% occur in home or public place ü Individual loses 10% chance of survival every min. 13

14 No One is Immune from SCA Ø SCA IS ONE OF THE LEADING CAUSES OF DEATH IN CANADA AND THE UNITED STATES Ø SCA DOES NOT DISCRIMATE AGAINST AGE, GENDER, PHYSICAL FITNESS LEVEL OR RACE Ø MORE PEOPLE DIE FROM SCA EACH YEAR THAN FROM BREAST CANCER, TRAFFIC ACCIDENTS, GUN-RELATED DEATHS AND AIDS COMBINED 14

15 Chain of Survival 1. Immediate Recognition and Activation of EMS 2. Early CPR 3. Rapid Defibrillation 4. Effective Advanced Life Support 5. Integrated Post-Cardiac Arrest Care 15

16 The Primary Survey Life Threatening Priorities and Assessments Airway Breathing Circulation 16

17 Cardiopulmonary Resuscitation (CPR) Life Threatening Priorities and Assessments COMPRESSIONS, AIRWAY, BREATHING 17

18 CPR Assessment Algorithm (Adult/Child) Scene Survey Determine Responsiveness (tap & shout) Call and Retrieve an AED Open Airway (Head-tilt-chin-lift) Examine Airway Responsiveness (tap & shout) and Retrieve an AED Survey A,B,C s Breathing Spontaneously EMS arrival 5 Second Breathing Scan Recovery Position and Monitor every 30 seconds *Choking: Look in airway after each set of compressions for foreign objects and remove as nescessary. Not Breathing, Breathing Irregularly and/or Gasping Apply AED and Follow voice prompts BEGIN CPR 30 Chest Compressions Followed by 2 Ventilations* Allow for Complete Chest Recoil PUSH HARD PUSH FAST EMS arrival 18

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20 Alarming Statistics " Approximately 40, 000 Canadians Experience SCA each year with 12, 000 occurring in Ontario alone " 80% of Cardiac Arrests occur in the home or public place " <5 Chance of Survival from out of hospital Cardiac Arrest " Immediate CPR can triple survival rates " If Immediate CPR initiated on SCA casualty and an AED is attached within 3-5 minutesà survival rate can skyrocket up to 76% " Clinical death occurs at 4-6 minutes; Biological death at 10 minutes " Average EMS response times in the City of Toronto is 9-11 minutes " For every minutes that passes, a SCA victim loses 7-10% chance of survival 20

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22 Heart Rhythms 1 2 AED 3 AED 4 22

23 Principles of Defibrillation ü Delivery of electric current/shock through casualty s chest ü Goal of interrupting and discontinuing lethal arrhythmias/disorganized electrical activity (VF, PVT) ü Reset heart into normal electrical and mechanical functionà Heart beat ü Attached to a casualty who is unconscious and not breathing and/or gasping 23

24 Cardiac Arrest Survival Rates: Early vs. Late Defibrillation No CPR Delayed Defibrillation Early CPR Delayed Defibrillation Early CPR Early Defibrillation Very early CPR Very Early Defibrillation Early ALS CPR CPR CPR Defibrillation Defibrillation ALS Defibrillation minutes Valenzuela TD, et al. New England Journal of Medicine 2000 Defibrillation 0-2% survive 2-8% survive 20% survive 50% 1,2 survive 24

25 Selecting an AED 1. Reputation of product (company?) 2. Ease of Use 3. Reliability 4. ENERGY (Biphasic, Monophasic, Joules) 5. Pediatric capabilities 6. CPR assistance 7. Peer-reviewed studies 25

26 Why Philips? ü Quick Shock Technology Fastest in the industry (shocks in as little as 8 seconds) ü Biphasic Energy (150 j, and pediatric capabilities, 50j) ü Most self-tests in the industry 85, daily, weekly, monthly ü CPR Assistance (frightened or inexperienced rescuers) ü 4-year lithium manganese dioxide battery ü Will abort shock if rhythm converts on it s own ü Only Philips check pad integrity ü Only Philips check operating temp ü World class customer support ü Largest market share for AEDS 26

27 Philips Quick Shock Survival Linked to Speed of Shock Delivery After CPR Survival 100% Times measured from end of Stop-CPR prompt, with AEDs at maximum energy 80% 60% 40% 20% 0% 0 Time to shock in seconds after CPR is stopped HeartStart Onsite, FRx & FR2 8s typical Defibtech* & LP500 Welch Allyn AED10 Cardiac Science G3 & Zoll AED+ Cardiac Science G3 Auto Medtronic CR+ & Welch Allyn AED20 30 Medtronic CR+ Auto 27

28 Why? Ø Why do I have to keep recertifying every year, it s a pain and an annoyance Ø Nothing has ever happened at our office before; at least nothing significant Ø Let s just put if off for now; we ll do it next year, if we get around to it Muttering these above phrases can have deadly consequences Its better to lose a minute of your life than to lose a life in a minute Learn what you need! 28

29 Recommendations for all Dental Offices 1) Every dental office should be equipped with an AED 2) All staff, including support staff should be trained yearly 3) Ensure medications are not expired and that oxygen tanks and supplies are replenished when necessary 29

30 Selecting a Training Provider 1. Reputation of company 2. Approvals from local, federal and H&S 3. Paramedic instructors 4. Tailored courses to meet the needs of dental office medical emergencies (not generic) 5. Reliability 6. Experience in the dental community 7. Evolving and keeping up with emerging trends in CPR/AED and Emergency Medicine 8. Dynamic, hands-on training 30

31 Complacency Can be Deadly In the end, it s a wife, a husband, a child, a family member, or a friend who ends up suffering as we are all potential patients ARE YOU PREPARED? PROTECT YOUR PATIENTS, YOUR STAFF, AND YOURSELF! BOOK YOUR TRAINING TODAY! CALL NOW 31