American Heart Association Promotes Hands-Only CPR
Well, this one came out of left field today. This afternoon the American Heart Association issued a press release promoting hands-only CPR or what some have called compression-only CPR. What is somewhat startling about this is not the recommendation of compression-only CPR in itself (which has been a subject of discussion for many years), but the timing of this release. Whereas, in the past, the AHA has normally issued revisions in the CPR guidelines in five year cycles and after many levels of peer review, including the International Liaison Committee on Resuscitation (ILCOR), they have issued this “clarification” prior to the scheduled October 2010 Consensus Conference. I guess that is why they are calling this a “clarification” of their 2005 ECC guidelines rather than a guideline change.
You might be wondering, ‘Will this change how I do CPR if the needs should arise in our office?’ Well, not really. Keep in mind that hands-only CPR does NOT replace the need for traditional CPR in many cases. It is just being promoted as a viable option, even a preferred option, in certain situations.
When is hands-only CPR now being recommended? Under the following circumstances:
- Event occurs out-of-hospital
- Patient is an adult
- When a sudden collapse is WITNESSED (most likely cardiac arrest)
If all of the above conditions are met then it would be advisable to do compression-only CPR without the ventilations. You would do continuous compressions, on the center of the chest, at a rate of 100 per minute (to the beat of the Bee Gees song, “Stayin’ Alive”). You would continue with compressions until the patient responds, an AED arrives, or until EMS arrives.
Under what circumstances would you perform traditional CPR rather than Hands-only CPR?
- Patient is a child or infant (event is more likely respiratory in nature)
- Collapse is NOT witnessed
- Event occurs in-hospital or in your dental practice
- Cardiac arrest due to noncardiac origins (e.g. drowning, drug overdose, etc)
Of course as always, if a rescuer is unsure of his ability to do traditional CPR or is unwilling to provide ventilations due to circumstances (e.g. no breathing barrier available) then it is better to Hands-only CPR rather than nothing at all.
Why does the American Heart Association feel will be the benefits of this clarification?
Well, studies show that in most US cities the prevalence of bystander CPR remain relatively low at around 27%-33%. Why is there reluctance to perform CPR on the part of between 67%-73% of bystanders (many of whom have had training in CPR)? Studies reveal that the reason most cited are panic and fear of causing harm to the person. In a nutshell, many question their ability to perform CPR correctly. Another factor, although far less frequently mentioned, is the fear of disease transmission.
It is the hope of American Heart Association that the clarification of when Hands-only CPR is to be performed will increase the prevalence of effective bystander CPR. Of course, time will only tell if it has the desired effect.
If you want more information, check out the American Heart Association Hands-only CPR website.
Dental Medical Emergencies - Rare But Tragic
On Tuesday, December 18th, the Chicago Tribune reported on the death of a Chicago area elementary school principal, Ms. Georgette Watson. Early reports say that she experienced a sudden cardiac arrest while undergoing an ordinary root canal. Ms. Watson had been sedated for the procedure although the type of sedation is unknown at this time. full story
While dental medical emergencies are rare they do occur, and at times with tragic results as the story of Ms. Watson highlights. In the U.S. there are currently around 150,000 practicing dentists. According to a survey of over 4,000 dentists conducted by Fast and others, the average dentist had to deal with 7.5 medical emergencies in a 10-year period of time. Looking at those numbers it is easy to figure out that thousands of medical emergencies occur in the dental office each year. Don’t let that alarm you though. Most of these so called “emergencies” are cared for by the dental team themselves without the need for EMS. The same survey mentioned above found that around 50% of these emergencies were fainting (syncope), with the next most common (at 8%) being mild allergy. Heart attack and sudden cardiac arrest make up only a small fraction of all dental emergencies.
There is no doubt that the use of sedation will come under scrutiny in the case of Ms. Watson. Especially will this be so if conscious sedation or general anesthesia was used. However, such scrutiny is unwarranted as the use of sedation in dentistry is now widespread with low incidence of complications. Numerous studies have concluded that the single greatest contributing factor in the occurrence of dental medical emergencies is patient stress. Therefore, stress reduction techniques, including conscious sedation, are critically necessary in the reduction of dental medical emergencies.
This story also highlights the importance of adequate medical emergency training for dentists, hygienists, and other dental professionals. Currently, most states require CPR training for dental staff at least every few years. Dentists who use conscious sedation and general anesthesia are often required by state regulations to have BLS and ACLS training, although some states surprisingly do not require this. While BLS and ACLS training are certainly helpful in the management of medical emergencies in the dental office, such courses have their limitations. Today, most BLS and ACLS courses were designed to teach doctors, nurses, EMTs, and paramedics how to handle medical emergencies. The unique emergencies occurring within the dental practice, and their specific treatment, are not typically addressed is such courses. Some organizations have responded to this gap in the current training options for dental professionals. For example, DDS Training, has developed BLS and ACLS courses that cover the typical subjects addressed in BLS and ACLS courses, but then expand upon this information by covering common stress reduction techniques, the importance of patient medical surveys, guidelines on the establishment of an emergency response team, and specific techniques used in the management of the most common medical emergencies occurring in the dental office. (Disclosure: DDS Training is the parent company of this blog.)
Due to a rapidly growing senior population, longer life expectancy rates, and the use of more advanced procedures in the dental field the occurrences of medical emergencies in the dental office are only going to increase in the future. Hopefully, the tragic death of this loved, and well-respected school administrator, Ms. Watson, will move dental professionals to take additional steps in the prevention and management of medical emergencies in their practices.