CPR Forth Year

1. VI
RESPIRATORY DISTRESS

2. General considerations
TERMS
 PaO2 arterial O2 tension [ 75 torr ]
 Hypoxia……….decr O 2
 Anoxia……….absence of O2
 normal respiratory rate …….16-18
 Hypoventilation……..slow ventilation
 Apnea…………no respiratory movem


3. RESPIRATORY
DISTRESS

4. Tachypnea…….increase Resp Rate
 Hyperpnea……increase venti ie ^ depth[than
normal] but just meets the demands.
 Hyperventilation……. Increase venti than
needs…………O2 level ^^^ …

Dyspnea……….difficulty in breathing
 Orthopnea…….. difficulty in breathing in
recumbent [not in upright ]


PaCO2 partial arterial CO2 tension [ 45 ]

5. Causes of respiratory distress
Hyperventilation
 Vasodepressor syncope
 Asthma
 Heart failure
 Acute myocardial infarction
 Hypoglycemia
 Overdose reaction


6. Hyperventilation
Vasodepressor syncope
Asthma
Heart failure
Acute myocar infarction
Hypoglycemia
Overdose reaction

7. GENERAL Management
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1-recognition of respiratory distress
2-terminate dent proc
3-p: depend on patient
some feels better on upright post
if patient is unconsc………supine position
4-A, B,C
5-definitive care
monitor vital signs
ttt of anxiety
Ttt pf respiratory problems

9. AIRWAY OBSTRUCTION
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CAUSES:
Foreign body……meat….large, alcohol, talk
In dent a foreign body--Oral c ---- -pharynx-- > -RESP TR------as ex
hand piece, head of mouth mirror
;gold crowns
Congenital defects of airway
Infections : epiglottitis , tonsillitis , Ludwig’s angina
Trauma
Tumors

10. Hand piece
Head of m mirror
crowns

11. prevention
when Objects- usually …> G I T…….
complications

rare-- bronchi ---respir complications
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TO AVOID ASPIRATION & RESP COMP
MANY MEASURES CAN BE USED
A)RUBBER DAM
B)ORAL PACKING
C)POSITION
D) assistant care
E) suction, Magill intubation forceps
F) ligature

12. RUBBER
DAM

13. ORAL
PACKING
PHARYNGEAL
CURTAIN

14. POSITION
PATIENT TURN TO ONE
SIDE
HEAD- DOWN POSITION

15. Magill
intubation
forceps

16. Hemostats & Cotton pliers are not suitable for removal of objects

17. Management of airway obstruc
N B important general points……
 If object falls in air passage don’t allow the
patient to sit up

recline the chair backwards….

do X –ray for chest & abdomen
 put him in left lateral decubitus position
with head down
 encourage coughing
 If object still not removed -emergency
fibroptic bronchoscope
 If failed --------thoracotomy

18. left lateral decubitus position
with head down

19. Management of airway obstruc
R-recognition of airway obst
see if complete airway obst or incomplete
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COMPLETE airway obst :
sign of compl airway obst
inability to speak
inability to breathe
inability to cough
universal sign for choking

20. UNIVERSL
sign for
choking

21. universal sign for
choking

22. If obst is relieved in 4-5 min ----normal

after 2-5m-----loss of consc

More 4------blood pr & pulse

disappear

23.  sign
of partial airway obst
Forceful cough

Wheezing

Crowing sound on inspiration
 With more obst

absent voice sounds

Cyanosis

Lethargy

disorientation


25. After R-recognition of airway obst
 T-terminate dental ttt
 P-supine … feet slightly elevated
 A B C ……>>>>>

BASIC AIRWAY MANEUVERS

26. BASIC AIRWAY MANEUVERS
B L S
A- Air way opening by... head tilt-chin lift …
This will open the airway obst… if tongue
is the cause of the obstruction ….
Or do jaw thrust maneuver if ……
 B- Breathing care by…
look listen &feel technique …..
in which rescuer put his ear near mouth &
nose of patient & listens &feels for air exchange

and if airway is still obstructed


27. Head tilt- chin lift technique

28. jaw thrust maneuver

29. look
listen &
feel
technique

30. this may be due to foreign body ……………
***Try to remove this foreign body by

- abdominal thrust [ Heimlich],

chest thrust

back blow,

finger sweep
 ****-if failed above & the object is at higher
level …….> do emergency airway opening

by a-tracheostomy

b- cricothyrotomy


31. abdominal
thrust
[ Heimlich],

32. -abdominal
thrust ,
Preparing position

33. abdominal thrust [ Heimlich],

34. abdominal thrust [ Heimlich], patient
on floor

35. abdominal
thrust
[ Heimlich ],
rescuer aside

36. abdominal thrust [ Heimlich], in
dental chair

37. chest thrust

38. chest thrust

39. finger
sweep

41. b-cricothyrotomy

43. Hyperventilation
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Means excess ventil more than required to maintain
Pa O2 & PaCO2
there may be increase in rate of resp or depth or both
Causes
-pain………stress
-acidosis
-drugs
Hypercapnea
Cirrhosis
CNS disorders

45. Signs & symptoms
C V S: palpitation, tachycardia , pain
 CNS : dizziness , disturbed consc or
vision
 RESPIR : short [ may in stress conditions]
rapid breath, pain
 GIT
: pain
 Musc : tremors, carpopedal tetany,
stiffness
 PSYCHIC :tension, anxiety


46. main Predisposing factor :

stress………
PREVENTION
 MEDICAL HIST
 PHYSICAL EXAMIN
 DENTAL CONSIDERATIONS

stress reduction


47. management
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1-R
2 -terminate dent proc….. remove dental materials
3-p MAY in upright posit to help respiration
4-A, B,C
7-definitive care
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
calm patient…….. Drug as diazepam
ttt resp alkalosis

48. ASTHMA

Defin : paroxysmal attacks of difficult
breathing ,tightness,& impending
suffocation without fever……
Commoner in young people
 Cause
 may allergy

respir infections

physical exertion


49. types
I-----Extrinsic asthma [allergic ]
more in children….
allergens ---- type I hypersensitivity
 II------intrinsic asthma [ non allergic ]
more in olders….
resp infect -develop of sympt
 III------Mixed asthma : involved I & II
 IV-----Status asthmaticus: not respond to 2-3
doses of B- adrenergic drugs


50. Clinical picture
Sympt& signs

cough

wheezing

dyspnea

tachpnea

active accessory ms of respiration

cyanosis

incr blood pressure


51. Position in asthema

52. prevention
History
 Dental consideration
 in acute attack avoid stress

use sedatives

avoid barbit &opium

avoid aspirrin [ aspirin asthma]

avoid sulfur dioxides as
preservatives , local anesthesia


53. MANAGEMENT OF ASTHMA
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1R
2- terminate dent proc
remove all dental material & instruments
3-p depend on patient
4-A, B,C
7-definitive care
calm the patient……….
bronchodilator as … adrenaline
isuprel
8-subsequent dental care

54. bronchodilator as isuprel