Airway A Head tiltchin lift Use of a

打開呼吸道 Airway (A) Head tilt-chin lift 壓額提下巴法

甦醒袋及甦醒口罩之使用 Use of a Resuscitation Bag and Mask

緊急處理與後送 Medical Emergency in the Dental procedure for Children with Disability 馬偕紀念醫院小兒部 彭純芝 醫師

大綱 • 內科急症 Medical emergency • 孩童的評估 Pediatric Assessment • 心肺復甦術的原則 Principles of basic and advance life support • 特殊狀況 – – – 異物吸入 過敏反應Anaphylaxis 痙攣Seizure 氣喘急性發作Asthma 氣管攣縮Bronchospasm 困難插管之氣道疾病 • 穩定與後送Stabilization and Transport

Childhood Disability The Need for special care • Differences in dental disease prevalence • Dental disease/treatment may be lifethreatening • Modifications to treatment plans • Special facilities • Treatment may be time consuming

Classification – disabled children • Intellectually impaired: mentally retarded, learning difficulties • Physically impaired: developmental, degenerative • Sensory impairment • Medically compromised • Combination of disabilities

Intellectual Impairment • • Cerebral palsy Birth anoxia Sever infection Autism Microcephaly Metabolic disorder Major trauma Some syndromes

Sudden, nontraumatic Cardiopulmonary Arrest Child • 多樣性heterogonous • Respiratory failure first Adult • Cardiac in origin • Ventricular fibrillation is most common terminal cardiac rhythm

Common Causes of Pediatric Cardiopulmonary Arrest • • Airway mismanagement Anesthetics/sedative overdose Airway obstruction Sepsis Hypovolemia Metabolic disturbances Respiratory infections Embolism

Common Clinical feature of Dental Emergencies • • Unconsciousness Altered mental status Hyperventilation Hypoventilation/Apnea Wheezing/Dyspnea Hypertension/Hypotension Tachycardia/Bradycardia Chest pain

Emergency Management • Primary survey – ABCDE: Airway, breathing, circulation, disability (neurologic function), expose – Purpose: identification and treatment of immediately life-threatening problems – History: “AMPLE” – Resuscitation: measures are instituted during primary survey to treat problems they are found

Pediatric Assessment Initial Assessment • Visual and auditory general impression – PAT: appearance, work of breathing, circulation to skin (外觀、呼吸、膚色） 開始處理病人之呼吸衰竭、休克、心肺衰竭 • 持續評估ABCDEs – 處理並調整處置之優先順序

Appearance— ”Tickles” (TICLS) • • • Tone: 活動力、肌肉張力 Interactiveness：清醒程度、互動程度 Consolability：可被安撫嗎？ Look/Gaze：眼神 Speech/Cry Lack of oxygen, ventilation or brain perfusion

Work of breathing • Abnormal airway sounds: Snoring, muffled or hoarse speech, stridor, grunting, wheezing • Abnormal positioning：sniffing position, tripoding, refusal to lie down • Retraction：胸骨上、肋間、肋骨下凹陷 • Nasal flaring 鼻翼搧動

Signs of increased Work of Breathing • • Abnormal airway positioning Retractions Nasal flaring Head bobbing Stridor Wheezing Grunting

Circulation to skin • Pallor 蒼白 • Mottling 大理石斑紋 • Cyanosis 發紺

“AMPLE” history in primary Survey • • • Allergies Medication Past medical/surgical history Last meal Events surrounding the emergency

Principles for Life Support

Comparison of the Pediatric and Adult chains of survival Pediatric link • Prevention • Early CPR • Early EMS activation • Early ALS Adult links • Early EMS activation • Early CPR • Early defibrillation • Early ALS Phone fast rather than phone first Phone first: if the child collapses suddenly or the suspected cause of arrest is cardiac

Pediatric Basic Life support 小於 8歲, 先作 2分 鐘CPR, 再求救 2 minutes

或Decardron IM 0. 3~0. 6 mg/kg