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Dr K K Aggarwal

Bystander CPR better when more people help

By Dr K K Aggarwal
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Patients entering cardiac arrest are more likely to receive good–quality bystander–initiated cardiopulmonary resuscitation if multiple people assist

Among cases of out–of–hospital cardiac arrest, CPR quality is associated with multiple rescuers initiating bystander CPR, being in a central or urban setting, and receipt of bystander–initiated CPR and longer duration of resuscitation as per Dr Hideo Inaba, at Kanazawa University Graduate School of Medicine in Japan in the journal Resuscitation.

Good–quality bystander CPR is less commonly performed by a family member, by older bystanders and in home environments.

The key to survival and positive neurological outcomes for those experiencing an out–of–hospital cardiac arrest is the initiation of bystander CPR. This CPR should be performed with chest compressions only, without mouth–to–mouth resuscitation.

Good quality means: Appropriate hand positions or finger positions for infants, compression rate of at least 100 per minute, compression depth of at least 2 inches or at least one third of the anterior–posterior diameter of the chest

Time to arrest or recognition of arrest to initiation of CPR is significantly shorter among those who provided good-quality CPR (median 3 minutes versus 4 minutes).

Soul does not depart the body immediately after death

By Dr K K Aggarwal
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According to Prashna Upanishad, at the time of death, the Prana Vayu (life force and respiration) merges with Udana Vayu (brain stem reflexes) and leaves the body.

But this does not happen immediately after clinical death, defined as stoppage of heart and respiration. Medically the term used for clinically dead patients is sudden cardiac arrest.

As per modern medicine, in cardiac arrest, the brain does not die for the next 10 minutes and during this period, if the heart can be revived, life can be brought back.

The revival of patient during this period can be remembered by the formula of ten which is that within ten minutes of the stoppage of heart (cardiac arrest), if effective chest compressions are given for the next 10 minutes with a speed of 100 per min (10 x 10), 80% of the cardiac arrest victims can be revived.

This period can be much longer in hypothermia state. If the temperature of the body is low, the soul does not leave the body till the temperature is brought back to normal. Today, this property of soul is also used as therapeutic measure where patients who cannot be revived in the first 10 min of clinical death are put in a freezing chamber and artificial hypothermia is produced and these patients can then be transported to an advance cardiac centre where even after 24 hours resuscitation measure can be applied after re-warming the body. Many people have been revived even after 24 hours of cardiac arrest with such a technology.

There are instances in literature where a newborn with hypothermia was declared dead and got revived in the cremation ground when the heat of the atmosphere brought his temperature to normal and the pressure of the wood worked like cardiac massage.

This aspect of “life after death” is a contribution of the modern science to the Vedic science. Though in Vedic literature, it was a well-known phenomenon as Savitri brought life back into Satyavan even after his clinical death.

The take home message is that one should not declare a patient dead in the first 10 minutes give cardiac massage and try reviving him with chest compression cardio pulmonary resuscitation (CPR).

(Disclaimer: The views expressed in this write up are my own).

How to recognize cardiac arrest

By Dr K K Aggarwal
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  1. Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.
  2. As per guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “are you all right?”
  3. If the person does not respond, the rescuer should call for help or ambulance and initiate excellent chest compressions.
  4. Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.
  5. Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.
  6. After assessing responsiveness, health care providers should quickly check the patient’s pulse.
  7. While doing so, it is reasonable to visually assess the patient’s respirations.
  8. It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.
  9. The key point is not to delay CPR.

Hands-only CPR Guidelines

By Dr K K Aggarwal
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  1. Bystanders should initiate compression-only CPR 10.
  2. Chest compression should be done at the rate of 100–120 per minute (updated from “at least” 100 per minute).
  3. Compression depth should be 2–2.5 inches (upper limit added) but no more than 6 cm.
  4. Compression time should be maximized.
  5. After each compression allow the chest to recoil completely and minimize interruptions in compressions.
  6. Feedback devices may be used to optimize compression rate and depth.
  7. The bystander who is trained and able should assess the collapsed victim rapidly to determine if the victim is unresponsive and not breathing normally and then immediately alert the emergency services.
  8. The victim who is unresponsive and not breathing normally is in cardiac arrest and requires CPR.
  9. The emergency medical dispatcher plays an important role in the early diagnosis of cardiac arrest, the provision of dispatcher-assisted CPR (also known as telephone CPR), and the location and dispatch of an AED.
  10. Social media may be used to summon rescuers to perform CPR.
  11. Bystanders and emergency medical dispatchers should be suspicious of cardiac arrest in any patient presenting with seizures and should carefully assess whether the victim is breathing normally.
  12. CPR providers should perform chest compressions for all victims in cardiac arrest.
  13. CPR providers trained and able to perform rescue breaths should combine chest compressions and rescue breaths.
  14. High-quality CPR remains essential to improving outcomes.
  15. When providing rescue breaths/ventilations spend approximately 1 s inflating the chest with sufficient volume to ensure the chest rises visibly. The ratio of chest compressions to ventilations remains 30:2.
  16. Do not interrupt chest compressions for more than 10 s to provide ventilations.
  17. Defibrillation within 3-5 min of collapse can produce survival rates as high as 50-70 %. Early defibrillation can be achieved through CPR providers using public access and on-site AEDs. Public access AED programmes should be actively implemented in public places that have a high density of citizens.
  18. The adult CPR sequence can be used safely in children who are unresponsive and not breathing normally. Chest compression depths in children should be at least one third of the depth of the chest (for infants 4 cm, for children 5 cm).
  19. A foreign body causing severe airway obstruction is a medical emergency and requires prompt treatment with back blows and, if that fails to relieve the obstruction, abdominal thrusts. If the victim becomes unresponsive CPR should be started immediately whilst help is summoned.

Bystander CPR better when more people help

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , | | Comments Off on Bystander CPR better when more people help

Patients of cardiac arrest are more likely to receive good quality bystander initiated cardiopulmonary resuscitation if multiple people assist Among cases of out of hospital cardiac arrest CPR quality is associated with multiple rescuers initiating bystander CPR being in a central or urban setting and receipt of bystander initiated CPR and longer duration of resuscitation as per Dr Hideo Inaba at Kanazawa University Graduate School of Medicine in Japan in the journal Resuscitation. Good quality bystander CPR is less commonly performed by a family member by older bystanders and in home environments. The key to survival and positive neurological outcomes for those experiencing an out of hospital cardiac arrest is the initiation of bystander CPR. This CPR should be performed with chest compressions only without mouth to mouth resuscitation. Good quality means Appropriate hand positions or finger positions for infants Compression rate of at least 100 per minute Compression depth of at least 2 inches or at least one third of the anterior posterior diameter of the chest Time to arrest or recognition of arrest to initiation of CPR is significantly shorter among those who provided good quality CPR median 3 minutes versus 4 minutes.

According to Prashna Upanishad at the time of death the Prana Vayu life force and respiration merges with Udana Vayu brain stem reflexes and leaves the body. But this does not happen immediately after clinical death defined as stoppage of heart and respiration. Medically the term used for clinically dead patients is sudden cardiac arrest. As per the modern medicine in cardiac arrest the brain does not die for the next 10 minutes and during this period if the heart can be revived life can be brought back. The revival of patient during this period can be remembered by the formula of ten which is that within ten minutes of the stoppage of heart cardiac arrest if effective chest compressions are given for the next 10 minutes with a speed of 100 per min 10 x 10 80 of the cardiac arrest victims can be revived. This period can be much longer in hypothermia state. If the temperature of the body is low the soul does not leave the body till the temperature is brought back to normal. Today this property of soul is also used as therapeutic measure where patients who cannot be revived in the first 10 min of clinical death are put in a freezing chamber and artificial hypothermia is produced and these patients can then be transported to an advance cardiac centre where even after 24 hours resuscitation measure can be applied after re warming the body. Many people have been revived even after 24 hours of cardiac arrest with such a technology. There are instances in literature where a newborn with hypothermia was declared dead and got revived in the cremation ground when the heat of the atmosphere brought his temperature to normal and the pressure of the wood worked like cardiac massage. This aspect of life after death is a contribution of the modern science to the Vedic science. Though in Vedic literature it was a well known phenomenon as Savitri brought life back into Satyavan even after his clinical death. The take home message is that one should not declare a patient dead in the first 10 minutes give cardiac massage and try reviving him with chest compression cardio pulmonary resuscitation CPR . Disclaimer The views expressed in this write up are my own .

Why can the body be revived even after hours of death in hypothermia?

By Dr K K Aggarwal
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  • It is a well–known phenomenon that cardiopulmonary resuscitation (CPR) is not successful if the body temperature is less than 35°C.
  • In hypothermic deaths, a person can be revived even after hours of cardiac arrest. Only when the body temperature is brought back to normal, will CPR be effective. This would mean that consciousness gets frozen and does not leave the body when the temperature is below 35°C. This forms the basis for induced hypothermia after death to revive the brain.
  • Modern science is silent about this mechanism but ancient Indian literature talks about it in great detail. As per Chandogya Upanishad (6.15.1), the process of death takes time and is a sequential process.
  • First, the motor indriyas organs (Karma Indriyas) stop functioning then the sensory indriya organs (Gnanaindriyas) followed by cessation of prana or respiration.
  • Once this happens, the frozen sensory organs, motor organs, manas (mind, body, memory and ego) and prana have to get dissolved in Tej and then leave the body, which means presence of Tej is the most important factor for consciousness to leave the body.
  • In modern science, Tej would be governed by the body temperature. That means if the body temperature is low, the motor and sensory indriyas and manas product (Vritti) will find no heat or Tej to dissolve and come out of the body.
  • Therefore, till the body temperature (Tej) is brought back to normal, the indriyas will cease to function but still be revivable.
  • This process may take up to 48 minutes in presence of Tej and there is no time limit if Tej is absent.
  • A clinically dead person with cardiac arrest therefore will have absent functioning of Manas organs, Sensory organs, mind, intellect, memory and ego with no respiration but yet revivable back to life.

How to recognize cardiac arrest

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on How to recognize cardiac arrest

• Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.

• As per guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “are you all right?”

• If the person does not respond, the rescuer calls for help or ambulance and initiates excellent chest compressions.

• Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.

• Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.

• After assessing responsiveness, health care providers should quickly check the patient’s pulse.

• While doing so, it is reasonable to visually assess the patient’s respirations.

• It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.

• The key point is not to delay CPR.

How to recognize cardiac arrest

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on How to recognize cardiac arrest

• Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.

• As per guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “are you all right?”

• If the person does not respond, the rescuer calls for help or ambulance and initiates excellent chest compressions.

• Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.

• Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.

• After assessing responsiveness, health care providers should quickly check the patient’s pulse.

• While doing so, it is reasonable to visually assess the patient’s respirations.

• It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.

• The key point is not to delay CPR.

How to recognize cardiac arrest

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on How to recognize cardiac arrest

Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.

As per Guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “Are you all right?”

If the person does not respond, the rescuer calls for help or ambulance and initiates excellent chest compressions.

Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.

Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.

After assessing responsiveness, health care providers should quickly check the patient’s pulse.

While doing so, it is reasonable to visually assess the patient’s respirations.

It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.

The key point is not to delay CPR.




How to recognize cardiac arrest

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on How to recognize cardiac arrest

• Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.

• As per guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “are you all right?”

• If the person does not respond, the rescuer should call for help or ambulance and initiate excellent chest compressions.

• Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.

• Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.

• After assessing responsiveness, health care providers should quickly check the patient’s pulse.

• While doing so, it is reasonable to visually assess the patient’s respirations.

• It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.

• The key point is not to delay CPR.

How to recognize cardiac arrest

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on How to recognize cardiac arrest

• Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.

• As per guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “are you all right?”

• If the person does not respond, the rescuer calls for help or ambulance and initiates excellent chest compressions.

• Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.

• Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.

• After assessing responsiveness, health care providers should quickly check the patient’s pulse.

• While doing so, it is reasonable to visually assess the patient’s respirations.

• It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.

• The key point is not to delay CPR.

How to recognize cardiac arrest

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , | | Comments Off on How to recognize cardiac arrest

Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.

As per Guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “are you all right?”

If the person does not respond, the rescuer calls for help or ambulance and initiates excellent chest compressions.

Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.

Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.

After assessing responsiveness, health care providers should quickly check the patient’s pulse.

While doing so, it is reasonable to visually assess the patient’s respirations.

It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.

The key point is not to delay CPR.

How to recognize cardiac arrest

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on How to recognize cardiac arrest

  • Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.
  • As per Guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “are you all right?”
  • If the person does not respond, the rescuer calls for help or ambulance and initiates excellent chest compressions.
  • Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.
  • Remember even well-trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.
  • After assessing responsiveness, health care providers should quickly check the patient’s pulse.
  • While doing so, it is reasonable to visually assess the patient’s respirations.
  • It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.
  • The key point is not to delay CPR.

How to recognize cardiac arrest

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , | | Comments Off on How to recognize cardiac arrest

Rapid recognition of cardiac arrest is the essential first step of successful CPR 10.

As per Guidelines, the lay rescuer who witnesses a person collapse or comes across an apparently unresponsive person should confirm unresponsiveness by tapping the person on the shoulder and shouting: “are you all right?”

If the person does not respond, the rescuer calls for help or ambulance and initiates excellent chest compressions.

Lay rescuers should not attempt to assess the victim’s pulse and, unless the patient has what appear to be normal respirations, should assume the patient is apneic or without respiration.

Remember even well–trained professionals can have difficulty determining if breathing is adequate or pulses are present in unresponsive adults.

After assessing responsiveness, health care providers should quickly check the patient’s pulse.

While doing so, it is reasonable to visually assess the patient’s respirations.

It is appropriate to assume the patient is in cardiac arrest if there is no breathing or abnormal breathing (gasping) or if a pulse cannot be readily palpated within 10 seconds.

The key point is not to delay CPR.