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Dr K K Aggarwal

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.

Gasping does not mean person is dead

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A gasping respiration means the brain is still alive and the stopped heart is still revivable, said Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Vice President (Elect) Indian Medical Association. He was conducting a camp atGitaRattanJindalPublic School at Rohini, Sector 7. 1194 students along with Nursery Training Teachers were trained and given one to one training in hands only CPR 10.

Dr. Aggarwal said that often people consider gasping as the sign of life and do not start resuscitation in time. Effective and continuous cardiac resuscitation in such patients can revive the heart. CPR 10 should be started within ten minutes of the death and continued for at least ten minutes. In children it can be continued till 35 minutes and in adults for 25 minutes. Mouth to mouth breathing is not required as it has been seen that only chest compression is sufficient for reviving the heart.

The function was chaired by Dr Sonia Jindal, Director, Gita Rattan Educational Group, Jindal Public School & Principal Ms Pawinder Pal Kaur.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 29132 people since 1st November 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute.”

 

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 which is 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 ten 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 ten minutes with a speed of 100 per minutes (10X10), 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 ten minutes 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 well known phenomenon as Savitri brought life back into Satyavan even after his clinical death.

Take home message is that one should not declare a patient dead in the first ten minutes give cardiac massage and try reviving him with chest compression cardio pulmonary resuscitation.