( By Dr. Natoobhai J.Shah & Dr. Sailesh N. Shah )

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a-Cardio-Respiratory Resuscitation

When heart stops suddenly, it can sometimes be revived if the technique of external cardiac massage is applied instantaneously. Life can be revived if this is done within the first four minutes of heartís stopping. After the passage of this time, it is impossible to revive the patientís brain completely. In fact, the damage to the brain cells can be irreversible and it may be unethical to revive a person in whom the " higher centres " of the brain, controlling intelligence, judgment, memory and social behaviour are permanently damaged. The life-sustaining vital centres of the brain are very sensitive to lack of oxygen. At normal room temperature, the brain cannot survive if the supply of blood containing oxygen is delayed by more than three to four minutes. Hence, to revive the effective pumping action of the heart, one has to race with the time factor - do it as soon as the heart stops. Please do not be overpowered by your emotions and waste time and energy once this critical period has passed. The technique of cardiac resuscitation can be learn fairly easily by even a layman. To wait for a doctor to arrive on the scene is to loose the patient. Those first four minutes are critical.

The technique of cardiac resuscitation which can be applied by even a non-medical person in a patientís own home is as follows :

  1. Give a short and sharp blow in the middle of the chest or on left side of the chest, near the left nipple. If you are lucky, this sharp blow itself might restart the heart. If not , immediately proceed as given below.

  2. Put the patient on hard surface, like the floor.

  3. Raise the feet so as to increase the blood reaching the heart and support them on a chair or a table.

  4. Force or extend the chin backwards so that the upper air passage remains unobstructed and free. Do not place a pillow under his head.

  5. Kneel by the side of patient and put one palm over the centre of the chest, in its lower portion.Put your second palm on the back of your first palm and grasp it firmly.

  6. With your elbow straight and arms in a vertical position, exert a rhythmic pressure, using the weight of upper portion of your body so as to depress the chest by about five centimeters (two inches). Repeat the same process about sixty times a minute. After every ten pressures (six times in a minute), inflate the lungs with air by direct mouth-to-mouth breathing.

All the above steps must be taken without wasting a second as soon as the patientís face exhibits a death-like appearance. This is bound to be accompanied by a loss of pulse, heart sounds and breathing. With previous training and rehearsals on a dummy, the above technique can be carried out in a matter of seconds to a minute. We must emphasize again, that after starting the external cardiac massage, if the effective heart beat is not obtained within five minutes, then it is wrothwhile to abandon it and accept this as an unsuccessful attempt. The outside time limit of a maximum of four to five minutes cannot be emphasized enough, because one has often witnessed pathetic scenes lasting for hours, with the relatives and the practicing doctor who continue trying in despair to revive the patient. This is probably because the lay public does not possess knowledge of the basic facts of the biology of life.

Other drugs which may be used in a given situation are I/V Soda Bicarb to counteract acidosis, Adrenaline either I/V drip or intracardiac, calcium chloride injection and a trial with D.C. Defibrillator.

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