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CPR

Understanding Post CPR Care – What Doctors Aim To Achieve

The goal of CPR (Cardiopulmonary Resuscitation) for patients who have had sudden cardiac arrests (heart attacks) or pulmonary arrests (lung failures) is to try and restore what doctors call “return of spontaneous circulation” (or ROSC).

A patient’s blood circulation will become “spontaneous” when the heart and lungs emerge from the arrested condition − thanks to CPR, such as chest compressions, rescue breathing, or both.

The heart and lungs then begin working again by themselves without the help of CPR, and the circulation of oxygenated blood to the body and brain of the patient becomes rhythmic and steady.

What happens after that, when the patient has been admitted to the hospital? Doctors need to see if the combined trauma of the heart or lung failure – plus the aggressive CPR – has caused any major impairments of various critical functions of the body. Doctors will also need to check why the heart or lungs had an arrest and try to solve the underlying health issues, so that the heart attacks or lung failure do not recur.

As with most medical practices, a Post CPR protocol helps doctors conduct all the necessary checks to address all injuries and treat underlying disease-related issues.

 

6 key Post CPR processes doctors usually follow

These 6 areas of specific monitoring and management in Post CPR care are among the most important ones:

 

1. Identification and treatment of the cause of cardiac arrest

Once ROSC has been achieved, the factors that contributed to cardiac arrest should be identified early for appropriate intervention to treat the cause. Doctors usually study the history of the events leading to the collapse, conduct careful physical examinations and investigations, and determine the cause.

Some of the commonly known causes of cardiac arrest could include:

a. Coronary artery disease: According to CDC (Centers For Disease Control and Prevention), this condition is caused by plaque buildup in the walls of the arteries that supply blood to the heart (called coronary arteries). If doctors suspect a blockage of these arteries, an emergency coronary angiogram may be needed.

b. Acute pulmonary embolism: According to UT Southwestern Medical Center, this manifests as a blockage of a pulmonary (lung) artery. The condition often results from a blood clot in the legs or another part of the body (known as deep vein thrombosis, or DVT) and travels to the lungs.

c. Cardiotoxic agents: Sometimes, drugs such as certain antidepressants, cardiac glycosides, and recreational drugs could be the main culprits that result in cardiac arrest. However, identifying the exact drug involved is usually a major challenge.

d. Metabolic disturbances: There could be several metabolic disorders, such as hyperkalemia or hypokalemia (too high or too low plasma potassium levels in the blood), or hypercalcemia (too much calcium in the blood), that can cause cardiac arrest. A Post CPR ECG may provide clues to diagnose this.

e. Sepsis: According to Mayo Clinic, sepsis is a potentially life-threatening condition where the body, in response to an infection, damages its own tissues. Sepsis is one of the common causes of cardiovascular collapse. Blood cultures are obtained, and the appropriate intravenous antibiotics are administered.

 

2. Airway and ventilation management

There are usually two different types of medical conditions related to airway ventilation that doctors have to contend with after ROSC.

Some patients may be awake and breathing reasonably well on their own. Some other patients, after CPR, may be comatose. These comatose patients should have a definitive airway established, and mechanical ventilation commenced.

This is usually done through “intubation,” where a tube is inserted through the patient’s mouth or nose, then down into their airway or windpipe. The tube keeps the airway open so that air can get through. The tube is connected to a machine that delivers air or oxygen.

Care must be taken to prevent hypoxia (too much oxygen in the blood) and hypocapnia (too little carbon dioxide in the blood). Either of these conditions can cause brain damage.

 

3. Blood circulation management

The medical term for blood-circulation management is “hemodynamic management.” Post-ROSC patients are often hemodynamically unstable, and their management can be challenging.

Doctors usually aim to maintain adequate blood supply to the brain and heart, and other vital organs.

One of the main goals of hemodynamic management is to avoid hypotension (low blood pressure). Post ROSC low blood pressure is believed to be one of the significant reasons for in-hospital death after CPR.

In a paper published by PubMed, titled “Significance of arterial hypotension after resuscitation from cardiac arrest” by Stephen Trzeciak et al.), they say that “Post-ROSC hypotension is common, is a predictor of in-hospital death, and is associated with diminished functional status among survivors.”

 

4. Targeted temperature management

High fever levels can cause severe brain damage to patients in Post CPR and ROSC stages.

Doctors, therefore, often begin with targeted temperature cooling (also called “therapeutic hypothermia”). According to Hopkins Medicine, temperature levels should usually be reduced to 32°C–34°C for about 24 hours.

This entire process has some risks. Shivering, as a side effect of hypothermia, hurts the patient’s organs, so it has to be avoided. Also, the patient should be gradually rewarmed at approximately 0.25°C–0.33°C per hour until return to normal temperatures. Rapid rewarming can lead to cerebral damage.

 

5. Blood sugar level management

In medical parlance, blood sugar management is often called “glycemic control.”

Hyperglycemia (high blood sugar levels) following ROSC has been associated with increased mortality, especially brain damage. Similarly, hypoglycemia (low blood sugar levels) is also associated with poor outcomes in critically ill patients after ROSC.

Blood sugar levels are usually monitored and then maintained by doctors using insulin therapy. Again, a delicate balance must be maintained between raising or lowering blood sugar levels, depending on each patient’s requirements and past diabetic history.

 

6. Brain function and seizure management

A paper titled “Post-resuscitation care” by Sohil Pothiawala, in The National Library of Medicine (Singapore Medical Journal) states, “The prevalence of seizures in post-cardiac arrest patients is about 12%–20%. Seizure is detrimental to brain function, so it should be treated promptly with anticonvulsant medication. An electroencephalogram should be performed without delay, and readings should be monitored frequently or continuously in comatose patients following ROSC.”

Besides managing seizures in Post CPR patients, doctors also go through “neuroprognostication” (i.e., trying to predict the patient’s potential for brain function recovery after the loss of consciousness during cardiac arrest and CPR).

Neuroprognostication helps doctors weigh the risks and benefits of life-sustaining treatment. Sometimes, patients may have a good chance of recovery without much brain impairment. But sometimes, doctors have to come to the sad conclusion that some patients, after recovery, would be irreparably brain damaged. In such cases, doctors may decide it’s more humane to let the patient’s life ebb naturally − than to artificially sustain the patient’s life without any hope of ever recovering from brain degradation.

Overall, the Post CPR responsibilities of doctors can be onerous and difficult. They have to do all they can to monitor, analyze, and decide what can be rectified. They also sometimes also have to face the truth that despite their best efforts to remedy some patients’ problems, it may only result in a sub-human life.

 

In summary …

Post CPR care is no simple matter. It involves a great deal of monitoring and balanced decision-making by doctors. To a great extent, good CPR administration before patients arrive at hospitals helps doctors enormously. Here’s our clarion call you too can follow: “Be a Zinda Dil. Learn CPR. Save Lives.”

 


 

References:

    1. Centers For Disease Control And Prevention (CDC). “Coronary Artery Disease (CAD).” Accessed August 29, 2022. https://www.cdc.gov/heartdisease/coronary_ad.htm
    2. UT Southwestern Medical Center. “Acute Pulmonary Embolism.” Accessed August 29, 2022. https://utswmed.org/conditions-treatments/acute-pulmonary-embolism/
    3. Mayo Clinic. “Sepsis.” Accessed August 27, 2022. https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214
    4. Trzeciak, Stephen, et al. The National Library Of Medicine, PubMed. “Significance of arterial hypotension after resuscitation from cardiac arrest.” Accessed August 29, 2022. https://pubmed.ncbi.nlm.nih.gov/19866506/
    5. John Hopkins Medicine. “Therapeutic Hypothermia After Cardiac Arrest.” Accessed August 29, 2022. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/therapeutic-hypothermia-after-cardiac-arrest
    6. Pothiawala, Sohil. The National Library Of Medicine, Singapore Medical Journal. “Post-resuscitation care.” Accessed August 29, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5523091/

 

Categories
CPR

CPR For The Elderly … Do The Risks Outweigh The Benefits?

One of the cardinal rules for CPR, especially when a patient who has collapsed is quite elderly, is not to rush to give CPR by default. A lot of people feel a great deal of discomfort with this dictum. They feel as if it is cruel to leave a geriatric person to die without their help.

Especially if you are untrained in CPR, and are a bystander in a situation where a senior citizen seems to have had a cardiac arrest (heart attack) or pulmonary arrest (lung function failure), you don’t know if it’s safe to do CPR. Yet there is some guilt about not following the principles of ethics − and just standing by, watching but not helping.

Of course, it is imperative to immediately call for an ambulance and professional medical help. But then what do you do if help takes a long time to arrive?

Most CPR courses and certification programs would teach you about the risks and benefits of CPR on old people. In many cases the risks of CPR on those past 70 years far outweighs the benefits. If you are not yet formally trained in CPR practices, we hope this article we have written will serve as primary information for you to know about the pros and cons of CPR for elders.

 

What research says about CPR for the aged

Shereen Jegtvig of Reuters Health reports a study led by Dr. Dionne Frijns, a geriatric medicine researcher at Diakonessenhuis Hospital in Utrecht, the Netherlands.

In this research, they found that about 40 percent of the patients studied had successful CPR (i.e., they had a “return of spontaneous circulation”) − but more than half of those patients ultimately died in the hospital.

For patients aged 70 to 79, the rate of survival to discharge was about 19 percent, for patients aged 80 to 89, the rate was 15 percent and less than 12 percent of patients over the age of 90 were eventually discharged.

Another study paper titled “Quality of life after in-hospital cardiopulmonary resuscitation for patients over the age of 80 years” (published in the Postgraduate Medical Journal and authored by Eleanor Burden et al) makes a very important point about CPR for patients in the high age groups.

To quote the authors: “Our results have shown that there is a risk of substantial functional decline associated with successful CPR in those patients over the age of 80 years. The majority of patients and relatives contacted after successful resuscitation expressed a negative view of the experience. Our study highlights the importance of having early informed discussions with patients and families about CPR in order to avoid detrimental outcomes and ensure patient wishes are correctly represented.”

 

CPR can actually hurt the elderly quite seriously

Quite often, we all see on TV serials how a young person “did the right thing” and saved a senior person’s life after a heart attack with unrelenting CPR. The aggressive compressions and rescue breathing seem heroic. But this kind of dramatic scene is not what may happen in real life.

In real life, the CPR process can actually be brutal on the seniors, as some geriatric specialists explain – and besides, the survival rates are low.

CPR means pushing down into the chest at least 2 inches deep and at least 100 -120 times per minute. With the addition of rescue breathing (especially with apparatus like bag masks) air has to be forced hard into the frail patient’s lungs.

Then, when medical help arrives, an AED (Automated External Defibrillator) may be used to give electrical shocks, or defibrillation, to help the heart re-establish an effective rhythm.

Even if all this CPR is successful, the post-CPR trauma to senior citizens often includes broken ribs, bruised lungs, airway damage, and at times, even internal bleeding.

 

The aged who are least likely to benefit from CPR

UCLA Health have on their website a valuable guide developed by Coalition for Compassionate Care of California. This PDF guide has listed those among the older population least likely to benefit from CPR. Here are the categories of people they have identified:

    1. The risks of CPR increase as patients’ ages increase. The older a patient is the less chances of CPR survival.
    2. Most older adults do not have the type of heart rhythm that responds to CPR (and subsequent AED defibrillation). Experts differentiate between “shockable heart rhythm” and “non-shockable heart rhythm” and patients of advanced age usually fall into the second condition. So, CPR and AED doesn’t have as good an effect on restoring their heartbeats.
    3. Those age-progressed patients with pre-existing chronic diseases of the heart, lungs, brain or kidneys may have far lower chances of survival after cardiac arrest and subsequent CPR.
    4. Senior people who have advanced stages of dementia have three times lower CPR survival rates than those without dementia.
    5. Older people in terminal stages of cancer have CPR survival rates of lower than 1 percent.
    6. Many of the patients of advanced age may already be close to death due to progressive organ failure. In such cases, their bodies may not have sufficient reserves to handle the lack of oxygen that occurs with cardiac arrest. Thus, despite CPR attempts, their hearts may not be able to respond by pumping blood effectively.

 

Helping seniors understand or opt for the DNR concept

There is a compassionate concept in many Western countries called DNR (“Do Not Rescue”) whereby very old patients, their families and their doctors can all discuss and let the patient make an important decision.

The patients are told of all the risks and benefits of CPR – especially about how the risks may outweigh the benefits in terms of damage to vital organs of the body or possible brain impairment or drastic reduction in quality of life after CPR. The patients are then allowed to make a choice to opt for DNR.

Opting for DNR means that the elder person signs a legal consent to not be given CPR if found in cardiac or pulmonary distress, and if they stop breathing or if their heart stops beating. By default, people around the patient are mandated by law and ethics to try and give CPR. But if the patient has signed the DNR (and wears a DNR bracelet) bystanders or medical professionals will know they do not want to be give torturous CPR.

(Note: Patients can change their mind at any time and update their consent forms as needed.)

It’s important to note that opting for the DNR is a decision ONLY about CPR (cardiopulmonary resuscitation). It is not a consent to stop any other treatments, such as pain medicine, other medicines, or nutrition.

In India, some initiatives have begun towards introducing the DNR concept, although it is all in a nascent form. The Science Section of the online newsmagazine, TheWire.in, in an article titled “New ‘Don’t Attempt Resuscitation’ Rules Don’t Guarantee Right to Dignified Death” by Dr. Saif Razvi, states that in May 2020, the Indian Council of Medical Research (ICMR) published its long-awaited ‘do-not-attempt resuscitation’ (DNA-R) guidelines.

A beginning has been made, even if we have to go a long way yet in converting this initiative into usable law.

 

In summary …

With the people of advanced age, it is sometimes more humane not to give CPR. Formal training in CPR best practices helps you know what to do. Here’s our clarion call you too can follow: “Be a Zinda Dil. Learn CPR. Save Lives.”

 


 

References:

    1. Jegtvig, Shereen. Reuters Health. “For elderly hospital patients, CPR often has poor outcome: study.” Accessed August 27, 2022. https://www.reuters.com/article/us-cpr-survival-elderly-idUSKBN0DP1IH20140509
    2. Burden E., Pollock L. and Paget C. Postgraduate Medical Journal 2020. “Quality of life after in-hospital cardiopulmonary resuscitation for patients over the age of 80 years.” Accessed August 27, 2022. https://pmj.bmj.com/content/96/1134/186
    3. UCLA Health. “CPR/DNR.” Accessed August 27, 2022. https://www.uclahealth.org/palliative-care/Workfiles/CPR-Decision-Making-Guide.pdf
    4. Razvi, Saif. Science – The Wire. “New ‘Don’t Attempt Resuscitation’ Rules Don’t Guarantee Right to Dignified Death.” Accessed August 27, 2022. https://science.thewire.in/health/icmr-do-not-attempt-resuscitation-guidelines-right-to-dignified-death/

 

Categories
CPR

CPR For General Adults: Processes, Protocols, Ethical Points

One question that always perplexes people is why seemingly healthy adults suddenly get heart attacks (or cardiac arrests). This question occurs even more strongly to us when we witness someone who appears completely normal and then collapses in front of us in a public space and seems to need urgent CPR to stay alive.

There is a belief prevalent among most medical writers that “a heart attack strikes someone about every 34 seconds”. How old this information is and whether it is still valid today is anyone’s guess … but given today’s lifestyles, many adults, much younger than we expect, have sudden heart attacks. And the numbers of sudden cardiac attacks are clearly on the rise.

In men, the risk for heart attack is said to increase significantly after age 45. In women, heart attacks are believed to be more likely to occur after age 50. But these kinds of numbers again demand a review.

Young men and women, even those just past their twenties or thirties, who seem to be otherwise fit and healthy, and who go to their gyms regularly, seem to keel over with sudden cardiac arrest that calls for immediate first-aid to make them survive. All this underscores the idea that more and more people need to learn CPR.

 

Adult CPR and its standard techniques

When you, as a bystander (with or without formal life-support training), see that an adult man or woman has had a sudden reason to collapse to the ground unconscious, the two things to check instantly are if the person is breathing and has a beating pulse.

If the breathing has stopped, it could be a lung failure (pulmonary arrest) … and if the pulse isn’t beating, it could be a heart attack (cardiac arrest). If both conditions of no-breathing and no-pulse occur, here’s what you need to do, according to HealthDirect (Government of Australia):

 

1. Get someone to call for an ambulance and medical aid

Once you get help making that emergency call to the nearest medical services or hospital, see if the patient is in the right and safe place for CPR. If you have to deal with a patient who is heavier than you, get help to move the patient to a safer place, away from traffic and crowds, to begin a CPR routine without delay.

 

2. If the patient is breathing but has no pulse, here’s what to do

Kneel by the patient’s side, press the lower part of the palm of your one hand on the patient’s chest (between the nipples) and clutch this hand with your other palm.

Then start compressing the chest, pumping in at least 2 inches deep, and relax a bit to let the chest rise back to position. Then compress again and let the chest return to position.

You have to do 100-120 such compressions per minute (you can time your compression frequency to the beat of the song “Stayin’ Alive” by the Bee Gees).

 

3. If the patient has no pulse and also no breathing, follow this sequence

You must do 30 chest compressions, then tilt the patient’s face and chin up to open the airway − and with your mouth over the patient’s mouth, you have to breathe air out of your lungs into the patient’s lungs.

Do 2 such “rescue breaths” (1 second each) with a bit of a gap to let the chest rise in between.

This process is a sequence … 30 chest compressions, face/chin tilt-up, 2 rescue breaths … then again 30 chest compressions, face/chin tilt-up, 2 rescue breaths … and so on.

 

4. Continue your CPR till professional medical help arrives

Yes, CPR is exhausting, and you never know how long you will have to persevere at such a fast tempo of compressions and rescue breaths till the ambulance and the medical experts arrive. That’s why it is vital to get someone to call the medicos even before you begin CPR so that you can get trained help on the scene as fast as possible.

 

5. If there are two people available, do CPR as a team

One person must do the chest compressions, and the other must give the rescue breaths. After 5 repeats of the whole process (i.e., 5 cycles), the two rescuers need to switch roles – so that neither of them gets fatigued before medical help arrives.

This is basic CPR to know and perform to save an adult with cardiac arrest.

 

The concept of the “chain of survival”

While being familiar with rudimentary CPR is essential for anyone, it helps further to know the “Chain of Survival” concept. What is this concept?

According to the Sudden Cardiac Arrest Foundation, the “Chain of Survival” refers to the sequence of actions rescuers must follow in rapid succession to maximize the chances of survival of general adult patients who suffer from sudden cardiac arrest. The standard “Chain of Survival” protocol has been evolved by the American Heart Association and is followed by the entire medical fraternity.

The “Chain of Survival” process is slightly different if followed in-hospital versus outside-hospital. The outside-hospital process consists of six steps:

 

    1. Activate emergency services. Make that call for an ambulance and medical help before all else.
    2. Provide high-quality CPR – do your best without let up until medical help arrives.
    3. When medical help arrives, they will bring an AED device. An AED (Automated External Defibrillator) is a sophisticated yet easy-to-use device that can analyze the heart’s rhythm and, if necessary, deliver an electrical shock, or defibrillation, to help the heart re-establish an effective rhythm.
    4. The medical team will then decide when it is the right moment to transfer the patient to the hospital for advanced resuscitation.
    5. The next process will be post-arrest cardiac care at the hospital.
    6. All the in-hospital patient recovery procedures will follow at this stage.

 

Bystanders can help save lives by addressing the first two links in the Chain of Survival – or at the most, be of help through the third stage. The rest of the chain is all in the hands of professional medical staff.

 

Ethical issues concerning bystander CPR

The CPR Consultants Training Center (authorized by the American Heart Association) states that there can be many occasions when bystanders are afraid to try CPR − and may even get stymied or refuse to give help to a patient who has fallen from a cardiac arrest.

Often, big-built male rescuers may feel afraid they may harm the female patient or crack her ribs if she is of a slight build. Or contrarily, small-built female rescuers may feel inadequate for the deep CPR compressions needed when the patient is an adult male of big build.

But it is considered unethical – even unlawful – in many countries worldwide to refuse to help, whatever the reason. This is because doctors believe it is everyone’s bounden duty to help, whether their CPR skills are great or not.

In the US, for instance, Good Samaritan Laws mandate that if you are near a patient who needs urgent CPR, you have to help.

That’s why knowing CPR and getting trained and certified in it is critical. This is important even in countries where the laws and ethics aren’t so strongly articulated.

 

In summary …

It’s humane to help. Would you not want some CPR help – good or bad – if you were the cardiac arrest patient? Here’s our clarion call you too can follow: “Be a Zinda Dil. Learn CPR. Save Lives.”

 


 

References:

    1. HealthDirect. “How to perform CPR.” Accessed August 25, 2022. https://www.healthdirect.gov.au/how-to-perform-cpr
    2. Sudden Cardiac Arrest Foundation. “The Chain of Survival from Sudden Cardiac Arrest.” Accessed August 25, 2022. https://www.sca-aware.org/campus/the-chain-of-survival
    3. CPR Consultants Training Center. “Problems with CPR.” Accessed August 25, 2022. https://www.cprconsultants.com/problems-with-cpr/

 

Categories
CPR

One Person CPR And Two Person CPR: Differences In Technique

Imagine this scenario. You are among a group of friends shopping at a mall when suddenly a slightly older adult near you collapses to the floor with what seems like a heart attack.

Since your group is closest to the fallen person, you are all moved to help immediately. One of you checks if the person is still breathing, but he is not. Another of you checks his pulse to see if it’s beating, but it’s not. You all know CPR is desperately needed to be given to the patient. What do you do? Here’s what you need to start with.

One of you has to be designated to call the ambulance as fast as possible and be on the lookout for professional help’s arrival. Another one of you needs to keep the crowds away from the patient to provide enough ventilation and space for his safety and comfort. The most confident two in your group need to start CPR, pronto.

How do you do the two person CPR technique, and how does it differ from the basic one person CPR technique? Let’s find out.

 

The basic one person CPR technique

Let’s visit the basic one person CPR technique first, so we can then gauge how the two person CPR technique will be different. The steps to follow for the one person CPR technique are these:

 

    1. Check if the patient is in a safe place, and place the patient’s body in a face-up, stomach-up sleeping position − for access to the patient’s chest, face, nose, throat, and mouth.
    2. Check if the patient is breathing. If there is no breathing, it could indicate respiratory or lung failure (pulmonary arrest). Then check if a pulse is beating at the patient’s wrists and neck. There could have been a heart attack (cardiac arrest) if there is no pulse.
    3. Get ready to do the CPR. Kneel beside the patient and press the heel (lower part) of the palm of one hand on the patient’s chest between the nipples. Clutch the other palm over the first one. Then, bearing down with the weight and pressure of your arms and whole body, begin compressions on the patient’s chest.
    4. Each compression must be at least 2 inches deep, with a small release gap to let the chest rise back to position. Then the next compression-and-release should follow …and the next one … and so on.
    5. Keep on with the compressions at a rate of about 100-120 compressions per minute. If you hum the song “Stayin’ Alive” by the Bee Gees, your compressing frequency and rhythm will be correct.
    6. All this is good if the patient has no pulse but is still breathing. But if the breathing has also stopped, you need to breathe for the patient. So, the technique changes a bit.
    7. Give 30 compressions on the chest. Then tilt the head and chin of the patient upward to open the airway. Put your mouth over the patient’s mouth and breathe out from your lungs into the patient’s lungs.
    8. Make it a deep and long breath of at least a second or two. Give a small gap for the chest to rise … and breathe again. This is called rescue breathing (or mouth-to-mouth resuscitation). You need to stop after two such breaths and go back to chest compressions again.
    9. Follow this sequence … 30 chest compressions, head and chin tilt-up, and 2 rescue breaths … then again 30 chest compressions, head and chin tilt-up, and 2 rescue breaths … you must keep at this till medical help arrives.
    10. One person CPR can be tough and exhausting, but it’s critical. If at any time you let up, and there is a gap longer than 4-8 minutes, the brain can become irreparably damaged, and the patient could die due to insufficient blood going to the brain.

 

The basic two person CPR technique

The process for the two person CPR technique is the same, except for these changes:

 

    1. One of the rescuers must be positioned near the chest area while the other one is positioned near the head of the victim. This arrangement allows quick position changes.
    2. The person positioned near the patient’s chest must do the 30 chest compressions, while the other rescuer (positioned near the patient’s head) is in charge of the head and chin tilt-up and the two rescue breaths to be given.
    3. The process must go on without a break for 5 cycles (i.e., each cycle consisting of 30 chest compressions by one rescuer, with the head-and chin tilt-up, and 2 rescue breaths from the other rescuer).
    4. At the end of 5 cycles, the two rescuers must exchange places, and the one who was doing the breathing now should do the compressions, while the other does the rescue breaths.

 

4 most-asked queries on One Person CPR vs. Two Person CPR

Naturally, there has to be a great deal of coordination if the two person CPR technique has to be used.

The good side of it is that when two people help, the task feels easier, and the rescuers don’t get fatigued quickly. They can keep going on at a steady pace for a longer time till professional medical help arrives.

On the flip side, the two person CPR technique can give room for lots of confusion if the two rescuers are both amateurs and don’t have a smooth protocol to follow.

The 4 most-asked queries of two person rescue teams are below – with their answers. Reading these can help when a two person CPR routine needs to be followed without glitches.

 

1. What is the advantage of two person CPR over one person CPR?

According to Barbara Jackson, a CPR expert writing on the CPR Certification Online HQ site, “Two person CPR is more efficient due to one person performing compressions and another giving breaths. It’s not as tiring, and there’s less of a delay between compressions and breaths. Therefore, it’s more efficient, and it’s more effective.”

 

2. When doing two person CPR, which rescuer decides the frequency of compressions and sets the rhythm?

The Advanced Medical Certification Course states that when performing two person CPR, the rescuer doing the compressions must quickly review and set the tempo for the compression ratio, and the rescuer doing the breathing must follow that cue. It would help a lot if the rescuer doing the compressions counted the compressions out aloud.

 

3. When switching positions in a two person CPR rescue, who calls for the switch?

The Online CPR Certification website (of the American Academy of CPR & First Aid) advises that the rescuer who is not performing the compressions should immediately stand up near the head of the victim, when the two rescue breaths have been given. This allows quick position changes without any interruption in the rhythm. The person performing the CPR compressions should say “switch” when it’s the other rescuer’s turn. This gives the other rescuer the cue to get into a position to perform CPR.

 

4. What is the correct way to switch positions between the two rescuers?

Medcourse.in states that the first rescuer should go to the head end and the second rescuer should come for compressions. This switch should occur fast, and the two rescuers should not cross over. The rescuer at the head end should go to the free side of the patient, not to the side of the first rescuer. The maximum changeover time can be five seconds − no more than that.

 

In summary …

It’s always good to learn both − one person CPR and two person CPR techniques. Here’s our clarion call you too can follow: “Be a Zinda Dil. Learn CPR. Save Lives.”

 


 

References:

    1. Jackson, Barbara. CPR Certification Online HQ. “Two-Person/Rescuer CPR Approach.” Accessed August 20, 2022. https://www.cprcertificationonlinehq.com/blog/two-person-cpr-method
    2. Advanced Medical Certification. “Two Rescuer BLS For Adults.” Accessed August 20, 2022. https://advancedmedicalcertification.com/lesson/two-rescuer-adult-bls-acls-online-handbook/
    3. American Academy Of CPR And First Aid, Inc. “What is a Two-Person CPR Method?.” Accessed August 20, 2022. https://www.onlinecprcertification.net/blog/what-is-a-two-person-cpr-method/
    4. Medcourse. “Two rescuer Adult BLS.” Accessed August 20, 2022. https://medcourse.in/lesson/two-rescuer-adult-bls/

 

Categories
CPR

When To Start CPR And When To Stop CPR: Learn The Nuances

It’s never enough to know what CPR (Cardiopulmonary Resuscitation) is or how it is done. Quite often, many small extra doubts occur to people who want to help patients who’ve suffered heart attacks or respiratory failure.

Prime among these doubts is when to start CPR. What signals do you look for to know it’s the right time to begin? And the other doubt is when to stop CPR. When should you hand it over to the experts or give it up?

Apart from this, rescue givers may find themselves wondering about a whole host of CPR-related nuances.

We have collated the top 6 questions most people ask about the finer details of the CPR process. Knowing these answers makes you better equipped to help and more confident.

 

When to start CPR

According to an article by Paul Martin in ProCPR.org, a website dedicated to CPR training, lay people may be somewhat fearful of judging whether or not CPR is required in an emergency when a patient has collapsed from a heart attack or respiratory failure. It would help if you looked for the following signs:

 

1. See if the patient has stopped breathing

If the fallen person is not breathing, it’s time to perform CPR immediately to start circulating oxygenated blood through the body. Remember, without blood flow, the heart stops beating, and the brain begins to die. If you start CPR within that critical time frame of 4-8 minutes after a cardiac or pulmonary arrest, there is hope that a person can survive without much brain damage.

 

2. See if the patient is taking occasional gasping breaths

When someone goes into cardiac arrest, they may continue to breathe for a while. Breathing may not stop, but it may become difficult or sound like short grunts. CPR compressions should be started immediately if the patient is occasionally gasping for breath.

 

3. Check if the patient’s heart has stopped beating

If you cannot feel a pulse, either at the patient’s wrists or the neck, begin performing CPR without delay. If the heart isn’t pumping, oxygen is not getting to the rest of the body. Your CPR chest compressions can keep blood flowing to the heart and brain until emergency medical teams can arrive, take over, and try other resuscitation methods.

 

4. Check if the patient is unconscious or unresponsive

Experts recommend that you should begin CPR if the person is unconscious or unresponsive. Don’t wait to know why the person is unconscious or unresponsive. Get to work on the CPR quickly. Perhaps you may wonder if doing CPR is risky when it’s unnecessary. But it is far less risky than not doing CPR when needed.

 

When to stop CPR

Sharecare.com, the sharing platform of the American Red Cross, suggests four conditions when you can stop CPR. Notice that these do not call on you to use your judgment on whether the patient has survived. That is a doctor’s call to make. There are four situations when you should consider stopping CPR …

 

1. You see an obvious sign of life, such as breathing

It’s essential to see if the patient’s breathing is steady and a pulse is regularly beating to a steady rhythm before you stop the CPR to wait for medical help. Keep the patient’s airway open by lifting his chin from his throat. Continue to monitor the person’s breathing and pulse for any changes in the person’s condition until emergency medical personnel take over. If the breathing and pulse seem shaky, don’t stop the CPR.

 

2. A trained medical responder has arrived with an AED

You can give up your CPR efforts if medical help arrives with an AED (an Automated External Defibrillator). This is a sophisticated but easy-to-use medical device. It can analyze the heart’s rhythm, and, if needed, deliver an electrical shock (or defibrillation) to help the heart re-establish an effective rhythm. It calls for trained professionals to use AEDs, which are more effective than just CPR.

 

3. You are too exhausted to continue giving good CPR

There could be times during CPR when you get physically exhausted to continue, and the quality of the compressions you can give wanes in effectiveness. It’s better in such cases to get another person nearby to provide the CPR with your instructions, and you recover from your fatigue. Get someone else to help till you catch your breath and can begin again.

 

4. The scene becomes unsafe for you to continue with CPR

Sometimes the scene where the patient has fallen becomes an unsafe place to continue with CPR. This happens when the weather changes to a dangerous level, or the traffic and crowds surrounding the area start swelling. The patient’s fall may sometimes cause a local stampede if the moving crowds are suddenly halted. In such cases, carry the patient as fast as possible to a safe place to continue with the CPR.

 

6 most-asked queries on the nuances of CPR – and their answers

 

1. Do you give CPR if there is a pulse but no breathing?

According to 123CPR.com, they advise that if the patient has a pulse but is not breathing adequately, provide ventilation without compressions. Give rescue breathing before you think of compressions.

 

2. Do you give CPR if someone is breathing?

VeryWellHealth.com, in an article by Rod Brouhard, states that if a heart attack patient seems to be gasping for breath, those gasps can sound like snoring, snorting, or difficult breathing. It’s called “agonal breathing.” Although it sounds scary, it could be a good sign for the victim’s survival if CPR is given immediately.

 

3. Do patients feel pain during CPR?

According to Sarver Heart Center, Arizona, patients may feel definite discomfort during CPR – like pressure, squeezing, fullness, or even pain. The pain can radiate to other areas of the upper body such as the arms, the back, neck, jaw, or upper stomach.

 

4. Does CPR break ribs?

FirstSupportCPR.com confirms that approximately 30% of patients receiving CPR may suffer rib fractures or bone breaks. CPR has to apply compressions that are at least 2 inches deep and at the rate of 100 -120 compressions per minute. Ribs may break while performing CPR, but when trying to save a person’s life, a broken rib or two is not what doctors worry about.

 

5. How long can CPR keep someone alive?

WebMD.com, in an article by Serena Gordon, cites Japanese research that shows that performing CPR for 30 minutes, 45 minutes, and even an hour gives patients the best chance of survival.

 

6. Does your brain get oxygen during CPR?

Research studies by NYU Langone Health state, “Even when performed under optimal conditions, conventional CPR rarely circulates enough oxygen to the brain.” Yet some oxygen is better than no oxygen. There is not yet a foolproof way to monitor the quality of brain resuscitation during CPR. A lot of research, though, is ongoing in this area.

 

In summary …

The more you know about the finer details of CPR, the more confident you’ll be when administering it to someone in need. Here’s our clarion call you too can follow: “Be a Zinda Dil. Learn CPR. Save Lives.”

 


 

References:

    1. Martin, Paul. ProCPR. “When to Perform CPR – How to Tell if Someone Needs CPR.” Accessed August 20, 2022. https://www.procpr.org/blog/training/when-to-perform-cpr
    2. ShareCare. “When can I stop performing CPR on an adult?.” Accessed August 20, 2022. https://www.sharecare.com/health/first-aid-techniques/when-stop-cpr-on-adult
    3. 123CPR. “CPR.” Accessed August 20, 2022. https://123cpr.com/cpr_pro.php?page=cpr
    4. Brouhard, Rod. Very Well Health. “Should You Perform CPR on Some Who Is Gasping or Unconscious?.” Accessed August 20, 2022. https://www.verywellhealth.com/performing-cpr-on-gasping-victims-first-aid-1298461
    5. Sarver Heart Center. “Frequently Asked Questions about Chest-Compression-Only CPR.” Accessed August 20, 2022. https://heart.arizona.edu/heart-health/learn-cpr/frequently-asked-questions-about-chest-compression-only-cpr
    6. First Support CPR and First Aid Training. “Broken Ribs During CPR.” Accessed August 20, 2022. https://firstsupportcpr.com/2021/05/31/broken-ribs-during-cpr/
    7. Gordon, Serena. WebMD. “Giving CPR for More Than 30 Minutes May Be Worth It.” Accessed August 20, 2022. https://www.webmd.com/heart/news/20131116/giving-cpr-for-more-than-30-minutes-may-be-worth-it#1
    8. NYU Langone Health. “Monitoring the Effectiveness of Brain Resuscitation in Real Time.” Accessed August 20, 2022. https://med.nyu.edu/research/parnia-lab/research-studies/monitoring-the-effectiveness-brain-resuscitation-real-time

 

Categories
CPR

CPR Techniques That Can Save Lives: Explained Step By Step

If there is one skill in life that is absolutely critical to learn, it is CPR (Cardiopulmonary Resuscitation). It’s the technique you use to save the life of someone in the crucial moments just after they’ve had a cardiac arrest (heart attack) or a respiratory arrest (lung failure).

Life hovers close to death in the minutes that immediately follow these heart and lung stoppages. Anyone nearby, whether trained in CPR or not, has to have the minimum basic knowledge to do what’s needed to save the fallen human’s life in such a touch-and-go situation.

Of course, getting formally trained and certified in CPR is always better because your rescue actions will be not only confident but also perfect. But in the absence of formal training, it’s still better to know what must be done and get going with your basic knowledge.

Read through this article, and get the familiarity you need to be able to help someone hanging between life and death after a cardiac or pulmonary arrest. But promise yourself to get formally trained as soon as you can find the time. There are excellent online courses and certifications you can take.

 

Steps to take before you begin CPR on a needy patient

There are a few steps to urgently take before you decide whether someone who has collapsed needs CPR or not. According to an article by the staff of Mayo Clinic you must follow these processes one after the other.

    1. Make sure the fallen person is moved to a safe environment. Move the patient away from traffic and crowds, and see that there is shade and enough air circulation.
    2. See if the person is conscious or unconscious. See if the person is breathing. If the person seems to have stopped breathing, go to the next step.
    3. Use the “tap-shout-tap” method that the Red Cross recommends. Tap the person’s shoulder, shout, “Are you okay?” and tap again. If there’s still no response, don’t keep on trying. Go on to the next step.
    4. Look for a beating pulse in the person’s wrist or neck. If there’s no pulse, do not wait longer than 10 seconds. Get someone nearby to call an ambulance IMMEDIATELY.
    5. And then ready yourself to begin CPR without delay.

Remember to call an ambulance before CPR because you can’t know how long you have to do CPR to get the person’s stopped heart or lungs to revive. You must do what you can to beckon professional medical help as fast as possible before you begin CPR.

 

The chest compression technique and its nuances

According to the American Heart Association (AHA) guidelines, here’s how compressions are begun and given.

    1. Position yourself to the patient’s side, and kneel on the ground.
    2. Place the heel (lower part) of one hand’s palm on the patient’s chest, between the nipples.
    3. Place your other hand on top of the first hand. Keep your elbows straight and position your shoulders above your hands to apply maximum pressure.
    4. Using your hands and body weight, pump down on the patient’s chest to a depth of about 2 inches, and then release until the chest bounces back to normal position. Compress again and let go. This is the compression technique.
    5. With every compress, you imitate how the heart pumps blood. You must aim to do at least 100 to 120 compressions a minute without letting up.
    6. Experts suggest that you mentally pump to the rhythm of the famous song “Stayin’ Alive” by the Bee Gees. The song’s beat will give you the correct timing of compresses.
    7. Even as you continue with the compresses unabated, look for signs of the patient’s revival or keep going.

If the patient has a stopped heart (cardiac arrest), the above process of compressing alone would do. But if the patient has also stopped breathing (indicating respiratory arrest), you need a slight variation of the technique above. This is what we will explain next.

 

When rescue breathing is needed and how to perform it

To get the patient to breathe again (even as you are getting the patient’s heart to beat again with compressions), you need to stop after every 30 compressions and do the rescue-breathing process.

A medically reviewed article in VeryWellHealth.com by Rod Brouhard, explains this process in good detail.

    1. First, move the patient’s head and chin to a position where you can best breathe into the patient’s lungs through the patient’s mouth. The “head-tilt, chin-lift” process (explained below) opens the person’s airway.
    2. Put your palm on the person’s forehead and gently tilt the head back. Then with your other hand, lift the person’s chin forward and up. This opens up the person’s airway. By raising the chin, you free the airway between the chin and the throat.
    3. Close the patient’s nostrils by pinching with your fingers, and put your mouth over the patient’s mouth.
    4. Breath out deep to fill the patient’s lungs with air from your lungs. Breathe for at least a second, and after the first breath, wait to see if the patient’s chest rises, then do a second breath.

Remember, this is not about stopping the chest compressions and doing only the rescue breathing. You have to follow the whole procedure in a sequence … 30 chest compressions, followed by the head-tilt/chin-lift, and two rescue breaths … then again 30 chest compressions, followed by the head-tilt/chin-lift, and two rescue breaths … and so on.

Check if either the heart revives or the breathing revives. If there is no response, continue till help arrives. Don’t let up.

Medical News Today, in an article by Amanda Barrell, states there is just an 8-minute window to save a patient’s life after a cardiac or pulmonary arrest. If oxygenated blood does not reach the brain in 8 minutes, it can cause irreparable damage and death.

 

Is rescue breathing safe for the patient and the rescue-giver?

There are a couple of questions people usually ask about rescue breathing. Here are their answers:

 

1. During rescue breathing, are you not pushing carbon dioxide (instead of oxygen) into the patient’s lungs if you are breathing out?

In their book titled “Basic Life Support Providers’ Manual” (Medical Creations, 2021), the authors M. Mastenbjörk M.D. and S. Meloni M.D. agree that rescue breathing does use your exhaled air. This air primarily consists of carbon dioxide, for sure. Nevertheless, it also contains all the oxygen your body did not use.

This unused oxygen can constitute nearly 17% of the exhaled air. This much oxygen, the authors state, is at least enough to keep life going in the patient until professional help takes over.

 

2. Is it safe to give mouth-to-mouth resuscitation at a time like now, when we still have the prevalence of Covid-19?

According to a press release by the American Heart Association (AHA), their guidelines for persons giving CPR changed after the Covid-19 pandemic.

The new guidelines advise healthcare workers to mandatorily wear an N95 mask, along with other personal protective equipment (PPE) like a gown, gloves, and eye protection, when performing CPR on people with suspected or confirmed Covid-19. They must also perform rescue breathing using a bag-mask device with a high-efficiency particulate air (HEPA) filter.

Members of the public also should wear at least a well-fitting mask when doing CPR and use the compression technique alone. Avoid rescue breathing.

 

In summary …

It’s time for all of us, whichever walk of life we come from, to learn what’s needed to help anyone in a life-and-death situation. Here’s our clarion call you too can follow: “Be a Zinda Dil. Learn CPR. Save Lives.”

 


 

References:

    1. Mayo Clinic. “Cardiopulmonary resuscitation (CPR): First aid.” Accessed August 14, 2022. https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600
    2. American Red Cross Training Services. “CPR Steps.” Accessed August 14, 2022. https://www.redcross.org/take-a-class/cpr/performing-cpr/cpr-steps
    3. American Heart Association CPR & First Aid Emergency Cardiovascular Care. “Hands-Only CPR Resources.” Accessed August 14, 2022. https://cpr.heart.org/en/cpr-courses-and-kits/hands-only-cpr/hands-only-cpr-resources
    4. Brouhard, Rod. Very Well Health. “How to Perform Rescue Breathing.” Accessed August 14, 2022. https://www.verywellhealth.com/rescue-breathing-steps-1298448
    5. Barrell, Amanda. Medical News Today. “CPR steps: A visual guide.” Accessed August 14, 2022. https://www.medicalnewstoday.com/articles/324712
    6. Mastenbjörk, Martin and Meloni, Sabrina. Basic Life Support Providers Manual. (Las Vegas: Medical Creations, 2021), Kindle.
    7. American Heart Association Newsroom. “New CPR guidance addresses more contagious COVID-19 variants amidst evolving pandemic.” Accessed August 14, 2022. https://newsroom.heart.org/news/new-cpr-guidance-addresses-more-contagious-covid-19-variants-amidst-evolving-pandemic

 

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CPR

What Is CPR For Medical Emergencies? Why Is It So Important?

Imagine this happening. A person of about 50 years suddenly collapses in the middle of the pavement as he moves around. People around, flustered, don’t know if he’s just unconscious or worse. They try to locate his pulse but feel nothing.

Does he have a heart attack? Someone calls for an ambulance. But how long will it take for the trained first responders to arrive? And what must bystanders do till then?

This kind of scenario happens so often that there is a medical protocol for trained − or even lay people − to help save the precious minutes of the fallen person’s life when his life may be saved.

The procedure by which anyone can try to keep the person alive till trained help arrives is called Cardiopulmonary Resuscitation (or CPR). Of course, everyone needs to learn this critical type of first aid formally. But even if you’ve had no formal training, you can still help.

Learn more about CPR − and who knows how many lives you may help save with your alacrity and immediate response of the correct kind.

 

What exactly is CPR (or Cardiopulmonary Resuscitation)?

Since many cardiac arrest cases (heart attacks) could happen when people are alone in areas far away from home or hospital, some important medical bodies have joined together to form a universally acceptable CPR regimen to follow for helping fallen patients.

The instructions and training methods for Cardiopulmonary Resuscitation (CPR) have been devised based on an extensive review of the evidence performed by the International Liaison Committee on Resuscitation (ILCOR) and are published jointly by ILCOR, the American Heart Association (AHA), and the European Resuscitation Council (ERC).

The International Red Cross (and Red Crescent) follow the same standard protocol worldwide.

This life-saving CPR methodology is a boon for people who needn’t watch desperately as they witness someone collapsing with what seems like a heart attack. If they know the broad CPR guidelines, they can pitch in and help in the crucial life-reviving moments till formal help arrives.

 

Why is CPR so life-critical in medical emergencies?

To understand how CPR helps, we must first understand what happens to the human body when a person has a cardiac or pulmonary arrest.

According to a medically-reviewed article in VeryWellHealth.com by Rod Bouhard, the heart and lungs are the two organs most important for human survival. The heart pumps blood into the lungs, where it is purified with oxygen and then returned to the heart for circulation through the rest of the body, most importantly, the brain.

This heart-lung tandem can get stopped suddenly and become life-threatening in two ways:

    1. Cardiac arrest can happen when the heart suddenly stops, Blood does not reach the brain causing loss of consciousness, and if this situation prolongs beyond 8 minutes, the patient dies.
    2. Respiratory arrest can happen when the lungs suddenly stop functioning. Breathing stops. Thereby, blood fails to get oxygenated, causing damage to the brain and body. A respiratory arrest will always lead to cardiac arrest (and death) if nothing is done to treat it.

In cardiac arrest cases, the idea behind CPR is to use chest compressions to imitate how the heart pumps. This could help revive the stopped heart or at least keep blood flowing throughout the body. In the case of lung stoppage, if some rescue-breathing is given to the patient through mouth-to-mouth resuscitation, it could help revive respiratory arrest.

The important thing is this: we can never say how long CPR needs to be given to revive the heart or lungs of a fallen patient. CPR is a challenging and exhausting procedure for the help-giver. Since every second is critical, it’s essential to call an ambulance before starting CPR. The sooner trained medical help arrives, the better.

 

When should CPR be ideally used − and by whom?

If you’re ignorant of what’s involved in CPR, you may be afraid to do it to help a patient in dire need. But, remember, it’s always better to try (even with a bit of knowledge) than to do nothing at all. According to an article by the staff of Mayo Clinic, “The difference between doing something and doing nothing could be someone’s life.”

Everyone should be familiar with CPR, even if not formally trained. Here’s more advice on the different types of people with or without formal CPR training on how to help a needy patient.

 

For totally untrained people:

If you’re not trained in CPR or are worried about giving more advanced techniques like rescue breaths, then at least provide hands-on CPR.

You need to clutch your palms and fingers of both hands, one on top of the other, and apply physical pressure on the patient’s chest, giving the patient uninterrupted chest compressions. You should ideally give 100 to 120 compressions a minute until paramedics arrive.

You don’t need to try rescue breathing. To make sure you are pressing the chest with the right timing, follow your movements to the rhythms of some popular songs … like the children’s nursery rhyme, “Row, Row, Row Your Boat” − or the famous song “Stayin’ Alive” by the Bee Gees.

 

For fully trained people:

If you’re well-trained, certified, and confident in your CPR ability, start the CPR − and between every 30 chest compressions, give two rescue breaths. This is usually the taught protocol.

See that the patient is in a shady and safe area with enough space. If a crowd is gathered, get someone to ask them to move a little away from the patient.

But don’t ask people to disperse. If they see you in action, they too will learn from the experience of watching you.

 

For trained people who’ve not brushed up often on their skills:

You may have all the skills learned long ago, but your skills may be rusty. If you’re not confident in your abilities, just do the chest compressions at a rate of 100 to 120 compressions a minute. Avoid rescue breathing. Keep going till medical help arrives.

But, promise yourself to go back to retrain and be up-to-the-minute on your skills when you next get the opportunity. What is the value of your earlier training if it’s not much use when it is most needed?

 

How can CPR be learned? Online or only in person?

Considering CPR’s importance, very few people take the formal training and certification. Hospitals and medical bodies have taken several initiatives to heighten public awareness and to ask schools, colleges, offices, and businesses to introduce CPR training at their facilities to get more people formally trained and certified.

Apart from this, many people may not be aware that CPR can also be learned online. The online courses are usually less expensive, and they are self-paced.

For online courses, students may be asked to buy mannequins they can practice on, and then with the help of video instructions and other course materials, the courses would teach CPR methods in detail. In the end, students usually receive a certificate.

There are excellent in person and online courses from the Red Cross (and Red Crescent), the American Heart Association, the National CPR Foundation, and the American Academy of CPR and First Aid, among others.

Whichever way you choose to learn, in person or online, a follow-up refresher course is recommended at least every three years.

 

In summary …

Let’s all solemnly commit to learning what’s needed to help anyone in a life-and-death situation. Here’s our clarion call you too can follow: “Be a Zinda Dil. Learn CPR. Save Lives.”

 


 

References:

    1. ILCOR. “International Liaison Committee on Resuscitation.” Accessed August 14, 2022. https://www.ilcor.org/
    2. American Heart Association. “CPR & First Aid Emergency Cardiovascular Care.” Accessed August 14, 2022. https://cpr.heart.org/en/
    3. European Resuscitation Council. “European Resuscitation Council – Welcome.” Accessed August 14, 2022. https://www.erc.edu/
    4. International Committee of the Red Cross. “International Committee of the Red Cross – Home Page.” Accessed August 14, 2022. https://www.icrc.org/
    5. Brouhard, Rod. Very Well Health. “Differences Between Respiratory Arrest and Cardiac Arrest.” Accessed August 14, 2022. https://www.verywellhealth.com/respiratory-or-cardiac-arrest-1298194
    6. Mayo Clinic. “Cardiopulmonary resuscitation (CPR): First aid.” Accessed August 14, 2022. https://www.mayoclinic.org/first-aid/first-aid-cpr/basics/art-20056600
    7. American Red Cross Training Services. “CPR Training with Red Cross.” Accessed August 14, 2022. https://www.redcross.org/take-a-class/cpr
    8. National CPR Foundation. “CPR Certification Class.” Accessed August 14, 2022. https://www.nationalcprfoundation.com/courses/standard-cpr-aed/
    9. American Academy of CPR And First Aid, Inc. “CPR Certification and Free Online CPR AED & First Aid Certificate Training Course.” Accessed August 14, 2022. https://www.onlinecprcertification.net/

 

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Diseases Affecting The Heart – And Your Questions Answered

When we think of heart diseases, it’s common for most people to think only of heart attacks. This is probably because heart attacks are the direst consequences of heart disease and affect people when they least expect it.

What most of us don’t realize, though, is that heart attacks don’t just happen all of a sudden. Deep inside our bodies, there may have been a build-up of several stages of heart disease over a longer time – till things suddenly cross the threshold and cause the “unexpected” attack.

Many patients and their carers get taken aback when their doctors then tell them of the many causes of silent heart diseases and show them how they may have neglected their hearts all along, only to be taken by surprise by a sudden, severe, life-threatening cardiac malfunction.

Since knowledge is power, we dedicate this article to educating all our readers about the many ways our hearts can acquire and manifest heart disease. The sooner we become aware that we need to monitor our hearts regularly, the sooner we can take measures to prevent heart ailments from escalating into significant diseases.

FAQs on major ailments and conditions that can cause heart disease

One essential thing to know is that if you have a genetic predisposition to heart disease − or some serious ailments like obesity, cholesterol, diabetes, or hypertension – these factors seldom work alone on your heart. They combine to damage your heart with a multiplicative effect. That’s why we must begin by screening ourselves for our hearts by checking if we have any of these ailments singly or together.

1. How does genetics cause heart disease?

When a family passes its medical history and traits from one generation to another through genes, that process is called heredity. A lot of heart diseases can manifest as a result of genetic causes.

But even as genetics plays a part, CDC.gov states that families also share the same home environment and lifestyles. Their food habits may be common, and their attitude to healthy exercise may get passed on from one person to the other. When parents smoke and drink excessively or develop sedentary or stressful modes of living, children learn to follow these habits. Thus, they also develop similar mindsets and methods as their parents, and that may cause their latent genetic heart problems to manifest much earlier in life than expected.

This is one of the reasons why more and more younger people are showing early signs of heart disease.

2. How is obesity connected to heart disease?

A paper published by the National Library of Medicine explains how deeply, and in how many ways, obesity (or being overweight) can affect the heart.

They write: “Obesity is associated with an increased risk of developing cardiovascular disease (CVD), particularly heart failure (HF) and coronary heart disease (CHD). The mechanisms through which obesity increases CVD risk involve changes in body composition that can affect hemodynamics and alters heart structure.”

In other words, being overweight can affect not only your heart’s condition and health, but also its structure, and behavior. Your heart may cease to act as it should in a healthy body.

3. How does cholesterol affect the heart?

Cholesterol is often described as a waxy substance found in your blood. Your body needs cholesterol to build healthy cells. But there are two kinds of cholesterol. LDL cholesterol (low-density lipoprotein) is considered “bad cholesterol”, while HDL cholesterol (high-density lipoprotein) is considered “good cholesterol”.

Usually, the HDL or good cholesterol helps to wash away the bad LDL cholesterol from your bloodstream. But, if you allow yourself to have high LDL cholesterol levels you can develop fatty deposits in your blood vessels. These can even harden as plaque and restrict or block the blood flow in your arteries. At times, those cholesterol deposits can break suddenly and form a clot that causes a heart attack or stroke.

High cholesterol can be an inherited issue, but often people exacerbate the problem by unhealthy eating or inactive lifestyles. According to Mayo Clinic, high cholesterol has no symptoms. So a blood test is the only way to detect if you have it. And that could be the only way to help your heart too.

4. Why is diabetes a serious issue for the heart?

 

When you have diabetes, you’re more at risk of heart disease. But what is the exact connection? According to Diabetes UK: “If you have high blood sugar levels for some time, even slightly high, your blood vessels can start to get damaged, which can lead to serious heart complications. This is because your body can’t use all of this sugar properly, so more of it sticks to your red blood cells and builds up in your blood. This build-up can block and damage the vessels carrying blood to and from your heart, starving the heart of oxygen and nutrients.”

Therefore, they recommend that you stay as close as possible to your target “HbA1c level”. This helps protect your blood vessels − and in turn, it also protects your heart.

HbA1c is also known as “glycated hemoglobin”. This is something that’s made when the glucose (sugar) in your body sticks to your red blood cells. Your body can’t use the sugar properly, so more and more of it attaches to your blood cells and builds up in your blood.

Even if you only have mildly raised blood sugar levels, if the conditions prolong over time, you put your heart at greater risk.

 

5. What does hypertension do to the heart?

People with high blood pressure over a long period become prone to developing “hypertensive heart disease”. This may manifest as heart failure, heart conduction arrhythmias (irregular heartbeats), acute coronary syndrome (sudden, reduced blood flow to the heart), or sudden cardiac death.

The Cleveland Clinic emphasizes that chronic high blood pressure greatly strains your heart. It makes it harder for your heart to pump your blood. Your heart muscles may get thick and weak. Or, the walls of your blood vessels may thicken, causing an even higher level of danger when combined with cholesterol deposits inside blood vessels.

The bad news is that when hypertension combines with obesity, it can do even more damage to the heart. The good news is that people who manage their high blood pressure can significantly reduce their risk of heart failure with medications and a change to a healthier lifestyle.

 

5 manifestations of heart disease that could appear in your body

Whatever the causes, heart disease can occur in your body in various forms of expression.

 

1. Coronary artery disease (blocked arteries)

According to an article in the health library of Mount Sinai hospital, coronary heart disease is a condition often referred to as “atherosclerosis”. It can happen either due to hardening of the arteries (due to cholesterol plaque fixing to artery walls) or thinning or narrowing of arteries (with age). People with this kind of problem usually feel symptoms of “angina” (chest pain) or sometimes suffer from a stroke.

 

2. Heart arrhythmias (irregular heartbeats)

 

 

Irregular heartbeats can feel alarming, especially if they occur suddenly without any warnings (as they usually do). According to WebMD you could have “tachycardia” (too fast heartbeats) or “bradycardia” (too slow heartbeats). A lot of arrhythmias are congenital. Talking to your doctor about your family medical history, and getting suitable medications, can help alleviate the issue.

 

3. Cardiomyopathy (diseased heart muscle)

According to Hopkins Medicine, cardiomyopathy (weakened or damaged heart muscles) may cause the heart to lose its ability to pump blood well. Heart muscles can degenerate due to viral infections, complex congenital defects, or certain types of cancer chemotherapy. The disease may go undetected unless symptoms like breathlessness or palpitations are visible or pronounced.

 

4. Endocarditis (infection of heart chambers and valves)

MedlinePlus writes, “Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium). It is caused by a bacterial or, occasionally, a fungal infection.” Germs are most likely to enter the bloodstream due to injection drug use (from unsterile needles), dental surgery, or other minor surgical procedures on the breathing tract, urinary tract, infected skin, etc.

 

5. Valvular heart disease (heart valve problems)

The heart has four valves — namely the aortic, mitral, pulmonary, and tricuspid valves. These are supposed to open and close in tandem to direct blood flow through your heart and to various parts of your body. According to the American Heart Association (AHA) reasons for heart valve damage could be congenital conditions (being born with it), infections, or degenerative conditions (wearing out with age). Among many other symptoms, there may be marked shortness of breath and dizziness.

 

In summary …

We’ve looked at five ailments or conditions that can cause or worsen heart disease, and we’ve also gone through five ways heart disease could present itself in your body. Knowledge is half the cure.

The moral of the story in all these situations? Begin monitoring your heart early in life for congenital issues. Keep up a healthy diet and exercise regimen and stay off vices like smoking and drinking. Be proactive. Treat your heart responsibly when it’s well. Please don’t wait till it’s ill.

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Physiological Changes In Obesity – And The Value Of Exercise

 

Did you know that obesity or being overweight does not only change your body’s appearance on the outside? It can impair many of your internal organs and skeletal framework, making you prone to several diseases.

Just as body weight does not accumulate overnight (it adds up slowly), in the same way, you have to bring your weight down slowly but consistently. For this, two things are essential. A strictly healthy diet as prescribed by a dietician – plus, more importantly, a regular and graduated exercise regimen, as recommended and supervised by a certified fitness instructor.

Many people with obesity think a diet alone can do the trick. But exercise is vital for five reasons, and we have covered this right at the beginning of this article.

Once you know how to reduce obesity gradually, also read how many other ways obesity changes the physiology of your body and mind − and how you will reduce all these ailments and internal damage with the proper diet and exercise.

Why diet alone cannot work for obesity, and you need to exercise

It’s usually apparent to anybody with obesity that they will have to throw out junk food and bad eating habits and begin afresh on a healthful customized diet.

Your diet must be designed for your age, gender, and health conditions. Despite what we all think, it’s possible that even if you are obese, you could be severely malnourished. According to the World Health Organization (WHO), people on an unbalanced diet can have unhealthy fat build-up without adequate vitamins, minerals, and other health-protective and health-regenerative ingredients.

Regarding exercise, there are five essential points to consider – all of these are vitally important.

1. Diet and exercise must work together:

Your exercise regimen has to be tailored to work in sync with your diet regimen. Your dietician and fitness instructor must put their heads together and devise a matched plan.

Neither should exercise make you tired and over-exhausted based on the slimming diet … nor should exercise be too light to use up the calories you consume each day. Intake and output have to be balanced.

2. Calibrated exercising is crucial:

When you have an obesity problem, overdoing specific exercises may injure your joints, muscles, and bones because your body is working out with a heavy weight load.

So, your fitness instructor will probably give you just enough exercises to get a good workout and help the weight come down gradually. When you’ve lost some weight, you will be lighter. It will be less harmful to your body as your exercise intensity slowly increases.

3. Moderate exercise with consistency is the key:

As we said earlier, no one quickly puts on a lot of body weight. It may be the result of weight accumulation over months and years. Therefore, your exercising also has to be moderate but consistent to bring the weight down gradually and in a healthy way.

Also, too much fat loss without simultaneous toning of muscles and skin will leave you with flabby arms or stomach pouches. As your weight goes down, your skin and muscles must shrink proportionately, states Health Match. This will happen aesthetically if your weight loss is slow but steady.

4. Exercising helps more than just obesity:

Exercising will help with many other ailments if you have them. You may have acquired illnesses like high blood pressure, cholesterol, diabetes, or even heart disease due to obesity − or alongside obesity.

All these ailments can benefit significantly from exercise, so remember that exercising is a holistic health practice. With exercise, the body’s energy and resources get redirected towards regeneration. And, so many ailments lose their aggressive hold on you and become progressively controlled, thus aiding the medications your doctor prescribes.

5. During exercise, your body produces “happy hormones”:

A lot of endorphins are created and infused into your bloodstream during exercise. Mayo Clinic has good things to say about endorphins –also known as the “happy hormones”. They make you feel good … energetic, peppy, and cheerful.

This may be a great relief if you’ve silently suffered from the psychological stresses, social guilt, and low self-esteem of being obese. So, remember, exercise does as much good for your mind as it does for your body when you are serious about losing weight and feeling great.

Look at the damage to your physiology that obesity can do

Here are just a few of the most critical illnesses that obesity can contribute to … there are several more too numerous to recount:

Obesity and diabetes

The Harvard School of Public Health writes of research on obesity that showed these results: “Compared with men and women in the normal weight range (BMI lower than 25), men with BMIs of 30 or higher had a sevenfold higher risk of developing Type 2 diabetes, and women with BMIs of 30 or higher had a 12-fold higher risk.”

They further explain that the fat cells in obese people, usually stored around the waist, secrete hormones that produce inflammation. And this inflammation makes the body less responsive to insulin. It changes the way the body can metabolize fats and carbohydrates. This leads to high blood sugar levels and, eventually, to full-blown diabetes.

Obesity and cholesterol

WebMD states, “Every 10 pounds you’re overweight causes your body to produce as much as 10 milligrams of additional cholesterol daily.”

When we have overweight bodies, the extra weight raises our chances of having too much low-density lipoprotein (LDL), or “bad cholesterol”. This clogs arteries and may even cause heart disease or a stroke. Being overweight also increases the triglycerides in our bloodstream (another type of fat), compounding the problems of high cholesterol levels.

Obesity and hypertension

Scientists and other healthcare professionals already know that obesity causes “atherosclerosis”, which involves the narrowing and stiffening of arteries. This often leads to high blood pressure (also known as hypertension).

However, in the middle of 2021, Medical News Today released information about new research. This research has found that obesity may raise leptin levels − which in turn triggers the abnormal growth of small blood vessels in the hypothalamus part of the brain. These may also be responsible for causing hypertension in people with obesity.

Obesity and heart disease

In an article titled “Weight: A Silent Heart Risk”, researchers at Johns Hopkins Medicine have written of a new heart-weight connection, other than the risks known hitherto to doctors. Most medical scientists already know that people with obesity (by genetics or lifestyle) are more likely to develop conditions like cholesteroldiabetes, and hypertension, which can all have a multiplicative effect on our hearts.

But now, John Hopkins writes, “Excess weight may be more than an “accomplice” in the development of heart problems. The pounds themselves can cause heart muscle injury. Down the road, this can lead to heart failure.”

Obesity and other ailments

There are a host of other ailments that you may not suspect of being triggered by obesity, but you must pay attention to these as well:

 

    • Obesity and cancer: CDC.gov quotes The International Agency for Research on Cancer (IARC) to say there are 13 cancers associated with overweight and obesity: meningioma, multiple myeloma, adenocarcinoma of the esophagus, and cancers of the thyroid, postmenopausal breast, gallbladder, stomach, liver, pancreas, kidney, ovaries, uterus, colon, and rectum.

 

    • Obesity and depression: Healthline states that it’s now clear to doctors that obesity aids depression, and vice versa. For long, the vicious cycle was studied to see what caused what, but finally, it has become hard fact-backed science.

 

    • Obesity and lung function: According to News Medical, as body weight increases, lung volumes decrease. This leads to restricted air entry. Further, obesity around the abdomen worsens lung function and respiratory symptoms, because of the fat layers affect the movement of the diaphragm, which enables lung expansion.
    • Obesity and musculoskeletal disorders: An interesting PubMed paper (by S C Wearing et al) states, “To date, the majority of research has focused on the impact of obesity on bone and joint disorders, such as the risk of fracture and osteoarthritis. However, emerging evidence indicates that obesity may also profoundly affect soft-tissue structures, such as tendon, fascia, and cartilage.”

 

In summary …

Obesity can cause manifold problems to your health if it is not taken seriously. Diet is important, but exercise is more critical and must be in step with diet.

A sedentary lifestyle that adds to body weight is both externally and internally very unhealthy, for both your mind and body. Get a move on, get physical, grow slimmer with exercise, and treat your heart responsibly in the process.

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Facts About Weight – And Why You Shouldn’t Believe Myths

The most important fact about weight is that overweight people get a bad rap, often erroneously. They are assumed to be lazy, or averse to exercise. They are believed to be overeaters, without self-discipline − or doomed by fat genes. They are also seen as people who are out of touch with reality, and ignorant that excess weight can cause serious diseases. This is needless and harmful stereotyping.

Overweight people usually suffer a lot because they may be genuinely trying to lose weight but they don’t realize it can be a tug of war. They lose some weight, and soon their bodies fight them to add the weight back. Why is this so?

Many people soon discover this “metabolic rate” dilemma when trying to lose weight. Metabolic rate refers to the rate at which your body burns the food and fat it consumes to create energy. To lower weight, you do exercises or eat certain foods to raise your metabolic rate.

But when you lose weight, the body’s metabolism slows down. So, in a way, your weight loss success becomes the cause for slowing down any further weight loss. The weight and fat then begin to reappear. And the cycle goes on and on. People often call it the “yo-yo weight loss effect”.

How do you escape this “yo-yo cycle”? Read on …

3 facts about weight and its relationship to metabolic rate

There are 3 interesting facts about how your metabolic rate can be increased – and you can thereby hope to reach your ideal body weight without the “yo-yo effect” …

Your Basal Metabolic Rate (BMR) is quite important for weight problems

Healthline states, “Basal metabolic rate is the number of calories your body needs to accomplish its most basic (basal) life-sustaining functions.”

Why is BMR key to body weight? Because it shows how active or inactive your everyday daily life is. The more generally active you are, the more calories you burn without additional exercise. Therefore, you must aim for an active movement-oriented life to lose weight.

Having more muscle raises your metabolic rate and weight loss

Physical fitness coaches always include muscle-building and weight training during exercise routines. The more muscle you have, the more calories your burn. In your body, your legs have the most muscle area … so the more you exercise using your legs, the more calories you can burn.

Mayo Clinic advises that if your body weight is composed more of fat than muscle, you must consciously build up your muscles in addition to just burning calories by movement.

Eating protein-rich food boosts your metabolism and aids weight loss

You burn calories even to digest food. Of all the food types – carbohydrates, fats, and proteins – it’s the proteins that burn the most calories during digestion.

According to a paper published by the National Library of Medicine, US, increasing protein intake boosts metabolism by roughly 15 to 30 percent. So, all in all, eat more proteins to lose weight.

 

Myths about weight − and the facts to replace them

There are a number of us who have wrong ideas about weight loss. The first step to losing weight is to lose these erroneous beliefs.

 

Myth 1: “If I exercise a lot, I can eat almost anything because I am burning it all.”

The fact:

To lose weight, you need to burn more calories than you consume. You can’t do that, though, unless you count calories and keep track of your intake and output. Medical News Today has a table that shows a “healthy calorie deficit” between intake and output of calories, calculated by age and gender.

What should your calorie deficit be? WebMD states, “A good rule of thumb for healthy weight loss is a deficit of about 500 calories per day. That should put you on course to lose about 1 pound (approximately 0.45 kgs) per week. This is based on a starting point of at least 1,200 to 1,500 calories a day for women and 1,500 to 1,800 calories a day for men.”

 

Myth 2: “Drinking a lot of water can increase my body weight. I should take diuretics.”

The fact:

Water can increase metabolic rate and burn more calories. This is contrary to how people think they can reduce their weight by taking diuretics. What are diuretics? They are medications that rid the body of water (usually prescribed for some other illnesses by doctors). Often, they are misused by those who want to lose weight. But this kind of water-weight loss is not the same as healthy weight loss due to reduced body fat or body mass.

A novel finding in a study published by Oxford Academic says, “Drinking 500 ml of water increases metabolic rate by 30% in both men and women. The increase in metabolic rate was observed within 10 minutes after completion and reached a maximum of 30–40 minutes after water drinking. The effect was sustained for more than an hour.” Hydration seems to help in weight control.

 

Myth 3: “Body weight is a genetic handover. Whatever you try, you cannot fight your genes.”

The fact:

Research does indeed show that your genes can lead to weight issues. But, here’s the fact. You are not fated to be fat just because your parents are; you can fight genetics with proper diet and exercise. There’s one gene that’s now getting a lot of attention, called FTO. WebMD claims scientists found that people with this gene have a 20% to 30% higher chance of obesity. If a cause has been found, the cure may hopefully not be far behind.

Besides genetics, your environment, lifestyle, and healthy choices may also significantly affect how much you weigh. One interesting theory is that obesity may run in families both because of genetics and the family habits inculcated around diet and exercise. What your parents teach you about healthful habits may be as crucial as the hereditary tendencies they pass on to you.

 

Assessing your risk for weight-related diseases

Ailments like cholesteroldiabeteshypertensionobesity − or a family history of heart disease − can all have a multiplicative effect on our hearts. If you are overweight or obese, you will only compound your health and heart risks if you have any of these ailments. Plus, beware of the silent stress symptoms below:

  • You smoke a lot or drink too much alcohol without self-control
  • You have a lonely, sedentary lifestyle, often digitally-addicted
  • You feel silently worried about most things, including your weight
  • Your work and relationships don’t gel with your personality type

The wise saying goes, “When you have a weight problem, don’t just ask what you are eating. Ask what is eating you.”

 

The 6 unbeatable weight loss best practices

Just do these 6 things every day without fail, and your weight will drop away naturally over time …

  • Eat healthfully, keeping track of calories – and get the right calories into your body (i.e., more lean proteins).
  • Exercise for at least 30 minutes daily with muscle building routines for the legs. Don’t focus only on upper body muscles.
  • Stay stress-free. Learn yoga, meditation, breathing exercises, and mindful living. Don’t fret about being fat. It’s solvable.
  • Keep your body well hydrated. Drink lots of water (as plain water) – not as water in tea or coffee or juices or fizzy drinks.
  • Check your health for other illnesses like hypertension, diabetes, cholesterol, and heart disease. Tell the doctor about your genetics.
  • If you have genetic ailments, teach your children early on how to eat and exercise healthfully to stave off any premature diseases.

 

In summary …

There is a deep connection between body weight and metabolic rate. Often, they work at cross-purposes and defeat your good intentions to reduce weight. But despite this, it’s imperative to follow a proper diet and exercise to lose weight and reduce the risks of many weight-related ailments. All these ailments eventually lead to heart disease.

Blow away the myths in your mind about weight, and learn the facts. Assess the risks of your weight and stress on your health and heart. Most of all, be conscious and responsible about your weight issues. By doing so, you will treat your heart responsibly.

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