If Heart Stops after Heart Attack
Heart attack is one of the commonest
causes of sudden death. The patient may complain chest pain and may become
unconscious with in a few minutes. Some times patients become unconscious with
out any chest pain. Heart may stop instantaneously due to electrical failure.
Except heart attack cardio-respiratory arrest may occur in electrocution, motor
vehicle accidents, drowning etc. Pulse is usually not felt during a cardiac
arrest if some body can start cardiopulmonary resuscitation (CPR) immediately.
Doctor or paramedics are not always required for this type of emergency. It
will be disastrous if relatives or friends of the patient wait for doctor or
try to send the patient to nearest hospital without starting CPR. If heart stops
brain can not get oxygen supply. Brain damage due to lack of blood supply
starts after only four minutes after stoppage of the heart beat and by ten
minutes brain damage becomes irreversible.
It is possible to maintain some
degrees of blood supply to vital organs like brain without using any equipment
except one’s own hands and breathing. This technique is called cardiopulmonary
resuscitation (CPR). In western world where CPR has been widely taught to the
lay public and has been proven to save countless lives by maintaining blood
supply to vital organs of the body till the heart attack victim can be
transported to a hospital. The technique of CPR is very easy and any body can
apply this technique to save life of a patient.
A B C of CPR includes
A- Open the airway
B- Ensure spontaneous or
assisted breathing
C- Maintain circulation or
blood supply
How to give CPR
1. If somebody becomes
unconscious, try to arouse him by shaking him firmly and asking loudly.
2. If there is no
response, attract some other persons around and call for help.
3. Turn the person over if
he is lying on his front.
4. Open the airway: In an
unconscious person lying on his back, the air passage may be occluded by the
tongue falling backwards against the back of the throat. One can open the
airway by tilting back the victim’s head with one hand lifting up his chin with
the other hand.
5. Assess whether there is
spontaneous breathing.
a. Look at the chest for
movement.
b. Listen for air escaping
from the victim’s nose
c. Feel for exhaled air from
the victim’s nose by using your back of the hand.
6. If the victim is not
breathing spontaneously mouth to mouth breathing is carried out. Take a deep
breath, form a tight seal with your mouth against the victim’s lungs. Watch for
the rise of the victim’s chest, signaling an adequate volume of air has been
delivered. 2 breaths should be delivered. In between breaths, release the
mouth-to-mouth seal to allow for exhalation.
7. Check spontaneous heart
beat: Feel for the hard part of the front of the throat (commonly called
“Adam’s apple”. Slide down-2 fingers side ways into the groove of the neck
muscles and press inwards. If spontaneous heart beat is present, one should be
able to feel a pulse. Take an adequate amount of time (about 5-10 seconds). If
no pulse is present, get help to try and summon an ambulance.
8. How to maintain blood
supply to brain if heart stops beating: If pulse is absent, external chest
compression must be started immediately:
a. Place the palm of the
one hand on the mid point of the sternum (beast bone). This is the landmark for
performing chest compressions.
b. Look both hands
together and position yourself such that your wrists, elbows and shoulders are
in straight line.
c. Apply rhythmic
compressions using your body weight transmitted through both arms. Each
compression should be about one and a half to two inches deep. A total of 15
compressions should be performed over duration of about 10 seconds.
9. After 15 compressions,
move to the victim’s head and deliver 2 breaths.
Each combination of 15 compressions
and 2 breaths comprise one cycle. Approximately 4 cycles should be performed in
every one minute. Patient should be reassessed from time to time for return of
spontaneous heart beat followed by spontaneous breathing.
Key points of CPR
1. Place the victim flat
on his back on a hard surface. If unconscious, open airway.
2. If not breathing, begin
artificial breathing.
3. Check hand pulse and
neck pulse. If pulse is absent, begin artificial circulation. Depress middle of
lower half of breastbone rhythmically. One cycle constitutes 15 chest
compressions and 2 chest inflation's (4 cycles per minute).
Steps of CPR
a. Check the victim and
see if he/she responds
b. Open his airway by
tilting his head and lifting his chin.
c. Look, listen and feel
for breathing
d. Open his airway, pinch
his nose, open his mouth, but maintain chin lift.
e. Blow steadily into his
mouth.
f. Place the heel of your
hand on the lower half of the sternum (breastbone), with the other hand on top.
Interlock the fingers of both hands and lift them to ensure that pressure is
not applied over the victim’s ribs.
g. Position yourself
vertically above the victim’s chest and, with your arms straight, press down on
the sternum to depress it 4-5 cm.
h. After 15 compressions
tilt the head, lift the chin and give 2 effective breaths, continuing compressions
and breaths in a ratio 15 to 2.
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