Have you ever been in a situation where your friend or colleague has suddenly suffered from a heart attack or chest pain of some sort? Have you ever panicked and not known what to do in such a situation? It can be terribly frightening if you aren’t prepared, if you don’t know what to do. What happens if you can’t help at that moment?
The leading cause of dead worldwide, sudden heart attacks can happen without any signs or symptoms. But in some cases, patient may experience shortness of breath, chest pain, dizziness, fatigue, nausea and vomiting before or during an episode of cardiac arrest.
Cardiac arrest is reversible in most victims if it is treated within a few minutes. For a layperson, it is often difficult to recognize cardiac arrest.
- If someone suspects or see an unresponsive person, the first and foremost thing is to call for emergency medical services.
- Begin Cardiopulmonary Resuscitation (CPR) immediately and continue until professional emergency medical services arrive.
- If two people are available to help, one should begin CPR immediately while the other calls for help.
- Get an automated external defibrillator (AED) if one is available and use it as soon as it arrives.
- AED is not readily available in our country, but more and more emphasis is being laid these days on their availability in public places. Also, due to scarce availability of ambulance services with trained personnel, CPR is often delayed.
- Cultural beliefs also make people hesitant to perform mouth-to-mouth resuscitation. It is difficult to learn and if performed wrongly it can lead to a lot of harm.
Considering all this, Indian society of anaesthesiologist (ISA) is now recommending compression only life support (COLS) especially for laypersons outside the hospital. Early chest compression and early transfer to hospital is of utmost importance. It can even be performed by family members who witness collapse of their near and dear ones. The method can be easily taught, and training can also be imparted telephonically. COLS have a series of predefined steps which need to be followed sequentially:
Chest Compression to Revive the Heart
It must be effective chest compression which should be performed continuously till help arrives.
- The rescuer should come from front, facing the victim, tap on the shoulder, speak loudly and ask ‘HELLO-Are you alright?’ in a language the victim can understand.
- The victim should not be shaken, there should be no vigorous movement of the neck as it could cause further harm the patient.
- If the person is not responding, then the rescuer should do a simple maneuver of head tilt and chin lift to clear the airway of the person.
- Five cycles of thirty chest compression should be given with both hands placed over the lower third of the sternum.
- Two mouth-to-mouth rescue breath should ideally be given after each cycle of chest compression.
- If the patient responds, either verbally or by purposeful movement, or is breathing normally, then cardiopulmonary arrest is unlikely. Such victim needs to be monitored constantly and shifted to nearby medical facility at the earliest.
If no response is elicited, the victim may be having cardiopulmonary arrest and would require further help. In any case, chest compressions should not be stopped in an unresponsive person till the ambulance arrives. If more rescuers are available, then they should continue the chest compressions one by one so that the compressions are effective should one person gets tired.
Early recognition of cardiac arrest, immediate initiation of chest compressions and early transfer of the patient to the hospital is critical to ensure a successful resuscitation of a patient by a bystander or a layman.
(Dr Udgeath Dhir is Director and Head Cardiac Surgery Fortis Memorial Research Institute)