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The ABCs of CPR

The ABCs of CPR

Just the other day, I was on a commuter train that hit a person on the track. The train screeched to a halt, and indeed, someone lay prone on the track. The conductor called for someone to perform CPR on the victim. I wanted to volunteer, but I wasn’t sure how to do it. What is CPR?

CPR stands for cardiopulmonary resuscitation. It is also called first aid.

You don’t have to be a doctor or healthcare professional to be able to do CPR. You can learn to do it from a very young age.

Even if you are not trained and not confident in doing it, you can always help when someone is in need.

In fact, the American Heart Association recommends that everybody – yes, that includes you who don’t know how to do anything! – should begin CPR by simply doing chest compressions on a victim.

It can actually mean saving someone’s life rather than standing around being uncertain.

Wait. So you want me to do chest compressions only? I watch a lot of TV shows, and they do more than chest compressions. They also do the ‘kiss of life’ or mouth-to-mouth resuscitation.

Here’s what you should do if you are completely not trained: HANDS ONLY CPR.

This means just do chest compressions at around 100 to 120 times a minute without trying to breathe into the patient’s mouth until someone more qualified arrives.

If you are trained, then you can do more. You can check the patient for a pulse at his neck and check whether he is breathing.

If there is no pulse and the patient isn’t breathing, then you can start chest compressions. Do 30 chest compressions before giving two rescue breaths through the patient’s mouth.

If you have been trained before but have forgotten/are panicking that you have forgotten, then just do chest compressions like the untrained.

CPR, first aid, drowning, AED, Star2.com

First, check the person’s airways and make sure nothing is blocking the nose and mouth.

Right. OK. So I should have done something. But I want to learn to do it properly from now on. How does CPR help the victim?

CPR can jump-start the heart’s rhythm.

And even if it doesn’t, at least the very act of compressing the chest can compress the heart muscles and squeeze out oxygenated blood from the heart to the brain, liver and other vital organs.

When the heart stops, it also stops supplying oxygenated blood to the body.

This can cause permanent brain damage within a few minutes, and death can happen after eight to 10 minutes.

Please give me a crash course.

Nothing substitutes an actual course, but these are the things you should be doing.

Just remember: A – B – C

Before beginning CPR, check if the surrounding environment is safe. For example, if there is a snake next to you, get the victim and yourself into safety first!

Then check if the patient is conscious or unconscious. Always tap and call the person, “Hello? Are you OK?” and wait for a response.

If there is no response, then the person is unconscious. If you have access to a phone (especially your mobile phone), call the emergency line (999 in Malaysia, or 112 globally for mobile phones only) before beginning CPR.

That way, you know trained help is coming even if you cannot revive the person.

If there are two of you, one person can call emergency while the other person can begin CPR.

You can also check if there is an AED (automated external defibrillator) device nearby.

CPR, first aid, heart attack, AED, Star2.com

If you are not trained, just do chest compressions at around 100 to 120 times a minute without trying to breathe into the patient’s mouth until someone more qualified arrives.

What does A – B – C stand for?

Airway

Breathing

Circulation/Compression

The American Heart Association reverses this and says CAB, because they want you to start compression first. I learned it as ABC. Well, as long as you know what to do.

First, you have to check the patient’s airways and make sure nothing is blocking the nose and mouth. If there is, remove it. Many times, the patient’s tongue might be obstructing his own airflow.

Put the patient on his back on a firm surface, like the ground or floor.

Kneel at his side, next to his neck and shoulder. Place the palm of your hand on his chest between his nipples, and place your other hand on top of your hand.

Then press his chest straight down by at least two inches. You won’t break the sternum this way. Do this 30 times.

Then tilt his head back and open his jaw. Pinch his nostrils shut and cover his mouth completely with yours, sealing it.

Breathe into the patient’s lungs for one second, and see if his chest rises. Breathe a second time. Don’t breathe too long or more than two times.

Begin your chest compressions again. If there is an AED available, apply the defibrillator as per the instructions.

After one shock, resume CPR. After two minutes, apply a second shock. Continue CPR till paramedics arrive.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
What happens when a snake bites you

What happens when a snake bites you

The other day, I opened the cupboard, and to my shock, a cobra was curled up in there! I had the presence of mind to shut the cupboard door on it. Thereafter, I quickly called the fire department to remove it. A cobra’s bite is very poisonous, right?

Yes. There are three types of poisonous snakes in Malaysia: the cobra, the pit viper and the sea snake.

There are plenty of other poisonous snakes in the world, especially in Australia. But only these three are poisonous in Malaysia.

Cobras can be recognised by their famous and unmistakable hoods, which flare when they are agitated. The hood is actually an extension of the ribs behind their heads.

Pit vipers can be identified by their pits, which are located between their eyes and nostrils. These pits are temperature receptors, which can sense the body temperature of their prey.

So yes, a viper can sense you when you are close.

Not all vipers are pit vipers, however.

Sea snakes can swim and are usually difficult to identify because they are under water a lot of time. In fact, they can hold their breath for up to an hour under water.

Their tails are flat to allow swimming, and they are from the cobra family. They are extremely poisonous. If you see a snake swimming in the water, get out immediately!

I would advise you not to spend too much time trying to identify a snake to see if it is poisonous however, if you find one in your house.

It’s best to just move slowly away and call the proper authorities to remove them from your home.

Be on the lookout for snakes as well when you are hiking in the jungle, or camping or doing any outdoor activities.

What happens when a poisonous snake bites me?

Snake bites, sea snakes, poisonous snakes, Star2.com

Snakebite venom contains proteins that are very toxic to the human body. These proteins can be divided into cytotoxins, haemotoxins, neurotoxins and cardiotoxins.

It depends on what type of poisonous snake it is. Doctors in the Accident and Emergency (A&E) department are trained to help identify what sort of snake it was that bit you in order to administer the appropriate anti-venom.

When a snake bites you, there is usually the presence of two fang marks at the bite site. Unlike human teeth, the fangs have ducts in them that contain venom from a gland.

The most common feeling you may have from snakebites is a sense of overwhelming fear. This may lead to nausea, vomiting, a very high pulse rate, fainting and cold, clammy skin.

This is in large part due to stories, TV, media and all the hype surrounding snakes!

Not all poisonous snake bites result in venom injection from their fangs. But when they do, there is redness, pain and swelling at the bite site, which may take up to an hour to appear.

Bites from cobras and vipers are extremely painful, and the inflammation may appear very quickly – within five minutes.

The bite area may also bleed and blister, and this can lead to tissue death. The bites from vipers, in particular, cause bleeding.

These are all called “local effects”, meaning effects that occur on the body site or area of the bite.

If a non-poisonous snake bites me, I will be OK, right?

Not necessarily. Even when a poisonous snake bites you and does not inject venom, it can cause tissue injury and infection. This is called a dry snakebite (which are up to 50% of all snake bites).

Same for a non-poisonous snake.The snake’s fangs may harbour a lot of bacteria, and this can lead to infection, including with the microorganism causing tetanus.

Moreover, if you are allergic to snakebites, you can go into anaphylaxis, which can result in severe shock and your body’s organs shutting down.

Are ‘local effects’ all I will get from the snakebite?

Unfortunately, no. The snakebite venom contains proteins that are very toxic to the human body.

These proteins can be divided into:

• Cytotoxin – this causes local tissue damage.

• Haemotoxin – the very name means a toxin that causes bleeding. This not only result in bleeding from the bite site, but also internal bleeding in your body.

• Neurotoxin – this one affects your entire nervous system and can lead to paralysis.

• Cardiotoxin – this one affects your heart.

Help! I have been bitten by a snake and I don’t know what snake it is. I happened to step on it when I was out running in the jungle. What do I do?

Snake bites, sea snakes, poisonous snakes, cobra, Star2.com

Cobras can be recognised by their famous and unmistakable hoods, which flare when they are agitated. The hood is actually an extension of the ribs behind their heads.

Are you alone? You will need help to go to a hospital as soon as possible, so flag down a passer-by and ask for assistance.

Don’t try to catch the snake in order to identify it!

If you can’t find anyone immediately, you still have to try to get help.

Do not try sucking on the bite yourself or allowing anyone else to try to suck the venom out.

Do not attempt to cut out the area of the bite either.

These actions will result in more infection and can damage your underlying organs. They will not remove the venom either.

Also, do not use ice or tourniquets. Tourniquets are not effective and can lose you a limb.

Do not pour alcohol on the bite.

Do take off any constricting jewellery, such as bracelets or rings.

Try not to use the affected limb to delay spread of the venom.

Part two of this article will appear in a fortnight. Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
The controversy surrounding the Heimlich manoeuvre

The controversy surrounding the Heimlich manoeuvre

You’re dining in a restaurant when someone at a table nearby starts choking. As they gasp for air, a bystander rushes to their aid.

If the bystander in this dramatic scene were trained in first aid at the American Red Cross, then the choking victim could be in trouble, say Janet and Phil Heimlich, adult children of the late Dr Henry Heimlich, whose namesake manoeuvre to help choking victims was developed in 1974.

Current Red Cross guidelines advise administering five blows to a conscious choking victim’s back with the heel of the hand, and then performing abdominal thrusts – the Heimlich manoeuvre.

Dr Henry, who said his technique saved thousands of lives, spent decades condemning the mixture of methods, arguing that the blows could actually drive an object lodged in someone’s windpipe deeper into the airway.

Dr Henry, who died in 2016 at 96, also maintained that there wasn’t scientific evidence proving the back blows actually work.

Citing this, and recent high-profile uses of the Heimlich manoeuvre, Janet and Phil recently launched their Hug, Don’t Hit campaign to educate the public on the technique’s significance.

The announcement is the latest development in a long-running disagreement between some members of the Heimlich family and the Red Cross.

“Kids as young as five and six years old have been able to perform the manoeuvre,” Phil said. “It’s clear, there are like four basic steps, and that’s why rescuers of all ages have been able to perform it.”

The Red Cross said it hasn’t found evidence supporting the idea that the Heimlich alone is better at preventing choking – the fourth leading cause of accidental death in the United States.

“This recommendation is based on reviews of scientific literature suggesting that back blows, abdominal thrusts and chest compressions are equally effective, and that using more than one method could be more effective in helping to dislodge an object when a person is choking,” Don Lauritzen, a spokesman at the organisation’s US national headquarters, said in a statement.

“To be clear, the Red Cross doesn’t discount the use of abdominal thrusts – but we have found no scientific evidence stating that this one technique is more effective than the others.”

Between 1986 and 2006, the Red Cross recommended the Heimlich manoeuvre to assist choking victims.

But in 2006, it began advising the combined back blow and Heimlich manoeuvre approach it does today.

The year before, a consensus conference held by the International Liaison Committee on Resuscitation determined that chest thrusts, back blows and abdominal thrusts were all effective for relieving choking in conscious adults and children older than one.

Still, the committee could not decide which one of the tactics should be used first.

At least one study, published in 1982, found “a back blow could transform the situation into one of complete blockage”.

The study however, has been challenged: It was partially funded by a nonprofit organisation Dr Henry founded.

Other leading US medical and first-aid groups, including the American Heart Association, the American College of Emergency Physicians and the National Safety Council all advise people to use Heimlich-style abdominal thrusts only, but not for children under a year old.

Local doctors follow this protocol too, and advise using the Heimlich in almost every instance of choking, given the narrow window one has to act.

“I’m an emergency physician,” said Dr John Purakal, an emergency doctor at University of Chicago Medicine. “The Heimlich manoeuvre is the only thing we ever got formal training in.”

The technique is also the only thing Dr Maura McKay, medical director at the Northwestern care center at Central DuPage Hospital, was trained in as well, during basic life support certification courses many doctors take through the American Heart Association.

“The only time you do back slaps is in an infant,” she said. “But never for adults.” – Chicago Tribune/Tribune News Service

What to do when someone breaks a bone

What to do when someone breaks a bone

A fracture is a broken bone. It requires medical attention. If the broken bone is the result of major trauma or injury, call 999 or your local emergency number.

Also call for emergency help if:

• The person is unresponsive, isn’t breathing or isn’t moving. Begin CPR if there’s no breathing or heartbeat.

• There is heavy bleeding.

• Even gentle pressure or movement causes pain.

• The limb or joint appears deformed.

• The bone has pierced the skin.

• The extremity of the injured arm or leg, such as a toe or finger, is numb or bluish at the tip.

• You suspect a bone is broken in the neck, head or back.

Don’t move the person except if necessary to avoid further injury.

Take these actions immediately while waiting for medical help:

• Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing.

• Immobilise the injured area. Don’t try to realign the bone or push a bone that’s sticking out back in.

If you’ve been trained in how to splint and professional help isn’t readily available, apply a splint to the area above and below the fracture sites. Padding the splints can help reduce discomfort.

• Apply ice packs to limit swelling and help relieve pain. Don’t apply ice directly to the skin. Wrap the ice in a towel, piece of cloth or some other material.

• Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk, and if possible, elevate the legs. – Mayo Clinic News Network/Tribune News Service

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