Have you ever been in a class and you are wondering about the benefits of the particular lecture? Well, happens to me a lot, but not this time. This lecture wasn’t just about theory (talk and go), it was a practical class on how to save lives. As a doctor, it is my job description to save lives. I have seen people die, have resuscitated some and watched some die despite best efforts at resuscitating them, because in Nigeria, frankly, I don’t know if any hospital has a defibrillator and very few have a mechanical ventilator. Shocker right? Today I want to share with you an experience I had after learning about basic life support (not bragging) and I also would like to pass on this information to you as much as I can. (It is an extremely wide topic).
She was a neonate and she had been on admission for many weeks because she was born premature with a very low birth weight. Finally she was doing well and gaining some weight and awaiting discharge. One day, she stopped eating and I happened to be the one on call that night. Following her symptom – we decided to rescreen for sepsis and treat accordingly. It was discovered that her PCV (packed cell volume – blood level) had also dropped. So in addition to antibiotics recommenced, we also transfused her. Our treatment didn’t seem to be having much effect on her. She just kept having apneic attacks (stops breathing) requiring persistent ambubagging, suctioning and CPR as her heart rate was also dropping. We did this the whole night. I’m talking about 10 hours straight on one child, alternating with the nurse on duty. Finally, at 6 am, it suddenly occurred to me that something could actually be obstructing her airways despite all our work. I picked her up, turned her around and instituted the anti-choking technique, repeating it about 4 times, then, I drop her back on the resuscitare. A few minutes later, you wouldn’t believe the thick mucus that found its way out of her mouth. The apnea stopped and less than 18 hours later she was crying for food.
LIFE SAVING TECHNIQUES:
There are many things that threaten our lives every single day, some we aren’t even aware of. The scariest of these are the ones that cause sudden death, one minute someone is talking to you, the next minute, they are gone. Sometimes, these situations arise in people that have health problems already like diabetes and hypertension. These are not techniques like cutting up someone’s throat in a restaurant because they are choking like Sandra Bullock did in “the heat” or even opening up the chest wall to let out air in a person with pneumothorax, Christina and her boyfriend from “grey’s anatomy” and Reese Witherspoon in “just like heaven” already showed us how. Lol.
Okay, first things first, Identify the problem. Is the person choking, gasping, unconscious? Are there any friends or family members around who can tell if the parson suffered from a previous illness and if they are on any medications?
Note** you cannot save everybody by yourself, so if you are trying to help, also make sure that arrangements are been made to take them to the nearest hospital. It’s all about teamwork.
An unconscious patient: check if the pulse or heart rate and the respiration are present.
- If there is no pulse rate and no respiration, check the eyes for papillary reflex. The pupils are the small, round black part of the eye inside the cornea. The cornea can be black, brown, blue or green. Normally, when light is applied to the pupils, it reacts by constricting. In a dead person, the pupil is dilated (i.e. wide open and there is no reaction). If the pupils are dilated, there is no need resuscitating as it shows that the person is brain dead. Well, at least in resource poor countries where we don’t have life support machine to place a person on, and if we did have, it would be a strain on the family’s pocket.
- If the heartbeat is present and/or dropping, and there is no spontaneous respiration, commence CPR (cardio-pulmonary resuscitation). CPR involves doing chest compressions and breaths to the person. Breaths could be given with an ambubag or mouth-to-mouth. 30 chest compressions to 2 breaths in an adult and 15:2 in infants. When giving the breaths make sure that the chest wall rises up. Continue until help comes.
- An unconscious diabetic: better to assume that the unconscious is from hypoglycaemia (low blood glucose). Just give the person a cube of sugar or a bottle of coke and rush to the nearest hospital. This is because hypoglycaemia kills a person faster than hyperglycaemia (high blood glucose).
In a choking adult, do the Heimlich’s maneuver.
- Wrap your arms the person from behind, with one hand firmly holding the other in a fist. Place your folded hand between the stomach (above the umbilicus) and the chest (just below the xiphisternum). Place the person’s legs at “at ease” position, and your right leg in between theirs. Then thrust upward to dislodge the object.
- In infants, sit on a chair with your left leg slightly extended at the knee joint to about 100 degrees. Place the child on your left arm resting on your left leg, tilted head down and smack on her back 5 times, turn her over face up on the right arm and apply 5 chest compressions with the index and middle finger of the left hand. Check to see if the object comes out. If it dislodges, remove it, if not, repeat the process.
|Photo credit: smmhc.adam.com|
Where to check for pulses:
There are so many places in the body where the pulse rate can be palpated peripherally, however, with rapid decompensation, the body focuses blood supply to the vital organs like the brain, heart and kidneys and withdraws from the periphery like the legs. In these instances, it is better to check for the heart rate in these parts;
- The radial pulse is at the outer part of the wrist (same side as the thumb).
- The carotid pulse at the junction between the base of the mandible (jaw) and the neck.
- The heart rate on the left side of the chest. It is usually the last to disappear. Though very rare, some people have their hearts on the right side
I hope you would be able to save some lives with this information.