CARDIO-PULMONARY RESUSCITATION

The hour after any major trauma or a heart attack has been termed the " Golden Hour" when any interventions based on scientific principles have the best chance of salvaging the victims. During this window period, it is often the lay public or bystanders often called the 'first responders' who have a critical role in instituting life-saving techniques like mouth-to-mouth resuscitation and external cardiac massage, evacuating victims from hazardous areas, arresting bleeding and other first aid measures till the arrival of the ambulance or shifting the victims to the nearest hospital. This is in view of the fact that lack of circulation to the brain for 3-5 minutes following a medical catastrophe will result in a brain-dead vegetative being despite the best possible medical care being given after this insult.

Teaching the ABC, an acronym for management of the Airway, Breathing and Circulation needs to be widely imparted at all levels of the society to develop life-savers and reduce morbidity and mortality. These simple drill can be very easily learnt on simulators called resusci-dummies and have been successfully applied to victims of smoke-inhalation, drowning, electric shock and trauma the world over.

Airway management involves simple clearing of the mouth of foreign material and instituting the chin-lift and jaw-thrust protocol. Breathing implies mouth to mouth respiration at a rate of 12 to 20 per minute when the 16% oxygen in the expired air can be provided to adequately oxygenate the victim. Circulation implies commencement of the cardiac massage when a 25-30 kg force is applied at a rate of one per second to the lower breast bone to squeeze the heart between it and the spine behing to create a palpable pulse. Successful outcome is seen when the tissues turn pink, with return of spontaneous heart beat and respiration and constriction of the pupils. Sometimes, an abrupt forceful upward thrurst at the pit of the stomach in victims of choking over food, known as the Heimlich manouvre has been known to 'pop' the obstructing material and restore breathing. On occasions, available kitchen knives have been used to create an emergency tracheostomy in the windpipe to restore breathing. Also a simple forceful thump over the breastbone in the central chest, a mechanical DC shock of sorts has been known to start the heart in victims of sudden cardiac arrest. The technics are simple, the equipment required minimal and the results most gratifying. Teaching the ABC of first aid must be made compulsory at all levels of education.