Friday, May 13, 2022

How Long Can You Do Cpr Before Brain Damage

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Drowning Prevention And Water Safety

Overview of Traumatic Brain Injury (TBI)

Drowning happens quickly, so being proactive about preventing drowning accidents is essential.

Children between the ages of 5 and 14, as well as adolescents and adults over 65, are at a higher risk for drowning.

Children under 5 years old face an extremely significant risk of drowning. Males have a higher risk than females, especially teenage males.

To prevent drowning, there are some best practices you can follow.

Do I Have To Remove A Persons Clothes To Do Chest

It is not necessary to remove a patients clothing in order to do chest-compression-only CPR. However, if an AED is available, turn on the device and follow the instructions, which state to remove patients clothing. Defibrillator pads must be placed directly on the patients skin in order for the electrical current to be conducted.

When To Stop Giving Cpr

Once you start CPR, dont stop unless one of these things happens:

  • The victim becomes responsive or starts breathing.
  • Another trained rescuer or EMS personnel arrive and take over.
  • An AED becomes available.
  • You are too exhausted to continue.
  • The area becomes unsafe.

Under older guidelines, rescuers would generally stop CPR after 30 minutesas it was believed if the victim hadnt resuscitated by then, they wouldnt.

However, the American Heart Association now states that giving CPR for as long as 38 minutes can have a major effect on the patients chances of recovery. They also say that keeping CPR going that long can improve brain function in survivors of cardiac arrest.

Some people have even recovered after three or more hours of CPRincluding this 29-year-old man . These days, there is no proscribed time to stop CPR unless one of the above situations occurs.

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Neurologic Injury And Clinical Manifestations

Global cerebral ischemia during cardiac arrest results in heterogeneous injury to the brain. Large projection neurons of the cerebral cortex, cerebellar Purkinje cells, and the CA-1 area of the hippocampus are the most vulnerable areas . The subcortical areas, such as the brainstem, thalamus, and hypothalamus, are more resistant to injury than the cortex . If the thalamocortical complex or extensive bilateral cortical regions are injured, dysfunction in arousal and consciousness may result . The impairment in arousal remains the most predominant neurologic problem during the early post-resuscitative period. A review on neuroanatomic and physiologic considerations of coma related to brain injury after cardiac arrest was recently published by Hoesch and colleagues in 2008 . Other areas that are prone to ischemic injury include the basal ganglia and cerebellum, which account for movement disorders and dyscoordination that are seen often after cardiac arrest. The brainstem can tolerate a greater degree of global ischemia. This is manifested as preservation of cranial nerve and sensory motor reflexes. Significant impairment of the cortex and thalamus with relative preservation of the brainstem results in vegetative and comatose states.

How Long To Perform Cpr

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CPR is a topic that will never cease being researched, and part of that research includes looking at how long to perform CPR. In 2000, the National Association of EMS Physicians released a statement that CPR should be performed for at least 20 minutes before ceasing resuscitation.

More research has been done since then that suggests longer time performing CPR results in higher survival rates. Unfortunately, there is insufficient evidence to make any concrete protocols, but at least we have a base line to go off of.

In this article, well talk about the research thats currently out there, and what we do know about survivals rates in relation to how long to perform CPR. As a caveat, this also supports why it is so important to retrain in classes like CPR, BLS and ACLS courses so that we can learn about whats proving to be most effective.

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Timing Of Cooling And Rewarming

The best time to initiate hypothermia after resuscitation and the optimal duration of hypothermia have not been defined. It is reasonable to believe that the benefits may be maximized if hypothermia is initiated as soon as possible after resuscitation. In the European study, the interval between resuscitation and attainment of target temperature had an interquartile range of 4 to 16 hours, with a mean of approximately 8 hours . Despite some delay, hypothermia still provided benefit. Rewarming should be undertaken slowly to avoid worsening neurologic injury, sudden vasodilatation, and shock . The European study rewarmed patients passively over 8 hours after 24 hours of hypothermia, whereas the Australian study reported active rewarming for 6 hours using a heated-air blanket, beginning 18 hours after ROSC . Preclinical studies have shown that delayed cooling negates the beneficial effect of hypothermia , and its beneficial effects may be enhanced even if it is initiated during the intra-arrest or resuscitation period or immediately after return of spontaneous circulation . There is a need to translate this preclinical research into human studies to help determine the optimal onset and duration of therapeutic hypothermia, and rates of cooling and rewarming.

What Is A Heart Attack

Cardiac arrest and heart attacks are often confused with each other, but they are not the same thing. A heart attack occurs when the flow of blood to the heart is blocked, often by a clogged artery. If the blockage is not removed, the part of the heart that receives blood from that artery will start to die.

Some heart attacks resemble cardiac arrest in that the attack comes quickly and is very intense. However, heart attacks can also feel fairly mild and the symptoms can sometimes be spread out over hours, days, or even weeks. Unlike with a cardiac arrest, the heart generally continues to beat during a heart attack. In addition, unlike with cardiac arrest, the symptoms of heart attack vary between men and women.

Heart attacks are often the end result of atherosclerosis, a condition in which plaque builds up in the arteries due to high cholesterol in the blood. Unlike with cardiac arrest, victims of heart attacks often have coronary heart disease.

This isnt always the case, however. Heart attacks can also be caused by coronary artery spasms that interrupt blood flow through an artery. These spasms can occur even in people who do not have coronary heart disease. Other causes include use of drugs such as cocaine, extreme pain or emotional stress, and exposure to extreme cold.

Heart attacks and cardiac arrest are not the same, but they are causally connected. A heart attack victim is at heightened risk of sudden cardiac arrest during recovery from a heart attack.

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What To Do If The Person Recovers During Cpr

CPR may revive the person before the ambulance arrives. If they do revive:

  • Review the persons condition if signs of life return . If the person is breathing on their own, stop CPR and place them on their side with their head tilted back.
  • If the person is not breathing, continue full CPR until the ambulance arrives.
  • Be ready to recommence CPR if the person stops breathing or becomes unresponsive or unconscious again. Stay by their side until medical help arrives. Talk reassuringly to them.

It is important not to interrupt chest compressions or stop CPR prematurely to check for signs of life if in doubt, continue full CPR until help arrives. It is unlikely you will do harm if you give chest compressions to someone with a beating heart. Regular recovery checks are not recommended as they may interrupt chest compressions and delay resuscitation.

What Happens After Therapeutic Hypothermia After Cardiac Arrest

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The medical team will carefully watch you. You will be in the intensive care unit. You may be on a ventilator to help with breathing. You may have various lines and tubes to support body functions.

People do not always respond right away to the procedure. It may take a couple of days. Healthcare providers often wait at least 3 days after the procedure to see how the cardiac arrest affected the brain. The procedure does not guarantee that you will regain brain function.

Some people do eventually wake up after therapeutic hypothermia. They may not have any lasting brain injury. Others might have some problems with thinking. They will need therapy. Sometimes, cardiac arrest may harm other organs, like the kidneys. You will need follow-up care.

Medical care will depend on the reason for the cardiac arrest and the degree of damage. Other health problems you have will also determine the care you need. You may need medicine, procedures, and physical therapy. Some people might need surgery for heart disease. Other people might need an automatic defibrillator. Almost everyone will need to stay in the hospital for a while. Talk with the healthcare provider about what to expect after the procedure.

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Cerebral Edema And Increased Intracranial Pressure

Usually, ICP is not elevated after cardiac arrest , but high ICP can compromise cerebral blood flow, and cerebral herniation can cause structural brain damage and death. In comatose patients with evidence of increased ICP, such as clinical signs of herniation or cerebral edema on CT scan, ICP monitoring may be helpful to guide therapies for optimization of ICP and cerebral perfusion pressure . Hypoxia, hypotension, and hypercapnia can worsen brain damage and should be avoided . In the absence of ongoing ICP elevation, prophylactic and long-standing hyperventilation aggravated a wide range of brain injury . Therefore, it is suggested that comatose patients be mechanically ventilated to achieve normocapnia .

Dont You Need To Check The Airway First

If you see or hear someone suddenly collapse and they did not show any sign of choking, you dont have to worry about checking the airway. Assume its a sudden cardiac arrest and follow the 3 Cs: Check for responsiveness , Call 911 and Compress at a rate of 100 per minute, about 2 inches deep. If by some chance an object is lodged in the throat, effective compressions likely will dislodge the object, similarly to the way abdominal thrusts dislodges objects.

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Cardiac Arrests Often Happen At Home

About 350,000 cardiac arrests happen outside of hospitals each yearand about 7 in 10 of those happen at home.3;Unfortunately, about half of the people who experience cardiac arrests at home dont get the help they need from bystanders before an ambulance arrives.4

If you see cardiac arrest happen , call 9-1-1 right away and then do CPR until medical professionals arrive. Keep reading to learn how to perform CPR.

Mechanisms Of Neuronal Injury After Cardiac Arrest

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Numerous clinical studies have tested therapies that are directed at specific steps of the injury cascade, and have failed to show an outcome benefit . Conversely, recent randomized trials demonstrate that therapeutic hypothermia is associated with improved survival and functional outcome following cardiac arrest. Although the mechanism underlying the neuroprotective effect of hypothermia is not fully understood, numerous hypotheses have been suggested . The ability of hypothermia to affect multiple points of the injury cascade may contribute significantly to its success as an intervention. These effects include retarding the initial rate of ATP depletion , reducing excitotoxic neurotransmitter release , altering intracellular messenger activity , limiting breakdown of the blood√Ębrain barrier , reducing inflammatory responses , altering gene expression and protein synthesis , reducing intracellular calcium, and changing glutamate receptor regulation .

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What Happens To Your Brain After Cardiac Arrest

Only 25 percent of adults will survive an in-hospital cardiac arrest, and even then the damage done to the brain can have lifelong consequences. Plus, out-of-hospital cardiac arrests, which are much more common, have an even lower chance of survival – about 12 percent. For those that do make it through, its difficult for physicians to predict how patients brains will heal. In a new study, scientists aim to improve methods used to predict brain healing and function in the months and years following cardiac arrest.

From Johns Hopkins University School of Medicine and the Radiological Society of North America, lead author of the new Radiology study Robert D. Stevens, MD, is looking for better ways to predict outcomes and guide treatment plans for cardiac arrest patients. “We need better methods to help clinicians understand the magnitude of these injuries and make more accurate predictions on recovery, thereby enabling more informed decision-making, he explained.

Its important to understand the distinction between heart attack, which is caused by a blockage in the blood vessels, and cardiac arrest, where the heart stops pumping completely, as a result of an irregular heartbeat. Learn more about the difference between these two conditions. Brain damage from cardiac arrest occurs because the brain is one of the many organs starved for oxygen when blood flow – and the heart – stops pumping. Learn more about what happens after cardiac arrest.

How Much Water Does It Take To Drown

It doesnt take a lot of water to cause drowning. Every year, people drown in bathtubs, shallow lakes, and even small puddles. The amount of liquid it takes to cause a persons lungs to shut down varies according to their:

  • age

studies indicate that a person can drown in 1 milliliter of fluid for every kilogram they weigh. So, a person weighing around 140 pounds could drown after inhaling only a quarter cup of water.

A person can drown on dry land hours after inhaling water in a near-drowning incident. This is whats known as secondary drowning.

Dry drowning, which refers to drowning that takes place less than an hour after someone inhales water, can also occur. However, the medical community is itself from the use of this confusing term.

Medical emergency

If you or your child has inhaled a significant amount of water in a near-drowning incident, seek emergency care as soon as possible, even if things seem fine.

Drowning happens very quickly, but it does take place in stages. The stages can take between 10 and 12 minutes before death occurs. If a child is drowning, it may happen much more quickly.

Heres a breakdown of the stages of drowning:

  • For the first several seconds after water is inhaled, the drowning person is in a state of fight-or-flight as they struggle to breathe.
  • The body enters a state called hypoxic convulsion. This can look like a seizure. Without oxygen, the persons body appears to turn blue and may jerk around erratically.
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    Clinically Dead The Blurred Line Between Life And Death

    19 June 2014

    Sometimes, the line between life and death can seem blurred. In one recent case, a woman was erroneously declared dead after having a heart attack and wound up freezing to death in a body bag in the morgue. Another woman gave birth to a baby three months after she technically died. Then, there was a case of a skier who became submerged under freezing water for hours, but was revived and suffered no brain damage.

    These and other cases reveal how hard it can be to distinguish the living from the dead. With the advent of mechanical ventilators, the clear-cut definition of death has now given way to other, more clinical definitions.

    But these terms, such as “brain death” and “circulatory death,” can create ambiguity about who is dead and who isn’t, experts say.

    What is death?

    Despite its frequent use, the term “clinical death” doesn’t actually have a consistent meaning, said Dr. James Bernat, a neurologist at Dartmouth College’s Geisel School of Medicine in New Hampshire. In most hospitals, the doctor in charge of a patient’s care makes the death determination, and there aren’t universal guidelines for when to make that call, he said.

    “You’re dead when a doctor says you’re dead,” Bernat told Live Science.

    Until the 1950s, death was considered to be the point when any one of the vital functions heartbeat, electrical brain activity or respiration ceased. Once one part of the system failed, then the others would soon shut down as well, the reasoning went.

    Cpr Survival Rates Are Lower Than Most People Think

    Brett’s Story: Back to College after a Traumatic Brain Injury

    By Carolyn Crist, Reuters Health

    5 Min Read

    – The majority of people believe cardiopulmonary resuscitation is successful more often than it tends to be in reality, according to a small U.S. study.

    This overly optimistic view, which may partly stem from seeing happy outcomes in television medical dramas, can get in the way of decision-making and frank conversations about end of life care with doctors, the research team writes in American Journal of Emergency Medicine.

    CPR is intended to restart a heart that has stopped beating, known as cardiac arrest, which is typically caused by an electrical disturbance in the heart muscle. Although a heart attack is not the same thing it occurs when blood flow to the heart is partly or completely blocked, often by a clot a heart attack can also cause the heart to stop beating.

    Whatever the cause of cardiac arrest, restarting the heart as quickly as possible to get blood flowing to the brain is essential to preventing permanent brain damage. More often than not, cardiac arrest ends in death or severe neurological impairment.

    The overall rate of survival that leads to hospital discharge for someone who experiences cardiac arrest is about 10.6 percent, the study authors note. But most participants in the study estimated it at more than 75 percent.

    Patients and family members should know about the realistic success rate and survival numbers when planning a living will and considering a Do Not Resuscitate order, Ouellette said.

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    What Is Life Support

    The term life support refers to any combination of machines and medication that keeps a persons body alive when their organs would otherwise stop working.

    Usually people use the words life support to refer to a mechanical ventilation machine that helps you breathe even if youre too injured or sick for your lungs to keep working.

    Another cause for the need of a ventilator is a brain injury that doesnt allow the person to protect their airway or initiate breaths effectively.

    Life support is what gives doctors the ability to perform complicated surgeries. It can also prolong life for people who are recovering from traumatic injuries. Life support can also become a permanent necessity for some people to stay alive.

    There are many people who have portable ventilators and continue to live a relatively normal life. However, people who are using a life-support device dont always recover. They may not regain the ability to breathe and function on their own.

    If a person on a ventilator is in a long-term state of unconsciousness, this can put family members in the difficult situation of choosing whether their loved one should continue to live in an unconscious state with the help of the machine.

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