Advanced CPR: Step-by-Step Procedure

Advanced CPR: Step-by-Step Procedure

By Prof.Midhu Kurian

Senior Writer, Healthcare Digital

Cardiopulmonary Resuscitation (CPR) is a life-saving technique used during cardiac arrest to maintain blood circulation and oxygen delivery to vital organs. This guide combines the best practices from various global standards into a single, advanced procedure.

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VIDEO EXPLANATION

Step 1: Assess the Scene & Victim

• Ensure the environment is safe for both the rescuer and the victim.
• Check for responsiveness by tapping the person’s shoulders and shouting, "Are you okay?"
• If unresponsive, immediately call for emergency medical services (EMS) and get an Automated External Defibrillator (AED), if available.

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Step 2: Check for Breathing & Pulse

• Place your ear near the victim’s mouth and nose to look, listen, and feel for normal breathing.
• Simultaneously, check the carotid pulse (in adults) or brachial pulse (in infants) for no more than 10 seconds.
• If no pulse and no normal breathing (or only gasping), start CPR immediately.

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Step 3: Begin Chest Compressions

• Hand Positioning:
  • Adults & Children: Place both hands (one on top of the other) on the center of the chest (lower half of the sternum).
  • Infants: Use two fingers (single rescuer) or two thumbs (two rescuers) on the lower half of the sternum.
• Compression Depth & Rate:
  • Adults & Children: At least 2 inches (5 cm) deep.
  • Infants: About 1.5 inches (4 cm) deep.
  • Rate: 100–120 compressions per minute.
• Allow full chest recoil between compressions to enable proper blood flow.

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Step 4: Provide Rescue Breaths

• Open the airway using the head-tilt, chin-lift method (unless spinal injury is suspected, then use jaw-thrust).
• Deliver 2 breaths after every 30 compressions (for single rescuer) or every 15 compressions (for two rescuers in infants/children).
• Breath technique:
  • Mouth-to-mouth: Pinch the nose and provide a full breath, watching for chest rise.
  • Bag-Valve Mask (BVM) ventilation: If trained, use a BVM to provide breaths, ensuring a tight seal over the victim’s mouth and nose.
• Each breath should last about 1 second, with visible chest rise.

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Step 5: Use an Automated External Defibrillator (AED)

• As soon as the AED arrives, turn it on and follow voice prompts.
• Attach electrode pads to the victim’s bare chest:
  • Adults & Children: One pad on the upper right chest, the other on the lower left chest.
  • Infants: If pads risk touching, place one on the chest and one on the back.
• Allow the AED to analyze the heart rhythm.
• If a shock is advised, ensure no one is touching the victim and press the shock button.
• Resume CPR immediately after the shock (or if no shock is advised), starting with compressions.

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Step 6: Continue CPR Until…

• Professional medical help takes over.
• The victim shows signs of life (breathing, movement).
• An advanced provider determines to stop resuscitation.
• You are physically unable to continue.

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Special Considerations

• Drowning Victims: Start with 5 initial rescue breaths before chest compressions.
• Pregnant Victims: Place the victim in a slightly left-tilted position to relieve pressure on the heart.
• Opioid Overdose: Administer naloxone (if available) alongside CPR.
• Trauma Victims: Maintain spinal precautions while opening the airway.

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Conclusion

This advanced CPR protocol integrates the best techniques from various international guidelines, ensuring the most effective resuscitation approach. Early and high-quality CPR, combined with rapid defibrillation, significantly improves survival rates.

VIDEO EXPLANATION

Heart Failure: Causes, Symptoms, and Treatment

Heart Failure: Causes, Symptoms, and Treatment

What is Heart Failure?

Heart failure is a chronic condition in which the heart is unable to pump blood efficiently to meet the body’s needs for oxygen and nutrients. This leads to inadequate circulation, causing fluid buildup in the lungs, legs, and other parts of the body. Despite its name, heart failure does not mean that the heart has stopped working but rather that it is functioning less effectively.

VIDEO EXPLANATION

Causes of Heart Failure

Several conditions can weaken or damage the heart, leading to heart failure. The most common causes include:

• Coronary Artery Disease (CAD): The buildup of fatty deposits in the arteries restricts blood flow to the heart, reducing its ability to function properly.
• High Blood Pressure (Hypertension): Excessive pressure on the heart forces it to work harder, leading to thickened or weakened heart muscles.
• Heart Attack (Myocardial Infarction): A previous heart attack damages heart tissue, reducing its ability to pump effectively.
• Cardiomyopathy: Diseases of the heart muscle, including inherited or acquired conditions, can lead to heart failure.
• Valvular Heart Disease: Malfunctioning heart valves affect blood flow, making the heart pump harder than normal.
• Diabetes: High blood sugar levels can contribute to artery damage and increase the risk of heart failure.
• Obesity and Lifestyle Factors: Poor diet, lack of exercise, excessive alcohol consumption, and smoking can strain the heart over time.

Types of Heart Failure

There are different types of heart failure based on which part of the heart is affected:

1. Left-Sided Heart Failure

   • Systolic Heart Failure (HFrEF): The heart muscle weakens and loses its ability to pump blood effectively.
   • Diastolic Heart Failure (HFpEF): The heart muscle becomes stiff and cannot fill properly with blood.

2. Right-Sided Heart Failure

   • Occurs when the right side of the heart fails to pump blood efficiently, leading to fluid retention and swelling in the legs, ankles, and abdomen.

3. Congestive Heart Failure (CHF)

   • A progressive condition where fluid builds up in the lungs and other body tissues, worsening symptoms over time.

Symptoms of Heart Failure

Heart failure symptoms may develop gradually or appear suddenly. Common signs include:

• Shortness of Breath (Dyspnea): Difficulty breathing, especially during physical activity or while lying down.
• Fatigue and Weakness: Reduced oxygen supply makes daily activities exhausting.
• Swelling (Edema): Fluid buildup in the legs, ankles, feet, and sometimes the abdomen.
• Rapid or Irregular Heartbeat (Palpitations): The heart beats faster to compensate for its weakened pumping ability.
• Persistent Cough or Wheezing: Due to fluid buildup in the lungs, often with white or pink-tinged mucus.
• Sudden Weight Gain: Rapid fluid retention is a sign of worsening heart failure.
• Frequent Urination at Night (Nocturia): The body tries to remove excess fluid while at rest.
• Cognitive Issues: Memory loss, confusion, or difficulty concentrating due to reduced blood flow to the brain.

Diagnosis of Heart Failure

Doctors use several tests to diagnose heart failure and determine its severity, including:

• Physical Examination: Checking for swelling, abnormal heart sounds, and lung congestion.
• Echocardiogram: A key test that assesses heart function and measures the ejection fraction (EF), which indicates how well the heart is pumping.
• Electrocardiogram (ECG): Detects irregular heart rhythms and past heart damage.
• Blood Tests: Identify heart stress markers like BNP (B-type natriuretic peptide) levels.
• Chest X-ray: Shows fluid buildup in the lungs and heart enlargement.
• Cardiac MRI or CT Scan: Provides detailed images of heart structure and function.

Treatment and Management of Heart Failure

Although heart failure is a chronic condition, it can be managed with proper treatment and lifestyle changes:

1. Lifestyle Modifications

   • Reduce salt intake to prevent fluid retention.
   • Maintain a heart-healthy diet rich in fruits, vegetables, and whole grains.
   • Exercise regularly, as recommended by a doctor.
   • Quit smoking and limit alcohol consumption.
   • Manage stress and get adequate sleep.

2. Medications

   • ACE Inhibitors & ARBs: Help relax blood vessels and reduce strain on the heart.
   • Beta-Blockers: Slow the heart rate and improve heart function.
   • Diuretics (Water Pills): Reduce fluid buildup and swelling.
   • Aldosterone Antagonists: Help remove excess fluid and lower blood pressure.
   • SGLT2 Inhibitors: A newer class of drugs beneficial for heart failure patients, particularly those with diabetes.

3. Medical Devices & Procedures

   • Implantable Cardioverter Defibrillator (ICD): Helps prevent dangerous heart rhythms.
   • Cardiac Resynchronization Therapy (CRT): Improves heart pumping efficiency.
   • Coronary Bypass Surgery or Valve Repair: For cases where blockages or valve issues contribute to heart failure.
   • Heart Transplant: In severe cases where other treatments are not effective.

Preventing Heart Failure

While some risk factors are unavoidable, adopting a heart-healthy lifestyle can significantly reduce the chances of developing heart failure.

• Control blood pressure and cholesterol levels.
• Maintain a healthy weight and exercise regularly.
• Monitor and manage diabetes if present.
• Get regular health checkups for early detection of heart issues.

Conclusion

Heart failure is a serious but manageable condition with early diagnosis, medical treatment, and lifestyle changes. Understanding its causes, symptoms, and treatment options can help individuals take proactive steps to improve their heart health and overall well-being. If you or a loved one experience signs of heart failure, seeking medical attention promptly can make a significant difference in quality of life and long-term outcomes.

Barium Enema: Step-by-Step Procedure

 

Barium Enema: Step-by-Step Procedure

A Barium Enema is a diagnostic X-ray procedure used to examine the colon and rectum. It helps detect conditions like polyps, tumors, ulcers, and inflammation.

Step 1: Patient Preparation

• The patient follows a clear liquid diet a day before the procedure.
• A laxative or enema is used to cleanse the colon.
• The patient fasts for several hours before the test.

Step 2: Positioning the Patient

• The patient changes into a hospital gown.
• They lie on their side on the X-ray table.

Step 3: Inserting the Enema Tube

• A lubricated rectal catheter is gently inserted into the rectum.
• The barium sulfate contrast is introduced slowly into the colon.

Step 4: Taking X-ray Images

• The patient is asked to turn in different positions for clear imaging.
• In a double-contrast study, air is introduced to expand the colon.
• The radiologist captures multiple X-ray images.

Step 5: Removing the Barium

• The enema tube is removed after the imaging is complete.
• The patient is asked to use the restroom to expel the barium.

Step 6: Post-Procedure Care

• The patient may experience white-colored stools due to the barium.
• Drinking plenty of fluids helps flush out the contrast.
• The doctor reviews the X-ray results for any abnormalities.

Phlebotomy: Step-by-Step Process (Blood collection procedure)

 

Phlebotomy: Step-by-Step Process

Phlebotomy is the process of drawing blood for medical testing, transfusions, or donations. Below is a step-by-step guide:

1. Preparation

• Gather necessary supplies: gloves, tourniquet, alcohol swab, needle, vacutainer, gauze, and bandage.
• Verify patient identity and explain the procedure.
• Wash hands and wear gloves.

2. Selecting the Vein

• Apply a tourniquet 3-4 inches above the venipuncture site.
• Ask the patient to make a fist to make veins more visible.
• Choose a suitable vein (median cubital vein is preferred).

3. Cleaning the Site

• Clean the selected area with an alcohol swab in a circular motion.
• Allow the skin to air dry to prevent contamination.

VIDEO -PHLEBOTOMY

4. Performing Venipuncture

• Hold the needle at a 15-30° angle and insert it into the vein.
• Attach a vacutainer tube and allow blood to flow.
• Fill the required amount of blood into the tube.

5. Removing the Needle

• Once the tube is filled, remove the tourniquet.
• Gently remove the needle and immediately apply gauze over the site.
• Ask the patient to apply pressure to prevent bleeding.

6. Post-Procedure Care

• Dispose of the needle in a sharps container.
• Label the blood sample correctly.
• Apply a bandage to the puncture site.
• Ensure the patient feels well before leaving.

Groundbreaking Study: Communication Between Two People in Their Dreams

VIDEO EXPLANATION

Groundbreaking Study: Communication Between Two People in Their Dreams

In a remarkable scientific breakthrough, researchers have achieved the first-ever direct communication between two individuals within their dreams. This incredible discovery opens new doors for understanding human consciousness, the subconscious mind, and potential therapeutic applications.

The Experiment: How It Was Achieved

A neurotechnology company, REMspace, recently conducted a fascinating study where two participants successfully exchanged a simple message while in separate lucid dream states. This was made possible through:

Lucid Dreaming: Both individuals were trained lucid dreamers who could recognize and control their dreams.

Advanced Monitoring Equipment: Brain activity and sleep patterns were tracked in real-time.

Communication Protocol: One participant received a word through an audio device while dreaming. They mentally repeated it, and the second participant later received the message in their dream and confirmed it upon waking.

This experiment has sparked immense curiosity about the untapped potential of our dreaming minds.

How This Discovery Can Help Psychiatric Patients

This breakthrough is not just a scientific milestone; it has significant implications for mental health and well-being. For psychiatric patients, dream communication could offer:

Therapeutic Healing: Many individuals with anxiety, depression, and PTSD struggle with overwhelming thoughts. Lucid dreaming techniques could help them process emotions and fears in a controlled manner.

Reducing High Tension & Stress: Dream training and controlled communication may offer a new way to relax the mind, reducing stress and improving sleep quality.

Cognitive Enhancement: By utilizing lucid dreams for self-exploration, patients can strengthen emotional resilience and problem-solving abilities.

Prof. Midhu Kurian’s Research on Sleep and Dreams

Renowned sleep researcher Prof. Midhu Kurian has also conducted extensive studies on how dream states influence mental well-being. His research, focusing on Nursing students and IT professionals, suggests that:

Lack of quality sleep affects creativity and productivity in  Nursing students.

IT professionals face high stress due to disrupted sleep cycles, leading to cognitive fatigue.

Dream training and lucid dreaming techniques can enhance relaxation and focus.

His findings support the idea that sleep plays a vital role in emotional health and brain function. With the latest discovery in dream communication, his research gains even more significance.

The Future of Dream Research :This breakthrough is only the beginning. With further research, dream communication could lead to: New therapeutic techniques for psychiatric patients. Skill development through dreams by enhancing memory and learning. A deeper understanding of the human mind and its potential beyond waking consciousness.

Science is now proving what ancient wisdom and dream theorists have long suggested—our dreams hold incredible power. Could the future of therapy and mental wellness be hidden within our dreams?

Ultrasonography (USG) Procedure: Step-by-Step Guide

VIDEO ULTRASONOGRAPHY

Ultrasonography (USG) Procedure: Step-by-Step Guide

Ultrasonography (USG) is a non-invasive imaging technique that uses high-frequency sound waves to create images of internal organs, tissues, and blood flow. Below is a step-by-step guide to the procedure:

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Step 1: Preparation

• Patient Instructions: The patient may need to fast for 6-8 hours (for abdominal ultrasound) or have a full bladder (for pelvic ultrasound).
• Clothing: The patient is asked to wear a gown and remove any jewelry or accessories.
• Positioning: The patient lies down on an examination table, depending on the area to be scanned.

       

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Step 2: Application of Gel

• A water-based ultrasound gel is applied to the skin over the area to be examined.
• The gel helps in transmitting sound waves and eliminating air gaps between the probe and skin.

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Step 3: Scanning with Transducer

• A transducer (probe) is moved over the gel-coated skin.
• The transducer emits ultrasound waves that penetrate tissues and bounce back as echoes.
• The echoes are converted into real-time images on the ultrasound screen.

       

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Step 4: Image Acquisition and Observation

• The sonographer adjusts the transducer’s position to get clear images.
• Measurements and observations are taken to assess structures, movement, or blood flow (in Doppler ultrasound).
• If needed, additional angles or pressure may be applied for better visualization.

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Step 5: Special Types of USG (If Required)

• Doppler Ultrasound: Evaluates blood flow in arteries and veins.
• Transvaginal/Transrectal Ultrasound: Requires insertion of a special probe into the vagina (for female reproductive organs) or rectum (for prostate imaging).
• Contrast-Enhanced Ultrasound: Uses contrast agents for detailed imaging.

        

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Step 6: Completion of Procedure

• The gel is wiped off the skin.
• The patient can resume normal activities unless advised otherwise.
• The ultrasound images are reviewed by a radiologist for diagnosis.

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Step 7: Report and Follow-Up

• A detailed ultrasound report is prepared and sent to the doctor.
• Based on the findings, further tests or treatments may be recommended.

Catheterization - Step-by-Step Process

Video Explanation 

Step-by-Step Process of Catheterization

Catheterization is a medical procedure in which a catheter (a thin, flexible tube) is inserted into the body to drain urine from the bladder. It is commonly performed in patients who have urinary retention, surgery, or mobility issues.

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Step 1: Preparation

1. Gather Supplies:

   • Sterile catheter kit (catheter, gloves, antiseptic wipes, lubricating gel, collection bag, syringe for balloon inflation in Foley catheter).
   • Sterile drapes and a container for waste disposal.

2. Patient Preparation:

   • Explain the procedure to the patient to reduce anxiety.
   • Position the patient:
     • Males: Supine position with legs extended.
     • Females: Supine position with legs apart and knees bent.
   • Provide privacy and maintain sterility.

3. Hand Hygiene & Gloves:

   • Wash hands thoroughly and wear sterile gloves.

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Step 2: Cleaning & Lubrication

1. Clean the Genital Area:

   • Males: Retract the foreskin (if uncircumcised) and clean the glans penis in a circular motion.
   • Females: Spread the labia and clean the urethral opening from front to back.

2. Lubricate the Catheter:

   • Apply sterile lubricating gel to ease insertion and prevent trauma.

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Step 3: Catheter Insertion

1. Insert the Catheter Slowly:

   • Hold the catheter about 2 inches from the tip.
   • Gently insert into the urethral opening while asking the patient to take deep breaths to relax.
   • Advance the catheter until urine starts flowing.

2. Balloon Inflation (For Foley Catheter):

   • If using a Foley catheter, inflate the retention balloon with sterile water (as per catheter size instructions).
   • Gently pull the catheter slightly to ensure proper placement.

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Step 4: Securing the Catheter

1. Connect to the Drainage Bag:

   • Ensure the catheter is properly connected to the urine collection bag.

2. Secure the Catheter:

   • Tape the catheter to the thigh (for females) or abdomen (for males) to prevent movement and irritation.

3. Adjust the Drainage Bag:

   • Keep the bag below bladder level to prevent backflow and infection.

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Step 5: Post-Procedure Care

1. Monitor Urine Output:

   • Observe urine color, consistency, and quantity.

2. Ensure Hygiene & Comfort:

   • Provide patient education on catheter care.
   • Perform regular perineal hygiene.

3. Document the Procedure:

   • Note the time, type of catheter, urine output, and any complications.

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Catheter Removal (If Needed)

1. Deflate the Balloon (for Foley Catheter):
   • Use a syringe to withdraw the sterile water.
2. Gently Remove the Catheter:
   • Ask the patient to take deep breaths while slowly pulling it out.
3. Post-Removal Care:
   • Monitor for urinary retention or infection symptoms.

This step-by-step process ensures safe and effective catheterization while minimizing complications.