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 Emergency & First Aid

January 2012
Life-threatening Emergencies- What to do?
Dr Priyadarshini Pal Singh

Life-threatening emergencies can happen anytime, anywhere. They result from pre-existing health problems, toxins, unintentional injuries,natural disasters or even violence. The trick is to know what to do.

Cardiopulmonary resuscitation (CPR) is the manual application of chest compression and ventilation to patients in cardiac arrest, done in an effort to maintain viability until advanced help arrives.
CPR allows oxygenated blood to circulate to vital organs such as the brain and heart. CPR started by bystanders doubles the likelihood of survival for a victim of cardiac arrest.

The preliminary steps of CPR as defined by AHA are:
  • Assess responsiveness by “Shake and Shout”
  • If unresponsive…
  • Call for help (nearest ambulance service)

Check CAB
C = Circulation
A = Airway
B = Breathing

Check circulation
  • Carotids (pulse felt next to Adam’s apple in the neck on any one side) for adults
  • Do not attempt to check carotid pulse on both sides simultaneously
  • In the absence of pulse, start CPR
  • Push hard
  • Push fast
  • Centre of chest
  • Place the heel of one hand straight,
    clasp fingers with the other hand,
    elbows straight and start chest
  • Provide 30 compressions, count your
    compressions aloud
  • Rate: @ 100/mins
  • Depth 1½ to 2 inch (4-5 cm)
  • After compression leave the chest to
  • No interruption

Check breathing
  • Quick assessment
  • No breathing
  • No normal breath
  • If not breathing, provide two effective rescue breaths
Note:The above steps are to be repeated till help arrives.


Choking occurs when a foreign object enters and rests in the throat or windpipe, blocking the flow of air. In adults, a morsel of food is often the culprit. Young children often swallow small objects. As choking cuts off oxygen to the brain, it is important to administer First Aid as quickly as possible.

Check for signs
  • The universal sign for choking are the hands clutched to the throat. If the person doesn’t give the signal, look for these indications:
  • Inability to talk
  • Difficulty in breathing or noisy breathing
  • Inability to cough forcefully
  • Skin, lips and nails turning blue or dusky
  • Loss of consciousness
You would need to perform abdominal thrusts (Heimlich manoeuvre) on someone else, which is explained as below :
  • Stand behind the person. Wrap your arms around the waist. Tip the person forward slightly.
  • Make a fist with one hand. Position it slightly above the person’s navel.
  • Grasp the fist with the other hand.Press hard into the abdomen with a quick, upward thrust – as if trying to lift the person up breathing.
  • Perform a total of five abdominal thrusts, if needed. If the blockage still isn’t dislodged, repeat the five-andfive cycle.
If you’re the only rescuer, perform back blows and abdominal thrusts before calling the local emergency number for help. If another person is available, have that person call for help while you perform first aid.

If the person becomes unconscious, perform standard CPR with chest compressions and rescue breaths.
Dr.Priyadarshini Pal Singh is Head,Dept.of Accident and Emergency in Apollo Indraprastha Hospitals,New Delhi

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