Duration of CPR May Be a Factor in Kids’ Survival

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Some children with in-hospital cardiac arrest can benefit from longer duration of cardiopulmonary resuscitation (CPR), a study has found. In the study among survivors, neurological outcome was favorable for the majority of patients.

Of the 3,419 children included in the study, 28% survived to hospital discharge, and 16.6% of these survivors had CPR longer than 35 minutes, according to Renée Matos, MD, MPH, of the University of Pittsburgh School of Medicine, and colleagues. A total of 60% of these survivors with longer-duration CPR achieved a favorable neurologic outcome, they reported in the study published Jan. 21 in Circulation: Journal of the American Heart Association.

In the mid-1990s, authorities considered pediatric CPR futile beyond 20 minutes’ duration or when more than two doses of epinephrine were provided.

Even though longer-duration CPR can benefit some children, the reality is that after the first 15 minutes of CPR, survival rate declines rapidly. Survival decreased by 2.1% for every minute of chest compressions over 15 minutes.

When CPR was longer than 35 minutes, those in the Surgical Cardiac category had the best survival to hospital discharge rate (25%), followed by, Medical Cardiac — 21%; General Surgical — 13%; General Medical — 10% and Trauma — 8%.  ([Medpage today)

Do not talk loose or you can be booked under section 295A or 505 (2) of IPC

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BJP MP Varun Gandhi had to spend four hours in judicial custody after his bail was rejected by the chief judicial magistrate, Pilibhit, in connection with a criminal case lodged against him, alleging him for making “hate speech” during the 2009 Lok Sabha elections. Later he was granted relief by an appeal in the district court.

What are the IPC sections 295A and 505(2) under which he was booked?

1. 295A: Deliberate and malicious acts intended to outrage religious feelings of any class by insulting its religion or religious beliefs.– Whoever, with deliberate and malicious intention of outraging the religious feelings of any class of 6[ citizens of India], 7[ by words, either spoken or written, or by signs or by visible representations or otherwise] insults or attempts to insult the religion or the religious beliefs of that class, shall be punished with imprisonment of either description for a term which may extend to 8[ three years], or with fine, or with both.

2. Section 505(2) in The Indian Penal Code, 1860: Statements creating or promoting enmity, hatred or ill- will between classes.– Whoever makes, publishes or circulates any statement or report containing rumour or alarming news with intent to create or promote, or which is likely to create or promote, on grounds of religion, race, place of birth, residence, language, caste or community or any other ground whatsoever, feelings of enmity, hatred or ill- will between different religious, racial, language or regional groups or castes or communities, shall be punished with imprisonment which may extend to three years, or with fine, or with both.

About the author: Dr K K Aggarwal is Padma Shri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA [blog.kkaggarwal.com]

Always write the dose and duration of treatment in the prescription

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The present case reminds me of a medical joke. A patient came to a doctor after six months and said I consulted you six month back for fever and you said do not take bath. Can I take it now?

Recently The National Consumer Disputes Redressal Commission has held a Delhi doctor guilty of “limited medical negligence” for verbally advising, instead of prescribing in writing, the use of eye drops to a patient who lost his vision following its prolonged application, reports TOI. The commission directed the doctor to pay the patient, compensation of Rs 50,000.

The commission said that the eye surgeon did not spell out in writing the “dosage and duration of the medicine”. And at the same time, it blamed Gupta for not turning up for follow-ups and for continuing the drops despite being provided just one vial by the doctor. There was an element of “contributory negligence” by the patient and the same was considered as a mitigating circumstance while awarding the compensation.

In 1993, the patient had pterygium left eye. Post operatively he was prescribed local application of Mitomycin-C. He was verbally told to take it for no more than two weeks as this could harm but was not documented. But the patient continued the drops and over a period developed dry eye due to prolonged use of the drug.

The national commission observed that since the doctor had converted just one vial of Mitomycin-C injection into eye drops the indication was for its limited use for about two weeks and not several months.

Because of this the commission held the doctor guilty of only ‘limited medical negligence’ for not having put down in writing the dosage and duration of the medicine in the prescription slip.

The doctor was guilty of ‘limited medical negligence’ since he had failed to put in writing the dosage and duration of the medicine.

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