Hypothermia is a major cause of mortality during winter in India

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Avoid hypothermia in this winter by taking certain necessary precautions

New Delhi, 20th January 2019: According to a recent report, about 44 people died in Delhi between 1 January and 6 January, includng a two-year-old child due to the cold weather conditions. Several of these deaths may probably be due to a condition called hypothermia.

Hypothermia is generally defined as having a core body temperature of 95 degrees Fahrenheit or lower and can occur when the outside environment gets too cold or the body’s heat production decreases.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “People can die of hypothermia in the winter season. Imagine a situation when you come across people lying in an area with no clothes early in the morning. One of them is shivering and the other one is not. The one who is shivering indicates that his body is trying to compensate with the low body core temperature. The other one, who is not shivering, may be dead, dying or normal. Recall your naturopathy teaching Sar Thanda, Pet Naram and Paon Garam. If the sole of the feet and the feet are cold and the person is not shivering, this is a medical emergency. On the contrary, if the person is not shivering and the feet are warm, it is not medical emergency. Therefore, hypothermia with no shivering and hyperthermia with no sweating are bad signs.”

An individual may suffer from hypothermia if he or she has been exposed to cool temperatures and shows one or more of the following signs: slowed or slurred speech; sleepiness or confusion; shivering or stiffness in the arms and legs; poor control over body movements; slow reactions, or a weak pulse.

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “In hypothermic deaths, a person can be revived even after hours of cardiac arrest. Only once the body temperature is brought back to normal CPR will be effective. That would mean that consciousness gets frozen and does not leave the body when the temperature is below 35°C. This forms the basis for induced hypothermia after death to revive the brain.”

Some tips from HCFI

Here are a few tips to help older people avoid hypothermia.

  • Make sure your home is warm enough. Set the thermostat to at least 68 to 70 degrees.
  • Even mildly cool homes with temperatures from 60 to 65 degrees can lead to hypothermia in older people.

To stay warm at home, wear long underwear under your clothes, along with socks and slippers. Wear several layers of warm loose clothing to help trap warm air between the layers. In India, wear a monkey cap.

  • Use a blanket to keep your legs and shoulders warm and wear a hat or cap indoors.
  • When going outside in the cold, it is important to wear a hat, scarf, and gloves or mittens to prevent loss of body heat through your head and hands. A hat is particularly important because a large portion of body heat can be lost through the head.
  • Check if any prescription or over-the-counter medications you consume can increase your risk for hypothermia.
  • Remember hypothermia with no shivering is a bad sign

Painkillers may increase risk of cardiac arrest

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Pain is one of the most common presenting complaints of patients. And, painkillers are the most widely used drugs, whether taken OTC or prescribed. But, they have side-effects and their adverse effects on GIT, kidney, heart and liver have been well-documented.

Now a new research published in the March 2017 issue of European Heart Journal – Cardiovascular Pharmacotherapy has shown an association of non-steroidal anti-inflammatory drugs (NSAIDs), especialy diclofenac and ibuprofen, to increased risk of out-of-hospital cardiac arrest.

All patients who had an out-of-hospital cardiac arrest in Denmark between 2001 and 2010 were identified from the nationwide Danish Cardiac Arrest Registry. Data was collected on all redeemed prescriptions for NSAIDs from Danish pharmacies since 1995. These included the non-selective NSAIDs (diclofenac, naproxen, ibuprofen), and COX-2 selective inhibitors (rofecoxib, celecoxib). A total of 28,947 patients had an out-of-hospital cardiac arrest in Denmark during the 10-year period. Of these, 3,376 were treated with an NSAID up to 30 days before the event. Ibuprofen and diclofenac were the most commonly used NSAIDs, making up 51% and 22% of total NSAID use, respectively.

Use of any NSAID was associated with a 31% increased risk of cardiac arrest. Diclofenac and ibuprofen were associated with a 50% and 31% increased risk, respectively. Naproxen, celecoxib and rofecoxib were not associated with the occurrence of cardiac arrest, probably due to a low number of events.

It is a common perception amongst the public that OTC drugs are safe because they are available over the counter. However, this study further highlights the fact that though available without a doctor’s prescription, OTC drug does not mean that it can be taken without a doctor’s advice. If not taken as directed, painkillers can cause side effects, at times potentially dangerous.

(Source: ESC Press release, March 15, 2017)

Dr KK Aggarwal
National President IMA and HCFI

Do CPR for 30 mins before transporting cardiac arrest victims to hospital

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Quite often we read about people collapsing due to a cardiac arrest. Former President APJ Abdul Kalam collapsed while he was addressing students in Shillong. He was immediately rushed to the hospital but could not be revived. More recently, Mr E Ahamed, Member of Parliament collapsed in the Parliament after he suffered cardiac arrest and passed away.

Such instances bring CPR or cardiopulmonary resuscitation back into the spotlight. The first instinct is to immediately rush a person to the hospital when you see somebody collapse suddenly. But at times, a first responder CPR may help revive the person until medical help arrives or a defibrillator is available.

Recently, a story was reported at WPRI News in February (Feb 16, 2017) about a major change in prehospital protocol policy in Rhode Island, USA for First Responders for the management of victims of cardiac arrest, which said: “Starting March 1, as dictated by the Rhode Island Department of Health, emergency response personnel will be required to conduct 30 minutes of cardiopulmonary resuscitation, or CPR, on cardiac arrest victims before transporting them to the hospital.”

The American Heart Association (AHA) has published updated Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in October 2015 in the journal Circulation, with some updates while continuing to emphasize on the characteristics of high-quality CPR: compressing the chest at an adequate rate and depth, allowing complete chest recoil after each compression (avoid leaning on the chest between compressions), minimizing interruptions in compressions, and avoiding excessive ventilation.

• The recommended chest compression rate have been updated to 100-120/ min from the earlier at least 100/min.
• The recommendation for chest compression depth for adults is at least 2 inches (5 cm) but not greater than 2.4 inches (6 cm). The earlier recommendation was at least 2 inches (5 cm).
• Chest compression should be started first before rescue breaths (C-A-B rather than A-B-C). The single rescuer should begin CPR with 30 chest compressions followed by 2 breaths.

The premise of a successful cardiopulmonary resuscitation (CPR) is earlier the better and longer the better.

When you come across a victim of cardiac arrest, three simple rules must be followed: Call the ambulance, check if the person is breathing or has a pulse and if not, then start chest compressions and continue for at least 30 minutes till medical help arrives.

Don’t stop CPR too soon …

Dr KK Aggarwal
National President IMA and HCFI

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