Posted in Psychology & Medicine

How To Feign Death

Usually to check if a person is dead, one checks their pulse and breathing. If you want to fake your death properly, you must be able to stop both of these. You can easily hold your breath, but how can one stop their own heart? The answer lies in a ball.

If you wedge a tennis ball, squash ball, baseball or any small but firm ball in each of your armpits and squeeze tightly, the pulse at your wrist will disappear. This pulse is the radial pulse, and the radial artery is a branch of the brachial artery further up the arm. If a ball is squeezed in the armpit, it compresses the brachial artery, stopping the blood flow to the radial artery and obliterating the radial pulse. Most people who are not medical professionals tend to use the radial pulse for taking a pulse, so this method can be used to make it look like you do not have a pulse. But as this trick only causes the radial pulse to disappear, it is ineffective if the other person takes the pulse at another site such as the carotid artery or femoral artery. However, if you can control the situation and the person checking to see if you are alive is not a doctor or nurse, then it is quite a useful trick to use.

Posted in Psychology & Medicine

Pulse

Blood, which supplies all the cells in the human body with nutrients and oxygen, flows through the vessels due to the pumping of the heart. Thus, blood flow directly transmits the force generated by every heartbeat. As the blood ejected by the heart causes the arteries to “pulse” by stretching and relaxing. As some pulses can be felt over the skin, they are very useful in patient examinations, especially a clinical exam of the cardiovascular system. Although people commonly know how to take a pulse from the wrist or neck, there are many more places a pulse can be taken from.

  • Radial pulse: Taken from the inside of the wrist on the side of the thumb.
  • Brachial pulse: Taken from the inside of the elbow.
  • Carotid pulse: Taken from where the neck meets the jawline, or 2~3cm either side of the Adam’s apple to be precise.
  • Apex beat: This measures the heartbeats directly, taken on the left chest between the 4th and 6th ribs (around the left nipple).
  • Abdominal pulse: Taken from above the belly button of a lying patient, may be able to see the pulse.
  • Femoral pulse: Taken from the middle of the groin. 
  • Popliteal pulse: Taken from the inside of the knee.
  • Posterior tibial pulse: Taken from the inside of the ankle behind the bone.
  • Dorsalis pedis pulse: Taken from the back (upper side) of the foot along the middle.

When taking a pulse, you use your second and third fingers (and the fourth if you want) and press lightly on the pulse point. If you press too hard, you may stop the blood flow and obliterate the pulse. As a pulse is measured per-minute, it is often taken for 10 or 15 seconds and multiplied by 6 or 4 respectively. Also, it should be noted whether the pulse has a regular rhythm, and if it is irregular, whether it is regularly irregular or irregularly irregular. If the pulse is over 100 beats per minute, it is called tachycardia, while less than 60 beats per minute is referred to as bradycardia. If it is irregular, it is called an arrhythmia.

An experienced doctor can diagnose different conditions such as an aortic stenosis or atrial fibrillation just from taking the pulse of the patient. Taking a pulse is also a crucial diagnostic tool in traditional Korean and Chinese medicine.

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Posted in Psychology & Medicine

CPR

CPR stands for cardiopulmonary resuscitation – or in plain English, artificially (and partially) restoring the function of the heart and lungs of an unconscious, pulseless person. As blood flow (perfusion) is critical in the survival of major organs such as the brain, this procedure can save lives by prolonging a victim’s life until the paramedics arrive to provide professional medical care.

When the heart stops beating, or becomes inefficient due to erratic beating, blood flow stops. In the case of the brain, this means that the cells will start dying after 4~5 minutes if perfusion is not restored. CPR can restore about 30% of perfusion, delaying the onset of brain death.

This may be critical when someone suffers a heart attack (myocardial infarction) and paramedics will not arrive for over 10 minutes. Ergo, this is one of the most important emergency skills one should know to help people in need as soon as possible.

There are different guidelines for CPR in many countries, but here is a standard procedure guideline (NZ).
It is summarised into the acronym: DR’S ABCD (doctor’s ABCD), and is a flowchart that goes from one step to the next (detailed explanation after summary).

  1. Danger: check that area is safe and risk-free
  2. Response: check for patient response by shouting, shaking, pain
  3. Send for help: pick one person to call emergency services
  4. Airway: check airway, remove obstruction, tilt head back and lift chin
  5. Breathing: check for breathing, go to CPR if no breathing
  6. Circulation: check for pulse if breathing, if no pulse, start CPR (30 chest compressions : 2 breaths)
  7. (Defibrillation): follow AED instructions

The first rule of first aid is that you must not put yourself in danger. For example, if the patient is on the road, pull them to a safe area to minimise the risk to your own health.

Then, check for a response. The easiest way is to call loudly to them such as “Can you hear me”, and inflicting pain (such as rapping on their chest or shaking their shoulders) and see if they become conscious.

If they remain unconscious, immediately designate a person around you by pointing to them (otherwise they will be less likely to be responsible) to call the emergency service (111, 911, 119 etc.), alerting them the location and state of the patient.

This is the point when clinical skills come in.

Airway: An unconscious person may have their airway obstructed by vomit or their own tongue (which falls back by gravity into the throat). You must secure the airway by scooping out any material, and clearing the tongue out of the way. This is done by tilting the head back far (as if they are looking up), then using one hand to pull their chin out. This opens the airway up so that mouth-to-mouth becomes effective.

Breathing: Put one ear right next to the person’s nose and mouth and check for any breathing sounds or air flow. If they are breathing, check the pulse to see if they are pumping blood. If not, go straight to CPR.

Circulation: It is best to check the central pulses such as the carotid (side of neck, next to the Adam’s apple), brachial (squeeze inner side of biceps) or femoral pulses. The carotid is often the easiest as most people know how to take it. If you feel a pulse, put the patient in recovery position as they are just unconscious, breathing and has blood flowing. If not, proceed to CPR (as you do with when the patient is not breathing).

CPR is composed of two actions: chest compressions and mouth-to-mouth breathing. The former is the strong compression of the chest wall to squeeze blood in and out of the heart; the latter is breathing air into the patient’s lungs and letting exhalation come out naturally.

Chest compressions are often misrepresented in medical dramas, and is extremely important that you do it correctly. First find where the sternum is (centre of ribcage, between the nipples) and place the heel of your left palm on it, then spread your fingers out. Put your right hand over your left and close your fingers around it for a good grip. If the patient is lying flat on the ground (with head tilted back), kneel beside them and stoop over their chest with straight, locked arms (bent arms exert much less pressure).

You are now ready to begin chest compressions. Press down hard, until the chest wall is compressed to about 1/3~½ depth (the chest wall is a springy structure, and do not worry about broken ribs, as being alive is more important for the person), then ease pressure to let it bounce back up. Ideally the time pushing and the time letting it bounce back should be the same, giving a good rhythm. Repeat this 30 times at the beat of 100/min, or in easier terms: to the beats of the Bee Gee’s song Stayin’ Alive (scientifically proven).

After 30 compressions, tilt the patient’s head back, lift their chin up, and lock your mouth over their mouth and nose to make an airtight seal. It is crucial that you use a face shield to prevent the spread of disease. Be aware that breaths are less important than the compressions, so if you do not have a face shield, let someone else do the breathing and focus on chest compressions. Pinch the nose closed to ensure air does not escape.
Forcefully breathe into them and look for the chest rising. Let go of the nose and pull away so that they can breathe out. Repeat once, then return to chest compressions.

After 2 minutes of CPR (30 compressions : 2 breaths, repeat 4 times), change places with another person capable of CPR, as otherwise you will tire out and become inefficient.

Defibrillation is only possible if you are near an AED (automated external defibrillator). Nowadays, AEDs are designed to be completely user-friendly so simply follow the instructions on the machine.

It is important to note that not all abnormal heart rhythms are “shockable” (see Flatline). Follow the AED’s instruction, as it will state whether shock is advised or not. Make sure that CPR is still happening continuously.

Repeat until help arrives.

As a final note, remember that the patient is dead whether you do CPR or not, so there is nothing to lose. Believe it or not, this will be of incredible help in calming your mind when struck with such an emergency. Even with CPR, there is a maximum 30% chance the patient will survive, 10% if it occurs outside the hospital. But if you do nothing, their survival chance will be 0%, so put all your energy into resuscitating them, and you may just save a life.