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Clinical Practice in Holistic Medicine

Management of Cardiac Arrest in the Outpatient Emergency Room

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                                  Normal Death
 In death, as it usually occurs in severe acute or chronic disease, the heart beat and pulse first cease at a time when not only the heart, but the organism as a whole is so affected by the disease that survival is no longer possible. Attempts at resuscitation in such cases of normal death are purposeless and meaningless.
                                 Sudden Death

Cardiac arrest which continues after the heart has first stopped leads, to death with­in a few minutes. That is to say, the end result of a "longer-lasting" cardiac arrest is sudden death.

                                Cardiac Arrest
    The term cardiac arrest means the sudden cessation of the pumping action of the heart in an intact, or nearly intact, or­ganism. It is only the heart, or primarily the heart, which is diseased and fails. The cardinal clinical symptom in cardiac arrest is sudden loss of consciousness, since the cells of the cerebral cortex are very sensitive to oxygen lack and are para­lyzed within 8—20 seconds when blood ceases to flow (sooner in the old, later in the young). To start with, there is only a functional paralysis, but after 4—6 mi­nutes, the cells die, usually first in the brain, soon after in other vital organs as well .
                       Adams-Stokes Attacks


     Sometimes the heart restarts spontaneous­ly before the circulatory arrest has led to permanent cell injury. Such short-lasting episodes of cardiac arrest with sponta­neous recovery are called Adams-Stokes attacks. Depending on how rapidly the heart starts again, the attacks are characte­rized by shorter- or longer-lasting losses of consciousness in the form of absence, black out, or fainting. The loss of con­sciousness often occurs without warning and without the patient experiencing any symptoms from the heart. In some cases, clonic or tonic seizures are seen. Short-lasting cardiac arrests with sponta­neous recovery often augur a later longer-lasting, deadly cardiac arrest. Thus, an Adams-Stokes attack is a clinical symptom which always should be taken seriously, since it can portend sudden death .












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