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YOU CAN SAVE A LIFE

 

Cardiac arrest As part of our obligation as a doctor we have to have annual update cardiopulmonary resuscitation training and this also applies to the whole practice team.

We have found over the past few years that it makes sense to have sessions which include a cross-section of staff and even opening it up to patients that want to participate aswell as the the young adults of staff.

A report of a rare miraculously saving of a life 

On December 23rd 2017 Dr Livingston was cosily at home recharging her batteries after a very busy surgery watching “Love Actually” with her daughter and her boyfriend when there was a loud frantic knock at the door. It was the  nextdoor neighbour she was totally beside herself. Her husband had collapsed.

Dr Livingston knew he had heart problems so she immediately went into ‘doctor mode’ She instructed the 2 teenagers ( her daughter had attended CPR training ago but her boyfriend had never attended any training) to bring their phones  ( not usually far from there sides, anyway!) Her daughter who remembered that there was a pocket mask strapped to the stairs in the hall had the presence of mind to grab that as well and the team hurriedly followed the neighbour to the house.  Sure enough the husband was sited against a wall in a collapsed state. Immediate assessment demonstrated he was unrousable, not breathing and with no pulse. He had had a cardiac arrest.

The team managed to drag him onto the kitchen floor. Instantly  the learnt procedure was put into action, and Dr Livingston allocated instructions to her team- the boyfriend called 999 and was communicating with the ambulance service ,very calmly listening and responding appropriately to their questions.

Meanwhile, Dr Livingston had immediately started CPR (basic life support with my daughter). Her daughter maintained good airway and Dr Livingston commenced chest compressions. She commented how exhausting it was and infact had not performed  this for many years in a ‘real situation’ and then only in a hospital situation. Her daughter astutely observed that her mother was getting tired and then took over cardiac compressions. Before the ambulance arrived a police car arrived with a defibrillator. Although she had had training on this but she had never actually used and automated external defibrillator. They followed the spoken voice instructions it gave them.

After about 3 shocks the A.E.D said in a clear voice ‘movement detected’. The team paused in shear amazement ‘It was incredible,’ commented Dr Livingston.

Subsequently, two ambulance crews arrived and they took over and when he seemed stable the patient was transferred to Ealing Hospital. On arrival at hospital the Glasgow coma scale was used to assess the severity of brain injury and prognosis. The initial Glasgow Coma Scale provides a score in the range 3-15; patients with scores of 3-8 are usually said to be in a coma, remarkably his was 15.

This was a true miracle, as it is reported that of cardiac arrests in a hospital set up only 7% of people survive this man not only lived to tell the tale but survived his near-death experience without any damage to his heart muscle or his brain, an outcome extremely rarely seen following an out-of-hospital cardiac arrest.

When Dr Livingston and myself discussed this, I felt empowered to blog about this and Dr Livingston felt it was paramount to share her story with other GP’s by posting on a closed facebook page called Resilient GPs. Usually she would get 1 or 2 responses  but on this occasion had over 700 !!

Many GP’s after reading the account  decided to open up their basic life support training to the staff’s teenagers and family and purchase pocket masks and keep them at home and in the car. Dr Livingston will be advocating to all staff and both her daughters to put a pocket mask in their  cars.

Moreover, the practice would be prepared to offer hosting CPR courses at the surgery for anyone interested or facilitate where a course could be done. 

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When the team  got back home after lots of cups of tea Dr Livingston asked her daughter how she was feeling and was she upset by it?

She admitted it was scary but even though it was 2 years since she had attended the course she said the thing she particularly remembered the trainer saying, 

‘If you dont do anything they will die so you may as well try. Even if just do chest compression that will help. That is what everyone needs to know- have a go !!’

 Dr Livingston felt immensely proud of these teenagers , who not only immediately jumped into action without thinking  but ‘saved a life’.

Well done – an absolute game – changer. 

A week after this there was routine practice training update. The first time with the new practice defibrillator. The trainer simulated a cardiac arrest, which was brilliant, but completely forgot the practices had it’s own device.!!

The most important thing if some one has a cardiac arrest is to fibrillate as soon as possible

A few days later Dr Livingston  passed the gentleman’s son in the street and asked how his father was feeling. He replied, ” he seems fine but that his ribs were aching a lot” he was virtually totally unaware of the magnitude of what had happened and not only had he survived but that his life had been restored without brain injury.

As days went by it gradually it registered this man’s life had been saved by a team that was confident and empowered to act quickly and efficiently and then the team were showered with gifts!

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You could easily learn this skill and be a potential life-saver.

The British Heart Foundation are determined to transform the UK into a Nation of Lifesavers: a country where everyone knows how to save a life.

https://www.bhf.org.uk/heart-health/how-to-save-a-life

Also you could inform the surgery that you wish to participate in training and when enough people have signed up they will arrange a session.

 

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C-r-y

imageOne early morning in February 3 years ago the phone rang and it was the wife of our Best man at our wedding. She was letting us know that she had woken in the night to a strange sound and following attempts at resuscitation by herself and the ambulance crew he had died suddenly. He was a handsome,highly intelligent,charming doctor/dentist/medical director of a pharmoceutical company who had been negotiating with NICE to accept Aricept as a treatment for Dementia.He had also been training for his 7th full marathon which he had taken part in and raised thousands of pounds for leukaemia following the death of his son’s best friend at the age of five.It was unbelievable and a total shock to all such a loss of someone so special. The night before he had been listening to opera with friends singing along with gusto and passion as he was also a musician, a pianist with talent.The funeral was an amazing musical tribute and those who spoke talked about his life with humour and sadness. Afterwards, his friends and colleagues commented that he had seemed the healthiest of everybody and as we chatted agreed it would have been a great party but it lacked one person. He was an ordinary East End lad made good commonly known as ‘Paul boy’! His only fault was that he was a Tottenham supporter which meant many an Saturday afternoon or a Boxing Day was spent in raucous banter whilst ‘the lads’ watched their rivals play – nothing more exciting than a London Derby!
This was an adult sudden cardiac death (SCD)as there was no evidence of disease on examination of his body after death and it was presumed death was due to sudden cardiac arrest,when the heart abruptly and without warning stops pumping.
Ironically, the week after he died the drug was passed!

I was reminded of this when a young attractive 25year old lady attended surgery recently devastated as she had lost her young partner in the same way. This young man had died suddenly without warning and his young partner and family had been left devastated.
She then told me that his mother had become very keen to support the charity CRY was founded in 1995 to raise awareness of conditions that can lead to young sudden cardiac death (YSCD); sudden death syndrome (SDS); SADS. She was also taking part in the CRY Heart of London Bridges Walk 2013 on 7th July. There main reason for supporting this charity is that it funds screening of anyone who could considered at risk as shown on the link. What a brave lady, the love she had for this man was tangible and this family had also lost someone very special whose life had just begun. The family are keen to support this charity as it raises money to screen anyone at risk and support research projects aswell as support bereft families.

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http://www.c-r-y.org.uk/general_information_on_cardiac_s.htm

CRY holds ECG screening clinics for those aged 14 to 35 at a number of established locations around the UK including Belfast, Cardiff, Colchester and London.The CRY mobile screening unit facilitates various screening events at other locations in the UK – often organised by CRY supporters. Details of where these clinics are and how to book are on the website.

What happens when sudden cardiac death(SCD) occurs
When SCD occurs, no blood can be pumped to the rest of the body. It is responsible for half of all heart disease deaths.
Sudden cardiac death occurs when the heart’s electrical system malfunctions. It is not a heart attack (also known as a myocardial infarcation). A heart attack is when a blockage in a blood vessel interrupts the flow of oxygen-rich blood to the heart, causing heart muscle to die. So if the heart can be compared to a house, SCD occurs when there is an electrical problem and a heart attack when there is a plumbing problem.
The most common cause of cardiac arrest is a heart rhythm disorder or arrhythmia called ventricular fibrillation (VF). The heart has a built-in electrical system. In a healthy heart, the sinoatrial node, the heart’s natural “pacemaker” triggers the heartbeat, then electrical impulses run along pathways in the heart, causing it to contract in a regular,rhythmic way. When a contraction happens, blood is pumped.
But in ventricular fibrillation, the electrical signals that control the pumping of the heart suddenly become rapid and chaotic. As a result, the lower chambers of the heart, the ventricles, quiver or fibrillate instead of contracting, and they can no longer pump blood from the heart to the rest of the body. If blood cannot flow to the brain, the brain becomes starved of oxygen, and the person loses consciousness in seconds. Unless an emergency shock is delivered to the heart to restore its regular rhythm using a machine called a defibrillator, death occurs within minutes. It’s estimated that more than 70 percent of ventricular fibrillation victims die before reaching the hospital.
When CPR and an AED (automated external defibrillator) are used together, the chance of survival following a cardiac arrest goes up to 50%, a ten-fold increase over CPR alone.

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This is why you may see Automated External Defibrillator (AED) machines are being hung on walls in supermarkets or other public places. I have frequently seen them in French supermarkets and hyper stores.
It is amazing that the nearest limited access AED is in Twickenham in a fitness club and the nearest 24 hr public access AED machine is outside an accountants office. To see the location of AED machines click on the link below:-
http://www.aedlocator.org/AEDLocations.php
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Who should be screened?
It is recommended that screening is requested via your GP if there have been any young sudden deaths in the family. Or if there are symptoms of:

Chest Pain (exercise related)
Severe Breathlessness
Palpitations
Prolonged Dizziness
Fainting/Blackouts

This checklist has been designed to help you determine whether you have a heart rhythm problem. If you have more than one of the symptoms below, see your GP.

    • Have you fainted or passed out during exercise, while emotional or when startled?
    • Have you ever fainted or passed out after exercise?
    • Have you ever had extreme shortness of breath during exercise?
    • Have you ever had extreme fatigue associated with exercise (much more so than others of your age and level of fitness)?
    • Have you ever had discomfort, pain or pressure in your chest during exercise?
    • Has a doctor ever ordered a test for your heart?
    • Have you ever been diagnosed with an unexplained seizure or fit?
    • Have you been diagnosed with epilepsy that fails to respond to medication?
    • Have you ever had exercise-induced asthma that medication didn’t control well?
    • Are there any family members who had a sudden, unexpected, unexplained death before age 50 (including cot death, car accident or drowning)?
    • Are there any family members who died suddenly of heart problems before they were 50?
    • Are there any family members who have had unexplained fainting or seizures?
      Do you have any relatives with the following conditions:
      Hypertrophic cardiomyopathy: thickening of the heart muscles.
      Long QT syndrome: a condition that results in a very fast, abnormal heart rhythm, which can cause fainting.

What is happening by way of research?

VeniceArrhythmias, a biannual meeting started in 1989 and, year after year, has become one of the most important international congresses in the field of arrhythmology with almost 3000 attendees and with more than 400 invited speakers.
As you read many cardiologists and electrophysiologists are preparing their abstracts to be presented at the Venicearrythmia conference next held in October 2013
VeniceArrhythmias, a biannual meeting started in 1989 and, year after year, has become one of the most important international congresses in the field of arrhythmology with almost 3000 attendees and with more than 400 invited speakers.image
At other venues and during the year there will be similar events. It is through these events that there have been major breakthroughs in screening and prevention of sudden death.Research in the channelopathies and cardiomyopathies is progressing rapidly and in the future it is expected that the majority of the genes involved will be discovered.
In the future, it may also be possible to diagnose all carriers easily – even in those people who have a normal ECG reading. It may also be possible to choose the best treatment based on the type of mutations involved, and the treatment may even be designed based on this knowledge.
In the meantime, better understanding of these conditions and improvements in methods for diagnosis should still result in better management. It is crucial that, when a heart disease such as a channelopathy or cardiomyopathy is diagnosed, all immediate blood relatives should be evaluated by a specialist cardiologist to find out if they have an inherited heart disease.

IMPORTANT
It needs to be considered in sudden death in especially younger adults where the post Mortem fails to provide a cause of death, it is important to send the heart to a pathologist who specialises in this field of medicine and this may be a relative, friend or attending doctor who makes that request.
However, to help this research and appreciate the true incidence there must be a change in the Law.
In the UK, unexplained sudden death is frequently recorded as due to death from natural causes. Until the law is changed and coroners have to refer hearts on to specialists we will not know the true figures. CRY’s fast track coroner / pathology service enables the cause of death in a sudden death case to be established more quickly and accurately than might otherwise happen if left to a local coroner lacking expertise in cardiac pathology.

Tests That Predict Risk

There are a number of tests that can be performed to determine if some- one is in a group that is at high risk for cardiac arrest. These include:
Echocardiogram – a painless test in which ultrasound waves are used to create a moving picture of the heart. The test can measure the strength of the heart’s pumping function (ejection fraction) and identify other problems that may increase a person’s risk for SCD.

Electrocardiogram – A painless test in which electrodes are attached to the patient’s chest to record the electrical activity of the heart in order to identify abnormal heart rhythms. Certain arrhythmias could point to an increased risk of SCD.imageHolter monitor – A cell phone-size recorder that patients attach to their chest for one to two days, recording a longer sampling of their heart rhythm. After the recorder is removed, the tape is analyzed for signs of arrhythmia.
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Event recorder – a pager-sized de- vice that also records the electrical activity of the heart over a longer period of time. Unlike a holter moni- tor, it does not operate continuously. Instead, patients activate the de- vice whenever they feel their heart beating too quickly or chaotically.
Electrophysiology study (EPS) – This test is performed in a hospital. A local anesthetic is used to numb areas in the groin or neck and thin flexible wires called catheters are
advanced through veins into the heart under x-ray to record its electrical signals. During the study, the electrophysiologist studies the speed and flow of electrical sig- nals through the heart and paces the heart to see if arrhythmias can be induced. The physician can also determine if a patient has had a prior heart attack or evidence of prior heart damage without know- ing it. All of this information can help determine whether the patient is in a group at higher risk for SCD.There is another interesting device
The AliveCor Heart Monitor app is designed for medical professionals, patients and health conscious individuals to record, display, store and transfer accurate single-channel electrocardiogram (ECG) rhythms. These recordings could be saved on the mobile phone or shared with others (such as your doctor) via email. The app is CE-mark approved.
imageThe Heart Monitor snaps onto your iPhone 4 or 4S like a case and wirelessly communicates with the app on your phone. No pairing between your iPhone and the Heart Monitor is required. The free AliveECG app will be available for download from the Apple App Store when you receive your Heart Monitor. Once in the app, create a free account and you’re ready to begin recording ECGs. It’s that easy to get started. http://www.AliveCor.com provides you with anytime, anywhere, fully secure, online access to all of your ECGs. Once you have the Heart Monitor and the AliveECG app you can create an account that gives you access to your ECG data.

Prevention

There are a number of things people can do to decrease the likelihood of becoming a victim of sudden cardiac death. To begin with, living a “heart healthy” life can help reduce the chances of dying of cardiac arrest or other heart conditions. This includes ex- ercising regularly, eating healthful foods, maintaining a reasonable weight, and avoiding smoking.
Treating and monitoring diseases and conditions that can contribute to heart problems, including high blood pressure, high cholesterol, and diabetes, is also important.
Finally, for some patients, preventing sudden cardiac death means controlling or stopping the abnormal heart rhythms that may trigger ventricular fibrillation.

Treating arrhythmias is done in three ways:

Medications – Medications, includ- ing ACE inhibitors, beta blockers, calcium channel blockers, and antiarrhythmics, can control abnormal heart rhythms or treat other conditions that may contribute to heart disease or SCD. But taking medication alone has not proved to be very effective in reducing cardiac arrest. These medications are sometimes taken by patients who also have an ICD, in order to reduce how often it fires.

Implantable cardioverter defibrillators (ICDs) – These devices have been very successful in preventing sudden cardiac death in high-risk patients. Like a pacemaker, ICDs are implanted under the skin. Wires called leads run from the ICD to the heart, and the device monitors the heart to detect any abnormal rhythms. If a dangerous arrhythmia is detected, the ICD delivers an electrical shock to re- store the heart’s normal rhythm and prevent sudden cardiac death. The ICD can also act like a pacemaker if the heart is beating too slowly.

Catheter Ablation – In this technique, radiofrequency energy (heat), cryotherapy (freezing), or other energy forms are used to destroy small areas of heart muscle that cause the dangerous, rapid heart rhythms. The energy is delivered through catheters that are positioned through the veins or arteries to the heart. Catheter ablation is sometimes done in patients who have an ICD to decrease the frequency arrhythmias the number of ICD shocks.
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If anyone has any particular concerns Dr Livingston has a special interest in this condition and is very knowledgable and would be pleased to discuss any related problem.

Posted by Dr Bayer

 
 

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Cardiac arrest App

imageRecommended by the British Heart Foundation

You may have seen this on TV but do you own it?
Hearing the Bee Gees takes me back to my happy youth…. And Vinnie’s ‘my boy’

Stayin’ Alive with Hands-only CPR
If someone has collapsed and isn’t breathing normally, pushing hard and fast to the beat of Stayin’ Alive by the Bee Gees can save a life.


A useful website to learn more about Cardiovascular disease which is an umbrella term for all diseases of the heart and circulation, including heart disease, stroke, heart failure and congenital heart disease.

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British Heart Foundation – Hands-only CPR.

Collectively, heart and circulatory diseases cause more than a quarter of all deaths in the UK, accounting for more than 159,000 deaths each year. The cost of premature death, lost productivity, hospital treatment and prescriptions is estimated at £19 billion.

The free app explains how to carry out Hands-only cardiopulmonary resuscitation (CPR) on someone in cardiac arrest using hard and fast chest compressions. The app also allows you to practice by making use of accelerometer hardware built into most smartphones. It means your mobile can measure the rate and depth of practice compressions, telling you if they need to do the compressions faster or slower; or whether they should push harder or softer.

 

 
 

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