How to rescue victims of cardiac arrest

I have put this piece up as a continuation of my last article entitled ‘Sudden death syndrome is not so sudden’. I mentioned in that piece that cases of SDS from cardiac arrest are on the increase in the country, thereby creating worries and anxieties.

As a reminder, a cardiac arrest occurs when the heart suddenly stops beating. A person who has a cardiac arrest would have slumped and become unresponsive to touch. The person will most likely die if he or she does not receive immediate treatment.

It is often caused by a heart attack from complicated medical conditions like hypertension; but other things, such as drowning and electric shock, can also cause it.

Many things such as drowning, choking, sudden infant death syndrome, asthma, infections or congenital abnormalities, can cause cardiac arrest in children.

When a person slumps, whether or not the victim survives depends largely upon the immediate intervention of bystanders. There is a brief time frame for saving the victim’s life.

The victims can survive if they receive immediate assistance from those around .To be effective, this treatment must be delivered quickly — ideally, within five minutes after collapsing.

Even the best emergency medical services may not be able to reach a victim within five minutes. This is why a prompt action by bystanders is so critical and why it is so important for all to have training in what we called Basic Life Support.

Basic life support

The BLS is the level of medical care, which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital.

Medical personnel, including paramedics and laypersons, who have received BLS training, can provide this service.

While the victim needs to be laid down on a flat surface probably on the floor, lying on the back, the rescuer should not attempt to sit the victim down as no active resuscitation is done that way.

The usual practice of pouring water on the head or body of a victim should be discouraged. This may cause hypothermia (low temperature) which is not good for survival.

It is not time to start forcing milk or malt drink in the person’s mouth; this is dangerous as it may block the airway. When the victims get to the hospital, it is always challenging trying to clear the airway of the particles in the mouth.

BLS is generally used in the pre-hospital setting, at home and can be provided without medical equipment.

The BLS procedure is explained below with an acronym: DRS ABCD

D: Check for danger signs. In cases of electrocution, rescuers should avoid moving too close to ensure their own safety (safety first).

R: Check for response by calling the person and shaking the shoulders.

S: If there is no response, shout for help. Get a second person to call the emergency numbers or the hospitals.

A: Check that the airway is open and clear any secretions from mouth and nostrils.

B: Check for any signs of breathing.

C: Start cardiopulmonary resuscitation. Give 30 chest compressions: Two breaths called ‘Kiss of life’. Continue CPR until responsiveness or normal breathing returns.

Do not stop to check the victim or discontinue CPR unless the victim starts to show signs of regaining consciousness, such as coughing, opening of the eyes, speaking or breathing.

Once the medical personnel or ambulance arrives, the rescuer may assist in moving the victim to the ambulance for onward transport to hospital.

Defibrillator: A defibrillator is a machine that gives the person’s heart a controlled electric shock that may make it to start beating again.

The steps listed above are guides and not training. It is mandatory for persons interested in doing CPR to attend the BLS training or have one done.

Conclusion

Regular medical check-up is key to preventing a cardiac arrest and should be promoted. Those who are over 40 years are advised to do a six-monthly or yearly comprehensive medical screening under the supervision of their physicians.

Those with unexplained or persistent symptoms such as weakness, weight loss, headache, body pain, and tiredness will also need guided medical checks.

In conjunction with the management of the Life Scan and Wellness health care, Lagos, there will be an enlightenment and health education session on Saturday January 16 from 8am.

Also, medical checks and necessary blood tests will be conducted throughout this January.

Participants are to indicate their interest by calling or sending text messages to 08023044890 or 08186549147.

Dietary guides will be available for diabetics and hypertensives.

LASSA Fever Fact Sheet

         FACTSHEETS ON LASSA FEVER

 

LASSA Fever Fact Sheet

Epidemiology

Lassa Fever is an Acute Febrile disease caused by the Lassa virus belonging to the arenavirus group. It was first described in the 50s and the virus was isolated in 1969 in Lassa, Nigeria. Lassa Fever occurs more often in the dry season, rather than in the rainy season. The multimammate rat (Mastomys natalensis) is the reservoir host of Lassa fever. Deafness is a common sequela, up to 1/3 cases. Case fatality rate varies from as low as 1%-25% to as high as 50%. The death rates are particularly high for women in the third trimester of pregnancy, and for fetuses, about 95% of which die in the uterus of infected pregnant mothers.
Cases have been reported in some states in Nigeria in January 2016 which includes Bauchi, Kano, Nassarawa, Niger, Rivers and Taraba. 
Transmission
Humans usually become infected with Lassa virus from exposure to excreta of infected Mastomys via direct exposure (to the excreta) of rat. Lassa virus may also be spread between humans through direct contact with the blood, urine, faeces, or other bodily secretions of a person with Lassa Fever. There is no epidemiological evidence supporting airborne spread between humans. Person-to-person transmission occurs in both community and health care settings, where the virus may be spread by contaminated medical equipment, such as re-used needles. Sexual transmission of Lassa virus has been reported.
Incubation Period is usually about 10 days but can range from 6-21 days.
Case Definition:

1. Suspected case- Illnesses with onset of Fever, with or without sore throat and at least one of the following signs: bloody diarrhea, bleeding from gums, bleeding into skin (purpura), bleeding into eyes and urine.
2. Confirmed case- A suspected case with laboratory confirmation (positive IgM antibody or viral isolation) or epidemiological link to confirm cases or outbreaks.

Clinical Presentation

1. Mild onset over days:
   - Fever, malaise, headache, myalgia, arthralgia, prostration
2. Gastrointestinal symptoms common
   - Anorexia, nausea, vomiting, diarrhea, abdominal pain
3. Cough, dyspnea, chest pain may be seen
   - Pulmonary edema after IV fluids
4. Central nervous system may be involved in late stages
   - Agitation, confusion, tremor to coma and convulsions
5. Hemorrhage
   - Gastrointestinal, conjunctival injection/sub-conjunctival hemorrhage
6. "Classic" presentation: fever, neck/facial swelling, bleeding (petechial hemorrhage) and shock (but not typical)

• Patients die from combination of increased capillary permeability, cardiac suppression and coagulopathy leading to a low effective circulating volume leading to shock, NOT loss of blood
• Common laboratory findings:
  • Early leukopenia, late leukocytosis
  • Mild-to-moderate thrombocytopenia
  • Elevated hepatic transaminases (AST>ALT)

Laboratory Confirmation
Lassa virus infections can only be diagnosed definitively in the laboratory using the following tests:

• Antibody enzyme-linked immunosorbent assay (ELISA)
• Antigen detection tests
• Reverse transcriptase polymerase chain reaction (RT-PCR) assay
• Virus isolation by cell culture.

This test can be done at Virology Reference Laboratory at Lagos University Teaching Hospital, Idi-Araba, Lagos.

Management
The only known specific treatment for Lassa Fever is Ribavirin and may be effective if given within the first six days of illness. It should be given intravenously for ten (10) days.

• Intravenous Ribavirin treatment should start as soon as a diagnosis of Lassa Fever is made.
• Give a single “loading dose” of 33mg per Kg body weight.
• Then give a dose of 16mg/ Kg body weight every 6 hours for 4 days.
• Then give 8mg/Kg every 8 hours for 6 days.
• Complete treatment course for individual patient clearly laying out the correct amount to give each dose.
• Once started, a Ribavirin treatment should not be discontinued until the 10 days course is complete.
• Supportive treatment should include; Paracetamol, Vitamin K (Phytamenadione), Heamacel, Ringers lactate, Quinine lactate, Quinine injection, and antibiotics- start by I.V.
• If patient is severely anaemic, consider transfusion.

Prophylaxis
Tablets:
Adults 500mg every 6 hours X 5 days
Children > 5 years: 500mg every 12 hours X 5 days
Adverse Effects of Ribavirin
Major side-effect is a reversible, most-often mild anemia. Women who are pregnant or planning to become pregnant are advised not to take Ribavirin
Prevention of Lassa Fever
High Index of suspicion for Lassa Fever should be entertained by health workers to improve case detection. UNIVERSAL PRECAUTION must be practiced in the management of suspected or confirmed cases as listed below:

1. Appropriate personal protective clothings (hand gloves, facemasks, eye goggles and overall) must be worn when attending to cases.
2. Hands must be washed after each contact with patient or contaminated materials. They must first be rinsed in disinfectant and then washed with soap and water.
3. Instruments and Dressings – Each patient must have an individual thermometer labelled with the patient’s name and kept in a receptacle containing disinfectant. The stethoscope and the sleeve of the syphgmomanometre must be decontaminated between each use by rinsing them in disinfectant solution
4. Bed covering – The use of a plastic sheet is essential to avoid the contamination of mattresses. They must be large enough to cover the entire mattress, be waterproof, and be thoroughly disinfected after the discharge or the death of patients.

In case of any suspected case of Lassa Fever, Lagos State Ministry of Health should be notified by calling these GSM numbers: 08022234273, 08037170614 and 08023169485.
Any suspected case should be taken to Mainland Hospital, Yaba.

NOTE: ALL ITEMS WITH POSSIBLE CONTACT WITH ANY CASE MUST BE THOROUGHLY DISINFECTED BEFORE REPEATED USE.

Sudden deaths are not so sudden

This is a true story of a high chief. The chief had just been decorated with another chieftaincy title. The following day in the midst of the celebration, the chief slumped and was resuscitated.

He had developed stroke, medically called cerebrovascular accident or brain attack.The chief was said to have had an underlying medical disorder that had to do with hypertension and diabetes, which was detected during one of his medical checks.

Chief was taken to India because he was told that he would not be able to walk again after treatment if he did an operation in Nigeria. However, when the chief returned to the country, he could not walk without assistance.

He went through several physiotherapy sessions to help in improving the power in his limbs. The chief told the attending physiotherapist that he was the cause of his problems because he defaulted from the recommended medical check and follow-ups.

Also, when one of the officers of a traffic agency in the country slumped while on duty, it was reported that he must have collapsed from accumulated stress.

The witness’ account read, “The whole thing happened so fast and so shocking. By the time they took him to the hospital, he had died.

Most sudden deaths are due to heart conditions and are known as heart attacks. Medically, they are called sudden arrhythmia death or sudden cardiac death syndrome.

In response to the tragic incident, the officer was declared as a true hero, while a group of medical doctors offered free medical checks and consultations to all officials of the agency.

The leader of the medical team said the gesture was in response to the incident that led to the official.

The doctor said many Nigerians were suffering from one life-threatening ailment or the other without knowing, and that the only remedy was to always be in touch with the doctor – an expert, for medical checks.

While I commiserate with the officer’s family and many other families that were affected in year 2015, I will suggest to the readers of this piece to have a healthy lifestyle this year.

Sudden death syndrome

Sudden death syndrome describes a sudden, unexpected death of adolescents and adults, which may occur during sleep, while awake, or just after exercise.

Sudden death Syndrome events are non-traumatic, non-violent, unexpected occurrences resulting from cardiac arrest within as little as six hours of previously witnessed normal healthy person.

Causes

Many sudden deaths are due to heart conditions and are known as sudden arrhythmia death or sudden cardiac death syndrome (heart attacks).

It is a condition, which creates an abnormality in the heart, causing it to speed up/slow down to the point where it can no longer pump blood in some cases, the heart will stop completely.

It is also caused by cerebrovacular accident commonly referred to as stroke or brain attacks.

This is mostly because of uncontrolled Hypertension and Diabetes.

Risk factors

Sudden death is common among those who are 40 years old and beyond; while it peaks for those who are over 60.

It affects men twice as it does women. Men are more susceptible because of activities, stress, hustling. Athletics and those involved in any sporting event are also highly susceptible.

Conditions such as hypertension, cancer, diabetes mellitus and respiratory diseases are all risk factors

Prevention

Regular medical check-up is key to preventing sudden death and should be promoted. Through it, chronic diseases such as hypertension, cancer, diabetes mellitus and respiratory diseases are diagnosed.

Those who are over 40 are advised to do a six-monthly or yearly comprehensive medical screening under the supervision of their physicians.

The various profiles of kidney, heart, lung, prostrate, breast, cervical and other blood profile, electrocardiogram, and echocardiogram are done under the guidance of a physician.

Unexplained or persistent symptoms like weakness, weight loss, headache, body pain, tiredness require guided medical checks. Blood pressure and blood sugar should be monitored regularly.

In conjunction with the Management of the Life Scan and Wellness healthcare, Lagos, there will be a routine medical education and checks throughout January 2016.

Participants are to indicate their participation by calling or sending text messages to 08023044890 or 08186549147.

Dietary guides will be available for patients.

DIETARY CONTROL OF DIABETES MELLITUS

TIMING OF MENU

Breakfast  7am -8:30am

Lunch  1:30-2:30PM

Dinner  6:00-7:30PM

In-between Meals : First  11am-12noon

FOODS TO BE TAKEN AS IN BETWEEN MEALS

• Carrots (2-3 pcs finger-sized)
• Apple (1 small size, costs about 50 naira)
• 1 or half grape fruit orange
• Pawpaw (hard one, 1 cup chopped)
• Watermelon (1 cup chopped)
• Orange (1 small size…costs about 20 naira)
• Walnut (Asala) 4-6 pcs…costs about 50 naira
• Kemos cracker biscuits 2pcs

NORMAL DIET

• Bread (2 slices of normal bread or 3 slices of wheat bread or 1/3 of Senegal bread…costs about 120 naira )
• Cornflakes (3/4 cup…dry portion)
• Swallows: Amala, Semo, Semolina – 1 cup ; Wheat, plantain flour 11/4 cup (1.25 cup)
• Eko (agidi) 1 wrap…costs about 20 naira + 1-2 moimoi (1 wrap + vegetables)
• Guineacorn pap – 1 cup + 1-2 moimoi (1.5-2 cups + milk)
• Unripe plantain – 1 moderate size + vegetable
• Yam 1.5 slices; Water yam 2-3 slices; Irish potatoes 2-3 pcs moderate size

FOODS THAT CAN BE FREELY TAKEN

• Cucumber
• Garden eggs
• All vegetables

FOODS TO BE TAKEN IN MODERATION

• Meat (lean meat)…1-5pcs per week
• Chicken or turkey (remove the skin)
• Fish (scaly fish…dried or fresh fish, stockfish/okporoko, kote, shawa, mackerel)
• Boiled Eggs…remove yolk(1-2 per week)
• Milk (skimmed milk e.g danoslim or marvel, soyabean powdered milk 2 tablespoon levelled/day.
• Tea (lipton, toptea, Eby’s tea, etc)
• Low cholesterol Vegetable oil

FOODS NOT ALLOWED

• Sugar, honey, pies, cake, sausages, Gala & pastries
• Fried foods (akara, dodo, fried meat, fried fish, etc)
• Beverages (milo, bournvita, ovaltine, chocolate drinks, carbonated soft drinks and alcoholic beverages)
• Melon (Egusi) and apon
• Fatty meat & fish

CAUTION !

• No pineapple, sugarcane, mangoes & banana
• No eba, fufu, lafun & iyan
• Do not skip meals!

Exercise at least 3-5 times a week for 30-45 mins .

Send feedback to Dr Adesanya via 08186549147 OR roayad@yahoo.com

DIABETICS AND HYPERTENSIVES: DIETARY GUIDES

Diet Plans for Diabetes, Hypertension Cardiovascular disease.

Food plays an important role in the treatment of specific diseases like diabetes, hypertension, cardiovascular diseases etc. The diet should be balanced and within the permissible calorie limits. Food should be distributed into small frequent feeds. The daily requirement should be well distributed between the different meals. Skipping a meal or fasting is not really advisable. 

General Instructions

1.     Different cereals contain almost the same amount of carbohydrate and so the quantity of cereal consumed should be noted rather than the type consumed. 

2.     Whole grain cereals are better, preferred for their fiber content and satiety value.

3.     Rice Gruel if consumed should be done so by discarding the rice water, and adding hot water. 

4.     Fish can be included in the diet, in the curry form. Fried fish is the best avoided. Shell fishes like prawns, lobsters etc should be avoided. 

5.     Poultry (Without Skin) can be used occasionally. Beef, Pork, mutton, liver etc should be avoided by cardiac patients. Trim off Excess fat (if any) before cooking. 

6.     Egg yolk has to be avoided by individuals with hyperlipidemia. 

7.     Use skimmed milk whenever possible, otherwise cream has to be removed before consumption. 

8.     Root Vegetable like Tapioca, yam, potato, etc are better avoided and if used, should be in moderation instead of cereals.

9.     Include more vegetables (esp. raw salads and green leafy vegetables) in your diet, as it is rich in fiber which in turn helps to reduce blood sugar and cholesterol levels. Raw salads with sprouted pulses enhance the nutrient composition. 

10.                        Fruits are restricted for diabetics and preferably should be consumed as such than having it in the form of juice. Select low calorie fruits from exchange list. 

11.                        Cardiac and hypertensive patients can take 3-4 servings of fruits. Whenever possible consume fruits with edible skins eg. apple. guava etc.

12.                        Sugar and sweet should be avoided by diabetic patients. Low calorie sweeteners can be used in moderation as substitutes for sugar, honey, sweets etc.

13.                        Cardiac and hypertensive patients should minimize their intake of sugar and sweets. 

14.                        Garlic, curry leaves, oatbran etc have blood sugar and cholesterol loosing efforts. Ginger, foods in rich with Vit- E and B Carotene reduces the risk of cardiac diseases. 

15.                        Alcohol intake injurious to health, 1 ml of Alcohol contains 7 calories. Alcohol can cause hypoglyemia and can increase triglycerides which can be harmful for the heart. 

16.                        Cooking oil used should be minimized and may be restricted to 10-15 ml/day. (2-3 tsp). Use cooking methods that require little or no fat.

17.                        Hidden fat in bakery products and snacks should also be taken into account. 

18.                        Preferably use a combination of cooking oils like sesame. ground nut, sunflower, rice bran, corn oil etc. use of coconut and palm oil should be maintained at minimum levels. 

19.                        Dinner should be enjoyed two hours before retiring.

20.                        Include foods from all the different food groups and thus consume a balanced diet. 

21.                        Regular exercise is most useful but physical strain after a meal should be avoided.

Foods to be avoided by diabetics. 

1.     Sugar, Honey,, Glucose and sweets of all varieties like cake, pastries, jams, jelly, sweetened drinks etc. 

2.     Roots and Tubers like potato, tapioca, yam etc

3.     Butter and fried preparations. 

4.     Horlicks, bournvita, boost etc

5.     Fruits like jackfruit, banana, mango, sapota etc. 

6.     Barley water, rice water etc. 

Cholesterol rich foods (To be avoided by cardiac patients)

1.     Whole milk and milk products

2.     Egg Yolk

3.     Shellfishes like prawn, crab, lobster etc. 

4.     Organ meats like kidney, liver, brain etc. 

5.     Chicken, duck with skin. 

6.     Sweet like pastries, ice creams etc. 

7.     Butter, dalda, coconut oil, palmoil

8.     Fried foods like chips, Samosa etc. 

9.     Alcoholic drinks, creams soups etc. 

Sodium rich foods (To be avoided by Hypertensive Patients)

• Salt (Avoid extra salt in food and table)
• Baking powder, baking soda, ajinomoto etc
• Bakery Products like biscuits, cakes, pastries, chocolates, bread, bun etc. 
• Salted chips, nuts, popcorn etc
• Pappads, pickles, dried fish etc
• Canned and Salt preserved foods
• Sauces, soup cubes
• Sausages, lobsters, meat and yeast extracts
• Carbonated beverages
• Readymade foods like cornflakes, noodles, fast foods etc.
• Proprietary drinks eg. Horlicks, complan, bournvita etc.

Send feedback to Dr Adesanya via 08186549147 OR roayad@yahoo.com