Why do the England and Wales Cricket Board (ECB) provide cardiac screening for professional cricketers?

Sudden Cardiac Death (SCD) or Sudden Cardiac Arrest (SCA) is where the heart goes into AN abnormal rhythm, known as an arrhythmia, suddenly and often without warning. The person affected will drop to the floor, will be unresponsive and will not be breathing, this is known as a cardiac arrest.

 

SCD/SCA can affect anyone, but there are certain risk factors that increase the chance of it happening, these are: -

  • Aged between 14-35
  • Men more than women
  • Putting the heart under physical exertion
  • Afro-Caribbean background - higher incidence of genetic defects

 

In an attempt to identify under laying heart abnormalities and prevent cardiac arrest, the ECB are now providing cardiac screening for all professional cricketers

Who is involved and what do they check when performing a cardiac screening session?

I attended a cardiac screening session performed for Glamorgan County Cricket Club players at the Sophia Gardens Wales stadium in Cardiff.

http://www.glamorgancricket.com/

The screening was carried out by CRY (Cardiac Risk in the Young) on behalf of the ECB sports science and medicine department.

https://www.ecb.co.uk/national-cricket-performance-centre/sport-science-and-medicine-team

 

The screening programme included an electrocardiogram, echocardiogram, medical history form and an interview with a Cardiologist.

 

 

 An(ECG) records the electrical activity of the heart. The heart produces tiny electrical impulses which spread through the heart muscle to make the heart contract. These impulses can be detected by the ECG machine.

The CRY mobile screening health questionnaire is a comprehensive document that asks questions about the players such as, age, ethnicity, smoking status and current medication. The CRY team measure and record the weight, height and blood pressure of all the players.

The questionnaire also asks about any symptoms the players may have during exercise, following exercise or unrelated to exercise such as, 

  • Fainting
  • Dizziness
  • Palpitations
  • chest pain
  • chest tightness
  • breathlessness more than expected 

There are also questions about family history, asking: 

  • high blood pressure 
  • high cholesterol
  • diabetes
  • heart disease
  • sudden death in the family under 50

The next section asks if the players have had any cardiac screening previously, have been seen by a cardiologist or have had a diagnosis of a cardiac condition.

The last section of the form asks the players to give information on how much exercise they do in a week, how may hours per day, how may days per week and at what level e.g. professional, international, county, club or recreational.

 

 Marchant De Lange having an echocardiogram 

 

An echocardiogram is an ultrasound scan of the heart. It is sometimes just called an 'echo'. Ultrasound is a very high-frequency sound that you cannot hear but it can be emitted and detected by the device. The scan can give accurate pictures of the heart muscle, the heart chambers and structures within the heart including the valves.

Marchant De Lange having a consultation with Cardiologist Dr Hamish Maclachlan 

 

If any abnormalities are detected the player will be referred to the Cardiology unit at St George’s Hospital in London for further testing.

Further testing will also be performed if any family members suffer from heart abnormalities or if the players become symptomatic at any time.

How long does a cardiac screen take?

The cardiac screening at Sophia Gardens Wales took approximately 40 minutes for each player. The team from CRY were able to screen 22 players in total, 13 contracted players and 9 academy players. The players that weren’t screened this year will be picked up next year due to being over 25 and classed as low risk, but also have a recent, valid, ECG.

 

Who are CRY?

Since its formation in 1995, Cardiac Risk in the Young (CRY) has been working to reduce the frequency of young sudden cardiac death (YSCD). CRY supports young people diagnosed with potentially life-threatening cardiac conditions and offers bereavement support to families affected by YSCD.

CRY promotes and develops heart screening programmes and funds medical research, as well as publishing and distributing medical information written by leading cardiologists for the general public. CRY funds specialist referral, screening and cardiac pathology services at leading UK hospitals.

CRY is a registered charity.

 

Can anyone have a cardiac screening?

CRY offers subsidised ECG and Echocardiogram screening to all young people between the ages of 14 & 35. 

Follow the link below for more information and screening events/locations from CRY.

 

https://www.c-r-y.org.uk/cardiac-screening/

 

 

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*We are currently offering a discount if you purchase a 'Wound Management Kit' in conjunction with any Wound Management & Suturing course, you will get them both at the discounted price of £387+VAT* 

Normal cost of Wound Management kit = £198+VAT

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*We are also offering a discount of the total price if you book onto the Sports trauma management on the 26/10/18 and Wound Management & Suturing on the 28/10/18 both of which are held at our premises in Cardiff.*

Normal Cost of Sports Trauma Management course = £363 + VAT

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**Please can contact the office if you wish to book any of these offers**  

 

Kit Content

 

The kit includes;

·        3 x Suture removal kit

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·        3 x Standard suture pack (containing; 1 x Treves forceps 13cm, 1 x Iris stitch scissors 11.5 cm, 1 x Kilner needle holder cm, 1 x T.O.E dissecting forceps 13 cm)

·       1 x 20 ml Normal Saline solution

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·       1 x Clinical waste bag

·       3 x 18 mm Sutures

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·       A training kit to practice your suturing skills. (contains; 2 x 4-0 18mm sutures, 1 x 3-0 27 mm suture, Soft leather sponge.)

     The training kit also includes a fine suturing pack plus containing; 1 x Kilner holder 14cm, 1 Iris stitch scissors 11.5cm, 1 x Toothed forceps 10 cm, 1 x Iris Non-toothed forceps 10cm, 1 x Crepe sterile paper, 1 x Tray with 2 integral pots, 2 x Dressing towels 43cm x 38 cm, 5 x Swabs 4 ply 7.5cmx7.5cm.

 

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Are you a medical professional looking to update your suturing skills or perhaps learn a new skill altogether? Why not attend one of our wound management course’s, follow the link to visit the website or call the office on 02921 304 101.

 http://www.lubasmedical.com/lubas-medical-courses/course-info/wound-management---suturing

 

What is CPR? (FAQS)

Posted by chris

 

 

What is CPR?

CPR (Cardio Pulmonary Resuscitation) is an emergency life saving procedure that is carried out when somebody is in cardiac or respiratory arrest. We combine rescue breaths and chest compressions to try and circulate oxygen around a casualty’s body to the major organs in preparation for defibrillation.

What is a cardiac arrest?

Cardiac – relating to the heart. Arrest – To stop.

Cardiac arrest is when the heart stops pumping blood (and therefor oxygen) around the body. This is often caused by an electrical or mechanical malfunction of the heart, an underlying heart condition, or following a medical emergency. During cardiac arrest, the vital organs are starved of oxygen and the casualty becomes unconscious and stops breathing.

Is a heart attack the same as cardiac arrest?

No. A heart attack is caused by a blockage in the arteries supplying blood and oxygen to the heart tissue. As the heart is a muscle, it requires oxygen to function correctly. If untreated, this can develop into a cardiac arrest as outlined above. Therefore, a heart attack could be the cause of a cardiac arrest

How effective is CPR at restarting the heart?

A common misconception is that CPR is designed to “re-start” the casualty’s heart. CPR is effective in circulating blood and oxygen to the vital organs until a defibrillator becomes available to shock the casualty (and theoretically restart the heart). Effective CPR within the first few minutes of cardiac arrest can more than double the chances of survival.

What is a ‘defibrillator’?

A defibrillator (or AED, which stands for Automated External Defibrillator) is a device that can deliver an electric shock to the heart of a casualty in cardiac arrest. The shock provides enough electricity to help “re-start” the heart under the right circumstances.

AED’s assess the casualties heart rhythm and “decide” if a shock is required. This makes them very safe and simple pieces of equipment for bystanders to use.

 

Can I use a defibrillator?

The simple answer is yes. Though it is highly preferred and recommended you have training before using a defibrillator, it isn’t a requirement. A defibrillator is a vital piece of life saving equipment that can be used by any bystander during cardiac arrest.

Defibrillators are becoming much more common in public places like supermarkets, train stations, public gyms, airports etc. These are referred to as PAD’s (Public Access Defibrillators). They are very effective at guiding the operator through the process of potentially shocking a casualty and will not allow you to shock someone who doesn’t need it.

There is no reason to be afraid to use a defibrillator if you suspect a casualty is in cardiac arrest.

Is CPR effective without mouth to mouth or rescue breaths?

Chest compressions combined with rescue breaths is still the recommended and most effective form of CPR.

However, if you have reason not to give mouth to mouth/rescue breaths e.g. the casualty has blood or vomit around their mouth, or you don’t know the casualty and are unsure as to the risks of infection, “hands-only” CPR is an acceptable alternative.

In casualty’s that have suffered cardiac arrest through a lack of oxygen (caused by drowning, asthma, anaphylaxis or in most children), “hands only” CPR is much less effective.

Chest compression's without rescue breaths are always still more effective than doing nothing at all!

How do I know if someone is in cardiac arrest?

Without an appropriate supply of blood & oxygen, the brain cannot function and shuts down. During cardiac arrest, the lack of oxygen to the brain will cause the casualty to become unresponsive or unconscious.

The casualty may make noisy, infrequent gasps or may show no signs of breathing. This is not normal breathing and would indicate the casualty is in cardiac arrest.

If the casualty is unconscious and has stopped breathing normally, they are in cardiac arrest. Call 999 and start CPR!

Will the casualty survive a cardiac arrest?

In the UK, fewer than 10% of people that suffer cardiac arrest, with an attempt of CPR outside of hospital, survive.

Where a cardiac arrest is recognised immediately, CPR is performed, and a defibrillator is used prior to medical professionals (Paramedics) arriving, survival rates of higher than 50% have been reported. This really highlights the importance of the recognition of signs and symptoms and importance of immediate CPR and defibrillation.

Can you be sued for doing CPR?

Nobody in the UK has ever been sued for attempting CPR. In 2015, the government introduced the ‘Social Action, Responsibility and Heroism (SARAH)’ act to protect those performing “acts of heroism”.

The link to this law is as follows:

http://www.legislation.gov.uk/ukpga/2015/3/introduction/enacted

Is adult CPR different from child CPR?

The ratio of compressions to rescue breaths in children is the same as the adult sequence, however, there are some modifications that make it more appropriate for children as follows:

·         Begin with 5 rescue breaths before the first 30 compressions.

·         Use one hand for compressions (or 2 if you find it difficult to compress with one hand) as children are smaller than adults.

·         Use two fingers to compress the chest of a baby (under the age of 1).

It is important to know that these modifications are not essential, and it is far more important that some form of CPR is given rather than nothing at all. There is a general fear that the “wrong” form of CPR given in children could make the situation worse. This is not the case and any attempts at CPR will have more benefit that doing nothing.

How effective is CPR at restarting the heart?

A common misconception is that CPR is designed to “re-start” the casualty’s heart. CPR is effective in circulating blood and oxygen to the vital organs until a defibrillator becomes available to shock the casualty (and theoretically restart the heart). Effective CPR within the first few minutes of cardiac arrest can more than double the chances of survival.

 

            Allergies - First Aid advice

 

 

Allergies occur when the body perceives a seemingly harmless substance as a threat and the immune system produces an inappropriate response.

 

Allergy is the most common chronic disease in Europe. Up to 20% of patients with allergies struggle daily with the fear of a possible asthma attack, anaphylactic shock, or even death from an allergic reaction.

 

In the 20 years to 2012 there was a 615% increase in the rate of hospital admissions for anaphylaxis in the UK.

 

Allergy U.K have reported that an estimated 21 million people in the U.K suffer with some form of allergy.  This figure includes 50% of all children.  These statistics show that allergies are an increasingly prevalent problem.   The severity of the allergy can differ from person to person, ranging from mild and simply inconvenient to a life-threatening anaphylaxis.

A person can develop an allergy to any substance and can also become allergic to something they have previously been able to tolerate. 

 

A specific protein contained in the substance will cause the allergic reaction.  Common substances people are allergic to include food such as nuts or shellfish, pollen, pet hair, chemicals such as hair dye, medications (such as penicillin and NSAIDS) and insects such as bees and wasps.

Symptoms can be varied and include:

·         Sneezing

·         Coughing

·         wheezing

·         Itching of skin and/or eyes nose

·         Rashes

·         Vomiting and diarrhoea

 

Allergic reactions are usually managed with avoidance of the substance that causes the allergy, but this is not always possible.

Medication can be used to treat mild-moderate allergic reactions and anti-histamines are widely available without prescription. Symptoms of the allergy can also be treated with medications such as steroid creams for rashes, nasal sprays for nasal irritation and emollients for eczema.

A severe allergic reaction can be life threatening and is known as Anaphylaxis.

Symptoms can include some or all of the below:

·         Swelling of the tongue, throat, difficulty in swallowing

·         Difficulty in breathing usually resulting in a noise known as stridor

·         Severe wheeze when breathing

·         Dizziness/collapse

·         Vomiting

·         Increase in heart rate

·         Rash (urticaria, hives)

 

If you suspect somebody is experiencing an anaphylactic reaction an ambulance needs to be called immediately. Treatment for anaphylaxis is an intra-muscular injection of adrenaline.  People who know they are at risk of an anaphylactic reaction will usually carry an auto injector so as to be able to treat themselves quickly in the event of a reaction.

Adrenaline is life saving and must be used promptly in anaphylaxis. Delaying the giving of adrenaline can result in deterioration and death. This is why using an adrenaline device is the first line treatment for anaphylaxis.

Here at Lubas medical we offer anaphylaxis training as part of our first aid courses. We can also provide a bespoke course to teach how to recognise an anaphylactic reaction and how to administer the recommended treatment.

For more information regarding allergies, and how to manage them visit:

www.allergyuk.org

You’ll find lots of useful information and a different article each day of allergy week highlighting a relevant topic.

 

 

 

 

Combat Concussion

 

Whilst working as a medic covering a Taekwondo tournament in December 2017 I dealt with an incident of concussion. The competitor returned this year and I caught up with her to find out what happened after the event. I was not expecting the story that followed.

Carla, a black belt in Taekwondo, was competing in a sparring contest. She was wearing the appropriate safety equipment including head guard and gloves.

I became concerned about the competitor after she received a blow to her head. She became unsteady on her feet and so the bout was stopped. I removed her from the ring, and she began to complain of nausea and photosensitivity. We moved to a quieter area as the noise levels were beginning to become a problem for her. Following a full assessment my immediate impression was that she was concussed and should not continue in the tournament. 

The assessment revealed that it was difficult for her to answer certain questions. She answered Maddocks questions with no problems, it was when I began filling in her details on my treatment record that she struggled. She was unable to recall her phone number and revealed that she hadn’t been able to remember things for a few days after hitting her head on a concrete archway in a friend’s house.

She began to drop her level of consciousness and I became increasingly concerned, especially as this was her second head injury in the space of a week. Although haemodynamically stable I felt her dropping level of consciousness, nausea and photosensitivity meant I needed to refer Carla to a Doctor as a matter of urgency. I was concerned that this could be a serious head injury, possibly an intracranial bleed. I called 999 and unusually a doctor, nurse and paramedic were on the ambulance that was sent. 

A concussion was diagnosed by the doctor, with the advice to see her own GP on her return to Devon. She left Cardiff that evening with somebody keeping a close eye on her during the long car journey home.

I contacted her in the days following and she said she was feeling tired but generally better. When I caught up with her she told me of her difficult year since.

It was a few weeks after the initial diagnosis of concussion that her symptoms began to worsen. Whilst attending another Taekwondo tournament, as an observer, her friends became concerned when she became vacant and began slurring her words. They quickly took her to hospital.

Numerous scans were performed and thankfully there was no evidence of a life threatening bleed. Following a detailed examination of Carla and her ongoing symptoms a diagnosis of post-concussion syndrome was made. She continued to experience impaired vision finding herself unable to focus for any length of time. 

The extreme tiredness that she encountered restricted her everyday life including her ability to return to work. Concentrating for any length of time lead to exhaustion, even the simplest tasks became difficult. The making of simple decisions such as what to eat for tea were now a challenge. Reading and listening to music became impossible. It took four months before she was back at work as a classroom assistant. This was facilitated by her occupational health department who developed an activity/sleep schedule to aid her rehabilitation. 

Her mental health suffered, experiencing emotional discomfort the year since her injury. Thankfully she has been supported through this with counselling sessions and is now taking medication to ease her depression.

Although some symptoms remain, especially travel sickness and tiredness, things are improving and for the first time in over a year she has returned to exercise. Her involvement with Taekwondo continues, and whilst she has been advised not to spar again, working as an instructor Carla continues to inspire young people to take up the sport. 

When teaching on our First Aid for Sports and Exercise (FASE) and Sports Trauma Management Courses, we stress the importance of recognition and correct management of concussion.

Keeping up to date on any change in guidelines and published research allows us to keep our information current. Hearing directly from someone who has experienced a serious concussion has helped us to understand it’s long-term effects and the impact it can have. 

Kind thanks to Carla Dunne for allowing us to share her story.  

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