Resuscitation Council - 2010 guideline changes

The 2010 Resuscitation Council guidelines have just been published and they don't make many fundamental changes to lay person first aid procedures.

The following changes in the BLS guidelines have been made to reflect the importance placed on chest compression, particularly good quality compressions, and to attempt to reduce the number and duration of pauses in chest compression:

1. When obtaining help, ask for an automated external defibrillator (AED), if one is available.

2. Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min

3. Give each rescue breath over 1 second rather than 2 seconds

4. Do not stop to check the victim or discontinue CPR unless the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally.

5. Teach CPR to laypeople with an emphasis on chest compression, but include ventilation as the standard, particularly for those with a duty of care.

CPR/Resuscitation changes explained

1. When obtaining help, ask for an automated external defibrillator (AED), if one is available.

The availability of defibrillators today in many workplaces and public areas as well as the overwhelming amount of evidence to show that defibrillators are essential in increasing a victim of cardiac arrest's life mean that we now should always ask for one to be brought to the scene of an incident.

2. Compress the chest to a depth of 5-6 cm and at a rate of 100-120 min

To ensure we get good quality chest compressions they simply need to be HARDER and FASTER than previously advised. Forget all that nelly the elephant rubbish and concentrate on compressing the chest sufficiently to pump the blood around the body and maintain a shockable rhythm so that when the defibrillator arrives it has a much better chance of success.

3. Give each rescue breath over 1 second rather than 2 seconds

This again just underlines the importance of minimising interruptions to chest compressions. Interruptions in chest compressions are common and are associated with a reduced chance of survival.

4. Do not stop to check the victim or discontinue CPR unless the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking, or moving purposefully AND starts to breathe normally.

This line simply underlines that we should never stop CPR once it has started unless the above are present. I think this leaves no doubt in the rescuers mind what should be done.

5. Teach CPR to laypeople with an emphasis on chest compression, but include ventilation as the standard, particularly for those with a duty of care.

We welcome this particular line as we come across lots of first aiders who have been taught chest compression only CPR and have never been taught how to perform rescue breaths. Although this was and still is an option for rescuers who are unable or willing to perform rescue breaths it never was intended to be something that was taught as a norm.

"Chest compression combined with rescue breaths is the method of choice for CPR by trained lay rescuers and professionals and should be the basis for lay-rescuer education..........Those laypeople with a duty of care, such as first aid workers, lifeguards, and child minders, should be taught chest compression and ventilation"

"Compression-only CPR is another way to increase the number of compressions given and will, by definition, eliminate pauses. It is effective for a limited period only (probably less than 5 min) and is not recommended as the standard management of out-of-hospital cardiac arrest." _________________________________________________________

Aspirin and heart attacks - the truth

Every year almost a quarter of a million people suffer heart attacks in the UK and a third die before reaching hospital*

Aspirin has been shown to reduce deaths from heart attack by 20-25%* and the earlier it is taken, the greater the benefit. When Paramedics are called to a person with a suspected heart attack, the first things they should do, if possible, is to give the patient a 300mg tablet of aspirin (unless the patient is hypersensitive to aspirin). This is referred to as ‘early aspirin’. But, a self-administered dose of aspirin taken upon onset of symptoms can be of even greater benefit; this is referred to as ‘immediate aspirin’.

It has been recommended, by eminent doctors and academics, that people at risk of a heart attack, that is, patients who have already had an attack, have a family history of heart disease, those with high blood pressure or cholesterol, and just about everyone over the age of about 50 years, should carry one or two tablets of soluble aspirin. A tablet to be chewed and swallowed immediately severe chest pain is experienced – even while 999 is being dialled!

What If I Already Take 75mg ‘Daily Aspirin’?

A ‘one off’ dose of 300mg aspirin, taken upon onset of chest pain, should not be confused with daily 75mg aspirin. Taking a daily prophylactic 75mg aspirin does not preclude the use of an emergency 300mg dose taken during a suspected heart attack or unstable angina.

Whats the Best Way of Carrying Aspirin?

You can of course carry aspirin in your wallet, bag or purse but you may find that the aspirin crumbles or becomes damp. There is a new device called ASPOD® (aspod.com ) specifically designed to carry an emergency dose of 300mg soluble aspirin. It attaches to your keyring, belt or bag, keeps you aspirin dry, safe and even illuminates so you can find them easily in the dark.

*British Heart Foundation 2007 Heart Disease Statistics
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Bacteria linked to asthma in children

A significant number of childhood asthma attacks may be triggered by treatable bacterial infections, a study in the British Medical Journal suggests.

Researchers studied 361 children, aged four weeks to three years, in order to see whether viral and bacterial infections were common during severe asthma attacks.

They found that the number of attacks was similar among children with bacterial respiratory infections and those with viral infections.

Viral infections have long been known to trigger asthma attacks, but the finding that attacks can also be brought on by bacterial infections could lead to a new treatment approach.

Hans Bisgaard, professor of paediatrics at the Danish Paediatric Asthma Centre, revealed: 'We found a significant relationship between bacterial infections and acute asthma attacks - above and beyond the expected relationship between viral infections and attacks.

'Scientists will now look into whether treatment with antibiotics can help children when they have an asthma attack if they are also suffering from a bacterial infection. Being able to use antibiotics to treat asthma attacks in children would be revolutionary.'

On a less positive note, a new study funded by Asthma UK has found that boosting levels of vitamins C and E during pregnancy does not reduce infants' likelihood of developing asthma.

Anecdotal evidence had suggested that children whose mothers had low levels of vitamin E were more likely to have asthma, but scientists at King's College London and Imperial College London have found no evidence to support the theory.
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October marks start of UK flu season

The UK's annual flu season has now begun and people in high-risk groups have been urged to have the flu jab as soon as possible.

Health experts have predicted that the strain responsible for last year's H1N1 'swine flu' pandemic will be of the seasonal flu viruses this year.

Professor John Watson, head of the respiratory diseases department at the Health Protection Agency (HPA), revealed that the agency has kept a close eye on the flu season in the southern hemisphere.

Some countries have experienced moderate levels of H1N1 activity, while others have had relatively few cases.

'We can never predict what will happen in any flu season but we will remain vigilant,' Professor Watson said.

'We should expect that flu viruses will circulate this winter and it remains important that everyone who is in an at-risk group receives their flu jab.'

Professor David Salisbury, director of immunisation at the Department of Health, recently advised people not to underestimate the effects of seasonal flu.

He said: 'It is not the same as getting a cold. It can seriously affect your health and the risks of developing complications are greater if you have certain pre-existing medical conditions.

'If you are in any of the identified at-risk groups, my advice, especially at this time of the year, is to visit your local GP surgery and get the vaccination as soon as possible.'
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Successful surgery may reduce stroke risk

Patients who undergo surgery to open up the arteries in their neck are likely to benefit from the procedure, a long-running clinical trial published in the Lancet medical journal has found.

A procedure called carotid endarterectomy (CEA) can be performed to remove fatty deposits that narrow the arteries in the neck, but the procedure can cause immediate stroke and death.

However, the latest research shows that successful surgery can halve the risk of having a stroke over the next five years, leading researchers at the University of Oxford to conclude that the overall benefits of surgery outweigh the risks in otherwise healthy under-75s.

The researchers assessed the effectiveness of successful CEA at reducing the likelihood of a stroke in 3,120 patients with narrowed carotid arteries.

Half underwent immediate surgery, while the remainder were not operated upon unless there was a definite need for it in the future.

The risk of immediate stroke or death was three per cent among those who had surgery. But for those who had surgery and survived, the subsequent risk of stroke was substantially reduced over the next few years.

Ten per cent of patients who did not have surgery had a stroke within the next five years, compared to just 4.1 per cent of surgical patients.

After ten years, the risk of stroke was 10.8 per cent for those who had surgery and 16.9 per cent among those who did not.

Lead researcher Professor Alison Halliday, from the Nuffield Department of Surgical Sciences, commented: 'This trial took more than 15 years to complete because we wanted to know about the long-term effects of surgery.

'The definite benefits that we have found will be of practical value to doctors and patients deciding in the future whether to take the immediate risk of having such surgery.'

Every year, about 150,000 people have a stroke in the UK, making it the nation's third most common cause of death.
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Call for bolder action on organ donation

Doctors in Scotland have welcomed a new campaign designed to improve organ donation rates.

The £500,000 marketing campaign was launched by health secretary Nicola Sturgeon during a visit to the Royal Infirmary of Edinburgh.

It aims to encourage people to add their names to the organ donor register so that they may potentially save someone's life.

Ms Sturgeon said that organ donation 'can make something positive come out of a tragedy'.

She revealed that more than 600 patients are waiting for a transplant in Scotland, many of whom will not receive the organ they need in time.

Dr Brian Keighley, chairman of the British Medical Association (BMA) in Scotland, welcomed the initiative, but called for 'bold action' to address the shortage of potential organ donors.

He revealed: 'Despite many high-profile campaigns to generate an increase in the number of donors, there has been limited success.

'The BMA believes that a change to a system of presumed consent for organ donation addresses this problem, by making donation the default position from which people may opt out during their lifetime if they so wish.'
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Study may pave way for better asthma treatment

Scientists hope that a new study will ultimately lead to better treatments for asthma - a condition that affects about 5.4 million people in the UK.

An international study, led by scientists at Imperial College London, has identified a number of versions of genes that appear to greatly increase an individual's chances of developing asthma.

The researchers looked at the DNA of more than 26,000 people, including 10,000 with asthma and a further 16,000 healthy volunteers.

Tests identified seven areas of the genome in which people with asthma showed differences when compared to people without asthma.

Commenting on the findings, which are published in the New England Journal of Medicine, Professor William Cookson from Imperial College London said: 'One of the problems with asthma research has been choosing where to intervene in the disease pathways.

'Our study now highlights targets for effective asthma therapies, and suggests that therapies against these targets will be of use to large numbers of asthmatics in the population.'

The study also suggests that asthma is not a single disease, and that asthma which develops in childhood may be biologically different from asthma that is acquired in adulthood.
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Campaign to raise awareness of early signs of cancer

A new campaign focusing on the early signs of cancer will be launched in the new year, the government has announced.

Fifty-nine local campaigns will alert people to the early signs of breast, bowel and lung cancer - the three biggest cancer killers.

According to experts, early diagnosis greatly increases the chances of survival and estimates suggest that as many as 10,000 lives could be saved each year in England alone if survival rates matched the best in Europe.

Care services minister Paul Burstow said: 'Our aim is simple - we want to save many more lives and achieve cancer survival rates among the best in the world.

'Our campaign will help people to be more alert to the early signs and symptoms of cancer and encourage them to seek medical advice as soon as possible.'

Jane Hatfield, director of policy and research at Breast Cancer Care, described the announcement as 'excellent news'.

She observed: 'Our own research has shown there are groups of women, particularly the over-70s and those from socially deprived areas, who aren't aware of the signs and symptoms of breast cancer, so it's vital that these projects are tailored to local communities and are delivered in a way that all women can benefit from them.'

The government also plans to trial a centrally-led campaign to raise awareness of bowel cancer symptoms and to encourage people to visit a GP as soon as they are concerned.

Pilots will be run in two regions and, if successful, the government intends to roll out a nationwide campaign.
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Stockings to help prevent blood clots

Thigh-length surgical stockings may be better at preventing dangerous blood clots than knee-high socks, a new study suggests.

Deep vein thrombosis (DVT) is particularly common in stroke survivors, many of whom are unable to move parts of their body.

This immobility increases the risk of blood clots developing in the leg veins and hospital patients are often given knee-high stockings to combat the risk.

However, the latest study from the University of Edinburgh suggests that these do little to prevent blood clots from developing in stroke patients.

The research team looked at more than 3,000 stroke patients in nine countries and found that those fitted with short stockings were 30 per cent more likely to develop DVT than those fitted with thigh-length stockings.

Martin Dennis, professor of stroke medicine at the University of Edinburgh, said that the findings may have 'important implications' for millions of patients.

'Unless reliable evidence emerges that short stockings do actually reduce the risk of DVT, long stockings should always be used in preference,' he added.

Meanwhile, doctors at University Hospital of Wales in Cardiff are trialling a new round-the-clock service to provide stroke patients with clot-busting drugs.

The drugs must be given quickly in order to work, but have previously only been available during regular working hours, as a specialist needs to be available to administer the dose.

However, staff have now agreed to work around the clock, seven days a week, to improve patients' chances of survival and reduce the likelihood of long-term complications.
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High dose aspirin "effective" against severe headaches

People with severe headache or migraine caused by drug withdrawal may benefit from taking high doses of aspirin, a study in the journal Neurology shows.

Scientists at the University of California, San Francisco (UCSF) Headache Centre found that patients who were given intravenous aspirin reported a significant reduction in pain 25 per cent of the time.

A more modest reduction in pain was observed about two-fifths of the time.

The study involved 168 patients, aged 18 to 75 years, the majority of whom had been admitted to hospital for severe headache complicated by medication overuse.

Participants were given 1g of aspirin - three times the typical dose - and were treated five times, on average.

Lead investigator Dr Peter Goadsby, professor and director of the UCSF Headache Centre, commented: 'These results tell migraine sufferers, their doctors and insurance providers that high-dose intravenous aspirin is a beneficial way to treat difficult withdrawal headaches via a medicine that is not addictive or toxic.'

Headaches can have a range of causes, including stress, squinting and underlying conditions, and are extremely common.

For instance, NHS figures suggest that over 40 per cent of the UK's population may be affected by tension-type headaches at any one time.
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Two popular supplements are "ineffective but harmless"

New research suggests that glucosamine and chondroitin, two supplements regularly prescribed to help patients with knee and hip osteoarthritis manage joint pain, produce "no clinically relevant effect".

The number of prescriptions issued for glucosamine and chondroitin has increased rapidly over the last ten years, with the treatments also available over the counter.

However, studies on the efficacy of glucosamine and chondroitin have produced mixed results, prompting Professor Peter Juni and a team of researchers at the University of Bern in Switzerland to launch their own investigation.

After looking at ten previously-published trials, Professor Juni and the team concluded that glucosamine and chondroitin, whether taken independently or together, had no bearing on joint pain or on joint space narrowing.

'Compared with placebo, glucosamine, chondroitin and their combination do not reduce joint pain or have an impact on narrowing of joint space,' the authors wrote.

'Health authorities and health insurers should be discouraged from funding glucosamine and chondroitin treatment.'

However, a spokesperson for Arthritis Research UK noted that Professor Juni also found glucosamine and chondroitin to be safe and had no issue with patients taking the supplements as long as they paid for them themselves.

'Glucosamine and chondroitin are two of the most popular health supplements for osteoarthritis and two of the most commonly investigated,' the spokesperson commented.

'Many trials have been done over the years but with mixed results. Some trials, but not all, have shown worthwhile improvements in pain. These compounds are also safe. NICE makes it clear in their guidelines on osteoarthritis that while they don't feel there's enough evidence to warrant the NHS paying for the supplements, some people may want to consider an over-the-counter trial as part of a wider self-management plan which includes exercise and keeping to an ideal weight, and we would support that view.'
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Campaign to reduce medicine wastage

The Welsh Assembly government has launched a new campaign in a bid to reduce the amount of medicines that are wasted.

More than 250 tons of medicines are returned to pharmacies and GP surgeries across Wales each year, either because they are out-of-date, surplus to requirements or no longer needed.

This means that at least £50 million worth of medicines is wasted, but in reality the figure is far higher as many unwanted medicines are incorrectly disposed of through household refuse.

Patients will now be given advice with their medication on how to avoid wasted medicines, while radio adverts and leaflets will also help to spread the word.

Doctors will also receive letters from Wales' chief medical officer and the NHS chief executive, reminding them to only prescribe medicines where necessary.

Health minister Edwina Hart commented: 'Millions of pounds worth of waste medicines are being burnt every year. This is money that could be better spent elsewhere in the NHS.

'We all have a duty to play our part in reducing the amount of unnecessary prescribing of medicines. This will ensure that the NHS is able to spend its money in the most effective way.'

Meanwhile, the Welsh government is supporting a UK-wide campaign aimed at highlighting the recent increase in sexually-transmitted infections among over-50s.
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Experts develop early meningitis detection tool

Scientists at the Health Protection Agency (HPA) have developed a new model that could be used to assess whether a suspected case of meningitis is bacterial or viral.

A lumbar puncture procedure is currently needed to confirm whether a patient's meningitis is viral or bacterial, the latter of which must be detected quickly to allow the best chance of survival.

Dr Toyin Ejidokun, an HPA consultant in communicable diseases, said that the new predictive model - which relies on a combination of blood tests and symptoms - could be used to provide a rapid indication of whether or not a patient needs antibiotic treatment.

'Prompt diagnosis and early intervention is crucial in protecting those with suspected meningitis and their close contacts, she confirmed.

'While further testing needs to take place to test the accuracy of the model, this simple model offers the prospect of a rapid predictive tool to help clinical and public health management of suspected bacterial meningitis cases.'

Steve Dayman, chief executive of Meningitis UK, described the model as an 'excellent step forward'.

Mr Dayman observed that it could help to save lives and pointed out that anything that helps to identify and treat the disease more quickly is a 'positive' development.
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