CPDme.com Blog

Emergency Services Show 2012 - Great CPD Opportunity for 2012

Fri, 11 May 2012 23:32:25 GMT

Want to visit ESS this year for Free?

The show will be held 21-22 November 2012 at Stoneleigh Park.

Online registration and our new website will be live in May. If you wish to be sent information on how to visit for 2012 please CLICK HERE

CPDme have confirmed that they will be attending and look forward to meeting both members new and old. Follow us on Twitter & Facebook for upto date information on the ESS2012.

Updates on the 2012 Show COMING SOON

Remember also to share us with your friends with a click:

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CPD Article Contributor - Geoffrey Del Mundo Panganiban RN

Wed, 09 May 2012 02:50:27 GMT

CPD Article Contributor

Geoffrey Del Mundo Panganiban

Geoffrey Del Mundo Panganiban is a Filipino registered nurse working in the Dubai Corporation for Ambulance Services.

He has a background in community development, volunteering and humanitarian work. With previous work experience in the Red Cross and Red Crescent Society.

Geoffrey's professional goals are to pursue a career in Pre-hospital Care and to carry out environmental missions.

He has written his first article for the CPDme website about 'Pink Medics' working within the Dubai Corporation for Ambulance Services.

Pink Medics by Geoffrey Del Mundo Panganiban RN

Wed, 09 May 2012 02:40:15 GMT

Pink Medics

Geoffrey Del Mundo Panganiban, RN

Dubai, United Arab Emirates (UAE): Do your protocols or clinical practice guidelines (CPG) say anything about patients or the family of patients having a preference for the gender of the attending medic? Have you heard of anyone refusing treatment with regard to the medic’s gender? If you find it strange or unusual, maybe you haven’t been exposed to Arab countries or Arab patients at least.

The Dubai Corporation for Ambulance Services have two (2) units specially dedicated to female patients. It uses the call sign Mama Units. The primary function of these units is to cater for Obstetrics, Gynaecology and Neonatal related emergencies but, sometimes these Mama Units serve as a backup unit for any case with a female patient requesting a female medic for assessment and treatment.

The two Mama units were added to the Dubai ambulance fleet which consists of about sixty (60) rigs including two (2) big buses that serve as support units in case of a mass casualty incident. This large ambulance is officially recognised by the Guinness World Records as the largest ambulance measuring 20.03 m (65.71 ft), with a total treatment and transport capacity of 123 patients and staff. This big bus ambulance contains among other things an operating theatre, three (3) intensive care units and eight (8) immediate care units.

A regular ambulance unit in Dubai is manned by three personnel, a driver with two nurses, paramedics or Emergency Medical Technicians (EMTs). Only the Mama units have three female staff on board, including the driver. Female medics have a greater exposure to training in Obstetric and Gynaecology Hospitals, and yes, the Mama medics are wearing pink uniforms.

The concept of creating units with an all-female crew originated from experiences of Arab families insisting, and only allowing, female health workers to take care of their female patient. This relates to Arab culture where only male family members can only touch or see a female relative, even in emergency situations.

So, the next time you a have a female Arab patient or you’re considering working in an Arab country, try to be conscious of cultural diversity. You may not find things like this in your EMT books, but you can learn by experience. Experience, is indeed, still the best teacher.

NEW CPDme Help/ Guide Videos Launched

Wed, 25 Apr 2012 21:27:24 GMT

The CPDme Development Team have put together some new videos for both the Public and CPDme Members to help them better understand both the benefits of CPDme and also an extensive How2Guide to managing your portfolio.

Check out our YouTube Channel by clicking here

Some videos are only available to Members by entering the Member Section of the website and clicking in the Video Guide Section. There is also a help video everywhere you see this Video Sign:

If you have any suggestions about Help or Guide Videos, email the development team at videos@cpdme.com

CPDme IPhone / Android App Development

Thu, 19 Apr 2012 21:14:43 GMT

CPDme is currently engaged in talks with suppliers regarding an IPhone / Android Application. However we need some feedback into what you would like our App to feature. Please email andrew at andrew.ormerod@cpdme.com with any suggestions.

If we implement your unique idea. We will reward your contribution with a 5 year membership token. Please add comments below or email Andrew

The CPDme Development Team

The Pedalling Paramedics raising funds for the ASBF

Thu, 19 Apr 2012 02:14:09 GMT

The

Pedalling

Paramedics

THE PEDALLING PARAMEDICS

Peter Davison and a team of his colleagues from East of England Ambulance Service are going to cycle from Lands End to John O' Groats in May 2012 in order to raise funds for the ASBF.

Their itinerary is as follows:-

4th - Land's End to Exeter

5th - Exeter to Chepstow

6th - Chepstow to Shrewsbury

7th - Shrewsbury to Lancaster

8th - Lancaster to Lockerbie

9th - Lockerbie to Edinburgh

10th - Edinburgh to Pitlochry

11th - Pitlochry to Inverness

12th - Inverness to John O'Groats

A fantastic effort in support of your charity the Ambulance Services Benevolent Fund.

Give them your support as they cycle through your area and by donating towards their fund raising efforts by clicking on the "widget" below.

For more Fundraising News from the Ambulance Services Benevolent Fund please follow this link.

Support the Ambulance Services Benevolent Fund

Thu, 19 Apr 2012 01:51:01 GMT

Support the Ambulance Services Benevolent Fund

AMBULANCE SERVICES BENEVOLENT FUND

Pride in serving, proud to have served...Relieved to receive our support when dealing with a personal crisis or period of hardship.

Your support today will help us to provide that extra help when the unforeseen has happened.

The ASBF is here for all ambulance service personnel whatever your role, serving or retired.

We have to attract donations and to help with this we need volunteer representatives at all ambulance sites and locations to ensure we can go on being there for Britain’s ambulance service heroes’ who are calling for our help.

There are many ways you can help to fundraise, from riding bikes from one end of the country to the other, organising a fundraising dance, making regular donations by signing up to a donation from salary scheme and, to make things really simple, by using Vodafone’s JustTextGiving.

To help with raising funds you can also purchase medal bars, pin badges such as the new Poppy badge, Diamond Jubilee medals and just arrived are presentation boxes of Diamond Jubilee cufflinks and much more!

For further information please visit the ASBF website:

www.asbf.co.uk

Or email:

enquiries@hotmail.co.uk

“The Ambulance Services Benevolent Fund is Caring for the Carers –

Together we can make the difference.”

Patron: Simon Weston OBE

Registered Charity # 800434

(words 213)

Medical Emergencies within the Dental Practice : Stroke (CVA)

Thu, 19 Apr 2012 01:16:35 GMT

Medical Emergencies

within the

Dental Practice

Stroke (Cerebrovascular Accident - CVA)

by Wendy Berridge

STROKE (CEREBROVASCULAR ACCIDENT – CVA)

DEFINITION A sudden attack of weakness affecting one side of the body due to an interruption of blood flow to part of the brain.

There are two types of stroke. The most common is caused by the presence of an atheromatous plaque or less commonly a blood clot, which blocks one of the blood vessels supplying part of the brain, which results in the death of the area of the brain the blood vessel supplies. The second cause is less frequent and occurs when a blood vessel in the brain ruptures, resulting in a haemorrhage which causes an area of the brain to become “squashed” by the pressure of the blood. In either type of stroke, the signs and symptoms are very similar and an area of the brain will die. A stroke can happen at any age, is the third largest cause of death, and the single biggest cause of severe adult disability in the UK.

The prognosis for stroke patients is variable, but the mortality rate is around 30% when the stroke is caused by a plaque, or blood clot, and as high as 80% when caused by a haemorrhage.

A Transient Ischaemic Attack (TIA) or mini-stroke is caused by a temporary disruption of blood flow to part of the brain. Symptoms may be similar to a cerebrovascular accident (CVA) but recovery occurs within 24 hours. However, 20% of people who experience a TIA will suffer a full CVA within a few weeks, therefore TIAs should be regarded as a warning sign that further TIAs or a complete stroke may occur in the future.

There are several predisposing factors that can increase the chance of a CVA and these include:

Hypertension

Diabetes

Heart Disease

Renal Disease

Obesity

Atrial fibrillation

Smoking

Excess alcohol consumption

Previous TIA/CVA

POSSIBLE SIGNS AND SYMPTOMS

The clinical features of a stroke can vary considerably and are dependent on the area of the brain which has been affected. The onset is sudden and rapidly progresses and can consist from mild confusion or difficulty in speaking to major symptoms including cardiac arrest. The signs and symptoms can include one or more of the following:

Paralysis of one side of the face

Paralysis of the limbs on one side

Confusion

Inability to speak clearly, or at all

Visual disturbances

Tingling down one side of the body

Numbness down one side

Seizures

Severe headache (sudden onset)

Coma

When a person presents with any of the symptoms described above it is essential that a CVA is considered as a possible cause and the emergency services called as quickly as possible.

If you suspect a stroke you should carry out the “FAST” test:

F - Facial Weakness - can the person smile? Has their mouth or eye drooped?

A - Arm Weakness - can the person raise BOTH arms?

S - Speech Problems - can the person speak clearly and understand what you say?

T - Test and Time - as soon as the person fails any test, it’s time to dial 999

REMEMBER: to test all three, but as soon as the person fails one of the tests send a colleague to telephone for a paramedic, because speed is important.

MANAGEMENT

The dental management of a person who has had a CVA is restricted to assessing and monitoring ABCDE (airway, breathing, circulation, disability, exposure) and provision of high-flow oxygen, together with an immediate call for a paramedic.

If the casualty is conscious then place them into a position with head and shoulders raised. High flow oxygen should be administered via the non-rebreathing face mask. It is worth remembering that although they may not be able to speak they will probably be able to understand what is happening and they will be extremely frightened. A calm management approach is essential.

If the casualty is unconscious but breathing then they must be placed into the recovery position, also receiving high-flow oxygen via the non-rebreathing face mask. If they are not breathing, not breathing normally, or you are unsure then cardiopulmonary resuscitation (CPR) must be started immediately.

The dental team can do little to prevent a CVA or TIA from happening. The medical history is an essential tool to help identify predisposing factors in patients who may have an increased risk from a CVA, as well as recording details if the patient has had either event in the past 6 months as there is a greater risk of having another CVA or TIA if this is the case. If so, it will be necessary to carry out a risk assessment to decide if treatment should be carried out, or possibly deferred by another 6 months as there would be a lesser risk then.

Wendy Berridge delivers CPR, Medical Emergencies and AED training to dental practices throughout Yorkshire and Lincolnshire.

Contact details:

Tel: 07771590513

email: wendyberridge@hotmail.co.uk

Open Day at training facility in Kendal on 29th April 2012

Thu, 12 Apr 2012 03:12:17 GMT

Mountain Trauma Rescue Services

Open Day

29th April 2012

Mountain Trauma Rescue Services would like to invite you to our open day at our training facility in Crosthwaite, Kendal on 29th April 2012.

This event is suitable for those wishing to join one of our future first aid or rescue courses, extreme sport event organisers, healthcare professionals and just those looking for a day out.

This is a free event and will include:

- Instruction on CPR and defibrillator use

- Advanced airway workshop (CPD event for healthcare professionals - certificate provided)

- An opportunity to visit our first aid and medical training facility and to get hands on our educational resources

- An opportunity to see our rescue equipment and event medical services set up and 4x4 response vehicle (great for event organisers and healthcare professionals wishing to work for us at future events)

- Opportunity to buy first aid equipment for use in remote areas

- Free refreshments throughout the day and prizes to be given away and much more.

This is a drop in event so pop by anytime between 10am and 4pm.

Address: Town Yeat, Crosthwaite, Kendal, Cumbria. LA8 8DN

We look forward to seeing you there!

Mountain Trauma Rescue Services

www.mountaintrauma.co.uk

CPD Articles Contributor

Wed, 11 Apr 2012 23:35:07 GMT

David Thornicroft

St Thomas Training

CPD Articles Contributor

David Thornicroft is the owner of St Thomas Training which specialises in delivering training on the Mental Capacity Act and Deprivation of Liberty Safeguards to the staff of health and social care organisations throughout England and Wales.

He is very happy to answer questions about the Act or of course to come and deliver training to your staff. He can be contacted on david@stthomastraining.co.uk, or via the website at www.stthomastraining.co.uk.

David Thornicroft

St Thomas Training

02380 970 914

david@stthomastraining.co.uk

The Mental Capacity Act 2005 and the use of Advance Decisions

Wed, 11 Apr 2012 23:27:12 GMT

The Mental Capacity Act 2005 and the use of Advance Decisions

by David Thornicroft

The Mental Capacity Act 2005 and the use of Advance Decisions

Many readers will be familiar with the Mental Capacity Act 2005, and you may well have attended training on it. You may well also have some understanding of the concept of Advance Decisions. But the whole issue of when you should treat a patient, and when you should withhold treatment, is still a tricky ethical and legal dilemma. This article attempts to provide some clarity.

The Mental Capacity Act 2005, which applies in England and Wales only, starts from the premise that individuals over the age of 16 years are able to make decisions about their own lives. These may not be very good decisions, and they may well be decisions with which parents and/or professionals may disagree, but ultimately there is a presumption that the individual can make them for him/herself.

The Act brought in many new concepts, one of which is the Advance Decision. An individual who has capacity (in other words who can make decisions about his/her own life) is now able to make an Advance Decision to reject any form of medical treatment.

Immediately there is a deviation from the main body of the Act here, because Advance Decisions can only be made by individuals who are over the age of 18 (not 16, as applies to most of the rest of Act).

An Advance Decision (sometimes called, wrongly, an Advance Directive) is legally binding, if properly made in the first place. It means that the individual has made his/her wishes clear, and that these wishes must be respected today and in the future.

So what are health and social care professionals to do to ensure that we comply with the law?

Let's take two scenarios to try to clarify. Scenario 1 concerns Katya, a 30-something female who is being driven along a main road by her husband Ian. They are involved in a head-on collision with an articulated lorry. The ambulance arrives to find Katya unconscious with severe head injuries. Ian, who is injured but conscious, tells the paramedics that Katya has always said she does not want to be resuscitated.

Scenario 2 concerns Alf, a 90-something resident of a nursing home for people with dmeentia. He has just suffered a suspected heart attack, and the ambulance is called. His daughter Gemma is with him at the nursing home and, just like Ian, she tells the paramedics that her father has always said he does not want to be resuscitated.

The question is: do you resuscitate both Katya and Alf, only one of them (which one?), or neither of them? And, most importantly, why?

Before the introduction of the Mental Capacity Act these were difficult questions. If you asked 100 paramedics you would probably get 101 different answers. However the Act does give clarity, if it is properly interpreted.

The first issue is whether or not Katya or Alf have capacity at the moment to make the decision for themselves. If they do, then the decision is up to them. In these cases, however, assuming that they are both unconscious and both incapable of communicating with you then they do indeed lack capacity (because one of the requirements of capacity is that the individual must be able to communicate his/her decision to you, in some form or another). Therefore the decision to resuscitate must be made by you.

The second issue is whether or not there is indeed a valid Advance Decision in place, specifically relating to resuscitation. Both Katya and Alf have relatives nearby telling you so, but this is not sufficient. It is possible to make a verbal Advance Decision (for example "I never want to be given electro-convulsive therapy", or "I never want to be given an injection"), but when it comes to life-sustaining treatment the Advance Decision must be in writing. It must be made at a time when the individual has capacity about the treatment that s/he is refusing; it must state specifically what treatment is being refused and in what circumstances; it must be signed and dated by the individual and it must be countersigned and dated by someone else to confirm that, in their opinion, the individual does have capacity about the treatment that s/he is refusing.

This is the point at which the scenarios may well diverge. Is it reasonable for the paramedic treating Katya, in all the chaos of a road accident, to search for the Advance Decision, then read it, check that it contains all the necessary details etc? No! The paramedic act in whats/he believes to be in Katya's best interests, which almost certainly means attempting resuscitation. The paramedic must also be prepared to justify his/her decision later. The paramedic will not be prosecuted as long as s/he has acted "reasonably".

However in Alf's nursing home it's a very different situation. The nursing home staff should have discussed such scenarios in advance with each resident and, where appropriate, with the family. It is entirely predictable that an elderly resident such as Alf may suffer a heart attack. The home should keep detailed records on the wishes of each resident. Those records should be easily accessible. So at the point of making the 999 call a good nursing home will already have told the paramedics that there is a valid Advance Decision in place stating clearly that Alf does not want to be resuscitated in the event of a heart attack. The paramedics, when attending the scene, should of course ask to see the Advance Decision, to satisfy themselves that it does exist. If so, then the decision is made. No resuscitation. And of course if the nursing home cannot produce the Advance Decision then the it's up to the paramedic to decide what is in Alf's best interests, which again almost certainly means attempting resuscitation.

Remember that the Mental Capacity Act is there to protect the individuals who lack capacity AND the people who care for them. Chapter 6 of the Mental Capacity Act Code of Practice is well worth reading, because it explains how carers, healthcare and social care staff can carry out their normal duties without fear of being prosecuted. The two crucial issues are set out in paragraph 6.22: (The carer) "must reasonably believe that the person lacks capacity to make that particular decision at the time it needs to be made, and the action is in the person's best interests."

Of course the wishes of the patient may conflict with our own instincts. We may feel it is morally wrong not to try to resuscitate Katya, or Alf, irrespective of their wishes. But the Act again makes clear that our own beliefs or morals are secondary in importance to the beliefs and morals of the individual. And that, surely, is how it should be.

David Thornicroft

St Thomas Training

02380 970 914

hello@stthomastraining.co.uk

-----------------------------------------------------------------------

Editor's note:

To learn more about the Mental Capacity Act please visit the St Thomas Training website where you can complete the e-learning module 'Mental Capacity Act - The Basics' free of charge (normally £15.00 plus VAT) until 30 April 2012.

Fire Risk Assessments & Staff Training - The Facts

Thu, 05 Apr 2012 03:46:47 GMT

Fire Risk Assessments

& Staff Training

by Eric Dempsey G.I.Fire.E

Small Businesses, Fast Food Outlets and Restaurants – Face Prosecution

FIRE RISK ASSESSMENTS & Staff Training - THE FACTS:

In 2005/6 the law in the

regarding Fire Safety changed. Over 118 out of date pieces of legislation were abolished and a new streamlined Act based on ‘Fire Risk Assessment’ was brought in. The Regulatory Reform Order (Fire Safety) 2005.

The biggest change being that employers or person in control of the building – known as ‘The Responsible Person’ are now responsible for fire safety within their business/premises and are required by this law to have a Fire Risk Assessment of their premises, implement its findings and train their staff in all regards to their safety. Everyone must be trained in Fire Awareness and know what to do in case of Fire. Fire Marshals must be trained to assist evacuations and fight the fire if safe to do so. To do this, they must be trained by competent instructors. The Fire Risk Assessment must be reviewed annually and staff must receive refresher training. This training must be recorded and kept with the Fire Risk Assessment for inspection by a Fire Officer at any time. The old ‘Fire Certificates’ are now defunct and are no longer valid.

Thousands of people are hurt and over 20 people per day either killed or seriously injured in fires involving Class F Cooking Fats fires in

kitchens. The Fire Service will not do this Fire Risk Assessment, but will certainly ask to see it on an inspection or for an after fire audit. Failure to have one will result in prosecution and that may render your Public Liability Insurance invalid. Many employers are falling foul of this legislation –

DON’T LET IT BE YOU!!!

In essence the ‘Responsible Person’ can delegate the Fire Risk Assessment to a person who is competent to do it but cannot delegate their legal responsibilities and liabilities – under the legislation itself.

Check for yourself and Google ‘Recent Prosecutions under the RRO (Fire Safety) Act. You will be shocked and surprised!

In addition, the ‘Responsible Person’ must:

Ensure that a fire risk assessment is carried out
Identify fire precautions and establish an Emergency Plan
Record findings of the risk assessment
Nominate one or more competent persons to implement control measures and review the fire risk assessment
Establish fire safety procedures for staff and anyone entering their premises
Inform employees about risks/control measures/identities of nominated competent persons
Establish means of contacting emergency services and provide them with relevant information
Ensure that premises and any equipment provided in connection with fire safety are adequately maintained by a competent person
Inform and co-operate with other occupiers (other responsible persons) within the building, concerning findings of significant risk and measures of prevention and protection

Duties of Employees

Comply with the law and assist employers in maintaining fire safety
Take reasonable care for the safety of themselves and others
Cooperate with employers regarding fire safety duties
Inform those responsible of serious and immediate dangers
Inform those responsible of any shortcomings in the employer’s fire protection arrangements

Training your employees not only fulfils your legal and moral responsibilities but is financially desirable. Many businesses that have a fire never recover the loss of contracts and goodwill and go out of business. Training is an essential part of the safety of staff and the public.

As a fire officer for almost 30 years before retirement I regularly attended complicated incidents involving fast food restaurants with deep fat fryers as Officer in Charge of tactics responsible for the deployment of personnel and equipment and well understand your concerns. These fires are dangerous and can cause serious injury or worse. They can also destroy a business. I will assess your staff and write training programmes to SUIT YOU. Remember an assistant trained in the use of extinguishers can save your business. A staff member trained in 1^st Aid can save your life.

I particularly enjoy training staff as Fire Wardens to give them confidence in this area. I have trained around 2000 in the last year alone. Often, they have volunteered for this possibly dangerous and responsible task in addition to their normal duties. It is in this area that my long years of experience can best be utilised working at national locations. Assessing need and providing a realistic and cost effective programme at your own location to remedy any deficiency.

Should you wish us to assist you to meet your legal obligations and assist in all matters regarding staff safety? Contact us to arrange your training. We can adapt any training required for local circumstances, give advice on FRA’s and carry them out. We will also help implement the requirements of the Risk Assessment if required.

Staff Safety Induction
Basic Fire Fighting for Civilian Staff including Extinguisher Training
Fire Marshall & Responsible Person
Emergency 1^st Aid @ Work

DON’T TAKE A CHANCE -

MAKE YOUR BUSINESS & STAFF SAFE TO SERVE

Training can be arranged via Eric Dempsey at

Arc Fire Training Services Ltd

Http://www.arcfiretrainingservices.co.uk

Or email Eric at arcfiretraining@ntlworld.com

Eric Dempsey G.I.Fire.E

Olympic & Paralympic Games Accommodation assistance

Thu, 05 Apr 2012 02:52:19 GMT

Accommodation

Assistance

Olympic and Paralympic Games

I am a Games Maker at this summer Olympics and Paralympics. I'm a first responder and based at Aquatic Centre (Olympic) and Rowing Centre, Eton Dorney (Paralympic). I need accommodation in these locations and would like to appeal to CPDme members if they can help; does anyone one want a lodger?

Tony Clough

E: antony.clough@btinternet.com

T: 01132866023

W: http://www.tcfirstaidtraining.co.uk

Pool Activity Level (PAL) instrument for Dementia Care

Wed, 04 Apr 2012 23:46:01 GMT

The Pool Activity Level (PAL) Instrument for Dementia Care

Developed by Jackie Pool, a leading UK specialist in dementia care, the Pool Activity Level (PAL) instrument has become the framework for care in settings across the UK for clients with cognitive impairments caused by conditions related to dementia, strokes and learning disabilities.

The PAL Instrument contains a valid and reliable tool for assessing level of ability which is recommended in the National Clinical Practice Guideline for Dementia (NICE, 2006), for activity of daily living skill training and for activity planning. The instrument also contains profiling tools for interpreting the assessment in order to plan and deliver effective, enabling care and support.

The PAL Instrument is available to photocopy from the PAL Instrument book or as a free electronic version by following the link below. Users of the PAL Instrument will need a PAL book.

The PAL book is published by Jessica Kingsley publishers. It contains background information, statistical evidence from the research study, case studies and a selection of possible activities, with sources for obtaining them and guidance for carrying them out with individuals who have different levels of ability as revealed by the completion of the PAL Instrument

To order the PAL book click here

To use the free electronic version of the PAL Instrument, follow this link

Jackie Pool

t: +44 (0)844 826 3101

m: +44 (0)7947 741249

e: jackie.pool@jackiepoolassociates.org

w: www.jackiepoolassociates.org

MEDICAL EMERGENCIES WITHIN THE DENTAL PRACTICE ANGINA and HEART ATTACK (MYOCARDIAL INFARCTION – MI)

Wed, 04 Apr 2012 17:49:57 GMT

Medical Emergencies

within the

Dental Practice

ANGINA and HEART ATTACK (MYOCARDIAL INFARCTION - MI)

ANGINA and HEART ATTACK (MYOCARDIAL INFARCTION – MI)

DEFINITIONS

Angina: Pain or discomfort in the chest due to reduced blood and oxygen flow to the heart.

Myocardial Infarction (MI): Damage or death to an area of the heart muscle resulting from a reduced or blocked blood supply. (Also known as a coronary thrombosis or heart attack).

Angina is a condition usually caused by the build up of a cholesterol plaque on the inner lining of the coronary arteries. Cholesterol is a fatty chemical which is part of the outer lining of cells in the body, and a cholesterol plaque is a hard, thick substance caused by deposits of cholesterol on the artery wall. Over time, the build up of the plaque causes narrowing and hardening of the arteries, and this significantly reduces the blood flow to the heart muscle. When a person is resting the heart is beating at its resting rate; when any type of exertion is undertaken the heart is required to beat more strongly and at a faster rate to ensure that an adequate supply of oxygenated blood is being circulated. This is a case of “supply and demand”, and the more exertion, the more cardiac effort is required, and the more oxygen the heart will need.

When the coronary arteries are narrowed less blood can be supplied to the heart muscle, so a situation will be reached where the demand of the heart muscle for blood will exceed that which the coronary arteries can supply. The heart muscle will therefore be deprived of oxygen and “cramps”, producing pain.

Typically, an angina attack occurs with exertion, and subsides with rest. If the narrowing of an artery reaches a critical level, angina can occur at rest (unstable angina).

A person with angina, especially “unstable angina” has a high risk of suffering a heart attack in the future.

Myocardial Infarction is the medical term for a heart attack. It is caused by a complete blockage of one of the coronary arteries, which results in the area of the heart supplied by that vessel becoming completely deprived of its blood supply causing the affected area to die. The usual cause of this is either for a clot (thrombus) to form on the wall of the blood vessel or for a plaque to rupture and cause a blockage. If the blockage occurs in a vessel supplying a large area of the heart then it is unlikely to be able to function normally and a cardiac arrest will result. If the area supplied is relatively small then it may be possible for the rest of the heart to compensate and normal cardiac function may be re-established.

POSSIBLE SIGNS AND SYMPTOMS

The symptoms of angina can be variable depending on the severity of the coronary disease, and can also be triggered by emotionally stressful situations which also increase the heart rate (supply and demand). However, on rest, the heart rate will slow down again and the symptoms should pass within approximately 5-10 minutes. Use of a glyceryl tri-nitrate (G.T.N.) spray will help to relieve the symptoms. If the symptoms persist despite rest and the use of G.T.N. spray the diagnosis should be reconsidered as it is likely that the casualty is having a myocardial infarction.

The signs and symptoms of a myocardial infarction can also be variable and it is important to remember that 30% of heart attacks are “silent” as they produce no obvious symptoms. A heart attack can happen at any time, including during rest. The pain is similar to that of angina, but is often more severe. Unlike angina, the symptoms of MI will not be relieved by the use of the G.T.N. spray. If the symptoms last longer than 10 minutes the casualty is probably experiencing a heart attack.

ANGINA

Crushing, vice-like pain, usually in the central area of the chest, can radiate to the left arm, neck or jaw

Breathlessness

Sweating/Pallor

Regular, fast pulse

Anxiety

MYOCARDIAL INFARCTION

Crushing, vice-like pain in the centre of the chest, possibly radiating to the left arm, neck or jaw. Can sometimes be described as indigestion. 30% of casualties experience no pain.

Breathlessness

Sweating/Pallor

Irregular pulse, often missing beats

Nausea

Anxiety

Light-headedness

Collapse

MANAGEMENT

Angina Sit the casualty upright and allow them to lean slightly forward as this makes it easier to breath. The dental chair in its upright position is ideal, otherwise it is best to sit them on the floor with their back to a wall. Under no circumstances insist that the person lies flat as this will not help with breathing and will put the heart under more pressure. High flow oxygen must be administered via the non-rebreathing mask and if the casualty carries their own glyceryl tri-nitrate (G.T.N.) spray they should be encouraged to use it by delivering 1-2 sprays sublingually. If they do not have their medication, or if it is out of date, then use your own supply from the drug box in the same way. The G.T.N. spray works by causing the blood vessels to dilate which will increase the blood flow to the heart.

If the pain does not reduce despite the G.T.N., then a myocardial infarction should be suspected and the paramedics must be called. A person who has angina will be familiar with their own condition and will tell you what is “normal” for them during an attack. If the symptoms are worse than normal or less responsive to treatment, then immediate transfer to hospital is required. If you are worried it is also a good idea to make the call, even if it is just for reassurance. Otherwise, once the symptoms have improved it is best to allow the casualty to rest before going home, as the G.T.N. will also have increased the blood flow to other organs and can result in a painful headache. Because of this, and the fact that they have just experienced an angina attack, it is best to arrange for someone to collect them if they have attended the appointment alone.

Myocardial Infarction Early recognition is very important because the casualty needs to be transferred to a coronary care unit as soon as possible, so telephone for an ambulance immediately if it hasn’t been done already. The casualty should be placed in the upright position as mentioned earlier and high flow oxygen administered via the non-rebreathing face mask. It may also be beneficial to administer dispersible aspirin. Make sure that the casualty is not allergic to aspirin and not already taking “anti-coagulant” drugs (such as Warfarin). If this is the case, allowing them to slowly chew a dispersible aspirin may help. However, it is still important to telephone for a paramedic immediately, and if you are unsure you can ask for advice.

Aspirin reduces the clotting ability of the blood, and chewing the tablet instead of swallowing whole allows the drug to be absorbed quickly into the bloodstream through the buccal sulcus. Ensure, therefore, that you have dispersible aspirin. The ideal dose is 300mg, although any strength will do.

If the casualty becomes unconscious then the airway must be opened and the breathing checked. If they are breathing then they must be placed into the recovery position as they are likely to vomit. Continue giving high flow oxygen via the non-rebreathing mask. Monitor the casualty constantly (ABCDE) and if at any time the breathing stops, the rate becomes abnormal, or you are unsure, then start CPR immediately.

Wendy Berridge has worked within the dental profession for over 26 years and delivers CPR, Medical Emergencies and Defibrillation training to dental practices within Yorkshire and Lincolnshire.

All training qualifies for Verifiable CPD and meets with current UK Resuscitation Council and GDC guidelines. It takes place at each individual practice, allowing for a personal approach, and resulting in a more relaxed atmosphere!

Contact details:

Tel: 07771590513

Email: info@berridgemedicaltraining.com

Website: www.berridgemedicaltraining.com

ASBF News - March 2012

Thu, 15 Mar 2012 03:38:59 GMT

AMBULANCE SERVICES BENEVOLENT FUND

NEWS March 2012

Two separate fund raising events are being organised by staff from East of England Ambulance Service.

A team of paramedics are riding on bicycles from Lands End to John O Groats in May 2012. Details/help please contact Pete Davison:

pete.davison@tscali.co.uk

A member of the emergency control is organising a dance to raise funds in Milton Keynes at ‘Bistro Live’- Wednesday 23^rd May 2012 -19.15 to midnight – tickets £20 includes three course meal. Tickets direct from: http:/www.bistrolive.com/customers/additonalPayments.asp?BookingCode=K8qU2o1. Further details please contact: craig.borrett@eastamb.nhs.uk Or phone Craig on : 07716 890070

Help raise funds by entering to run in the London 10k in May – the ASBF have 12 free places available. Applications can only be made through Simon Fermor ASBF Secretary:-

asbf.enquiries@hotmail.co.uk

VUE National Triathlon emergency services competition – teams welcome with the overall winners presented with a £1000 donation for their service charity – ambulance service competitors would choose the ASBF.

www.vue-cctv.co.uk

The ASBF has recently registered with Vodafone’s ‘JustTextGiving’ service – which allows mobile phone users of any network to give donations to charity. Enter 70070 into the “to” box – Write in the code ‘ASBF44’ add the amount you want to donate – Your text might look like this ‘ASBF44 £5’ Press ‘Send.’ The text itself is FREE! Smart phone users will have the option to claim Gift Aid immediately via their phone to increase at no cost to them which will increase their donation by 25%!

Other ways to raise money for the ASBF for ‘FREE’ – make Everyclick.co your search engine by following this link:-

www.everyclick.com/uk/ambulanceservicesbenevolentfund

and then select the ASBF as your chosen charity.

A further development to’ Everyclick’ is another simple and free method of fund raising –

‘Give as you Live’:- www,giveasyoulive.com/join/ambulanceservicesbenevolentfund

Shopping with ‘Give as you Live’ can raise up to 4% of your purchase expense for the ASBF at no extra cost to you

The ASBF will have a stand at the following event so if you’re visiting please go along and say hello and have a chat, we will be pleased to see you.

AMBULEX – at the Fire Service College, Morton in the Marsh – 13^th – 14^th June 2012.

For information visit: www.ambulex.com

Visit the ASBF website where you can purchase ambulance service car stickers, pins, blazer badges, Diamond jubilee medals and the new enamelled medal bars and much, much more.

Or, to make a regular donation please sign up to one of the donation from salary schemes like ‘Give As You Earn’.

For more information about your charity please visit:

www.asbf.co.uk

Or email:-

asbf.enquiries@hotmail.co.uk

THE AMBULANCE SERVICES BENEVOLENT FUND HAS BEEN CARING FOR THE CARES FOR OVER 25 YEARS – WE NEED YOUR HELP TO RAISE FUNDS SO THAT WE CAN CONTINUE TO THRIVE AND DEVELOP OUR FUTURE CARE PROGRAMMES – TOGETHER WE CAN MAKE THE DIFFERENCE!

PATRON: SIMON WESTON OBE.

REGISTERED CHARITY # 800434

(438 words)

Child CPR

Thu, 15 Mar 2012 03:06:21 GMT

CHILD CPR by Tony Clough

A child is defined as being aged under puberty and an infant under 1-year old. What you need to remember, children are not small adults they have many physiological differences that will need to be discussed in a separate article.

It is not unknown, but highly unlikely, that a child will have a cardiac arrest; when requiring CPR it is more common for a child to have had an accident or illness that caused them to stop breathing (respiratory arrest) and then for their heart to stop beating (Cardiac Arrest). So it is with this in mind that the Resuscitation Council (UK) guidelines for Child CPR differ to Adult CPR.

Child CPR (Newborn to Puberty)

· Method - Danger/Response/Airway/Breathing

· Result – Unresponsive/Non-Breathing infant

· 5-Rescue Breaths

· 30-chest compressions

· 2-Rescue Breaths

· Repeat – CPR at ratio 30:2 for 1-minute (Approx. 3 reps of 30:2)

· 999 – If no one has called emergency services it must be done now

· Continue - CPR at ratio of 30:2

Previous articles have referred to the primary survey Danger Response Airway Breathing (DRAB) to define whether a casualty is in the state of dying and requiring Cardio Pulmonary Resuscitation (CPR). Once again this approach needs to be adhered to, but obviously the language you speak to a child needs to be refined slightly for them to be able to understand.

Danger – Children don’t have life experiences and the foresight to see they are getting themselves into perilous situations and sometimes the scene can be amusing but it can make it difficult for would-be-rescuers to assist. Circumstances involving children are highly sensitive and emotional; the highly charged scene can drive first aiders into putting themselves in danger and becoming a casualty. If you cannot access a scene because of safety issues please call the emergency services – they have the equipment and training to deal with these situations – a call to the emergency services is a positive first aid action.

It is extremely likely that you will have more than one casualty to deal with. Children are not usually alone; they will have parents, grandparents, brothers, sisters or other guardians in close proximity. They may not just put themselves into danger but may suffer from ‘shock’ which is perilous situation in its own right.

Response – Once you know the scene and bystanders are safe you need to quickly decipher the conscious ability of the child by using the Alert Voice Pain Unresponsive (AVPU) scale. With an infant it’s difficult to strike up a conversation to decide whether they are Alert or responding to Voice; nevertheless, talk to the baby in a very calm manor but use your senses – they are never usually wrong! – Babies usually have good colour and are constantly on the move- a silent, limp, pale child is very rarely healthy; use these early visual clues.

To confirm the infant is Unresponsive we need to check their Pain response; this is done by the ‘Tap-and-tickle’ method. Tap the child’s arms, shoulders and hips as if tickling and look for a normal reaction; if you’re still unsure, run your finger-nails along the soles of the feet – the normal reaction is to move away from the response. If the child fails these basic tests you can diagnose your patient has being Unresponsive.

Airway – The delicate airway of an infant needs to be protected. If you look at an adult head it is a pea-on-a-drum; while a baby’s head is larger and has a bulbous back. When a baby is unresponsive and on its back with its shoulders on the floor the bulbous rear part can push the head into the bowing position with the chin almost of the chest and compromising the airway. With this in mind it is best practise to raise the shoulders slightly by either, putting the palm of your hand beneath the Childs shoulders and cupping your thumb and forefinger around the neck for support or, placing a folded magazine/newspaper or towel beneath the shoulders of the child and position the head in the flat neutral position.

With young children do not perform a full Head-Tilt-Chin-Lift as you would to an Adult; you can equally kink and compromise the airway by over extension; start with the ‘sniffing’ position; increase the tilt the nearer the child is to puberty and adulthood.

Once you have positioned the child correctly you need to take a look in the mouth and remove any foreign objects you may find using your thumb and forefinger as pincers.

Tip: The infant’s pallet is very delicate and has the consistency of a fine membrane. Never blind sweep the mouth for objects with your finger has you can do untold damage and penetrate the pallet.

When you know the airway is clear, leave the head in the correct position and place yourself so you can look down the Childs chest, listen at the airway for breathing and feel any breath on your cheek (Look, Listen and Feel). An infant breathes at a more rapid rate than an adult (20-40 breaths/min) and is more diaphragm orientated – they breathe from their tummy muscles. So when you look, listen and feel watch their breathing mechanism and look for 4-8 normal breaths in 10 seconds. If you have any doubts about normal breathing and the child remains unresponsive you must commence CPR immediately.

Tip: At this stage - If there are bystanders available allow them to call the emergency services but if you are alone remain with the casualty and perform CPR for 1-minute.

Start CPR by giving 5-rescue breaths; with small infants the best technique can be ‘mouth over nose and mouth’ – this is where the rescuer places their mouth over the nose and mouth of the infant to give rescue breaths. Use the usual technique of pinching the soft part of the nose and breathing through the mouth of older children.

Tip: Don’t over inflate the child’s lungs; over inflation may damage the lungs and air may spill into the casualty’s stomach causing them to vomit.

Follow the 5-rescue breaths with 30-chest compressions. Force needs to be applied to the central chest between the nipples; with infants the pressure of two-fingers may be sufficient, the pressure of one-hand to small children and adult two-handed method for children close to puberty. Nevertheless, the compression must be at least a third of the depth of the chest of all casualties under the age of puberty and at a pace of 100 to 120 compressions per minute.

Following chest compressions give two-rescue breaths.

Repeat the process of 30-chest compressions to 2-rescue breaths (30:2) for 3-repetitions; this is approximately 1-minute of CPR; if an ambulance has not yet been called it is now time to do so – it may be necessary for the rescuer to leave the casualty to make the call. For children over 1-year old a defibrillator needs to be requested. Once it is confirmed an ambulance is enroute CPR must be returned to immediately at a ratio of 30:2 and be continuous until assistance arrives and takes over the care of the casualty.

This adapted CPR is known as ‘Child/Infant CPR’ and is best care practise for all casualties under puberty who are unresponsive and not breathing normally. This practise can also be used when casualties are brought from non-oxygenated atmospheres such as drowning or toxic atmospheres. If the lay person has not been taught in these techniques then Adult CPR should be performed.

Tony Clough

Tony Clough FIRST AID TRAINING Ltd

http://www.tcfirstaidtraining.co.uk

Medical Emergencies within the Dental Practice : Hyperventilation (Panic Attack)

Tue, 13 Mar 2012 04:04:08 GMT

Medical Emergencies

within the

Dental Practice

HYPERVENTILATION

(PANIC ATTACK)

DEFINITION Breathing at an abnormally rapid rate whilst at rest.

Hyperventilation is literally “excessive breathing”. When we breath in, there is only a trace of carbon dioxide in the air. When we breath out, we breath out 4 percent carbon dioxide. Hyperventilating results in low levels of carbon dioxide in the blood, which causes the signs and symptoms of this condition.

A hyperventilation attack can often result from anxiousness, or a sudden fright. The condition of hyperventilation is often mistaken for asthma. Asthmatics may hyperventilate immediately after an inhaler has taken effect by opening the airway, however the difference between the two conditions is the large volumes of air can be heard entering the lungs during hyperventilation, compared with the tight wheeze of the asthmatic.

A panic attack can also occur at any time – it can occur when people are alone, in public, or even when they are asleep. There is often no known trigger. Panic attacks usually begin very suddenly, reach a maximum intensity after about 10 minutes and then slowly subside over the next 30 minutes.

Respiration is an important system in the maintenance of blood pH, (which is slightly alkaline with a pH of 7.4) and the levels of carbon dioxide in the body have a direct effect on this level. A decreased or low pH is called “acidosis” and a rise in pH is called “alkalosis”. If there is a reduction in carbon dioxide in the body this will cause the blood pH to rise producing an alkalosis. This begins to have an effect on the body’s metabolism and one of the first things to be affected is the drop in the available level of calcium to be used by the nervous system. If a person hyperventilates they “blow off” far too much carbon dioxide, this raises the blood pH and lowers the calcium concentration, resulting in muscle spasms and sensory disturbances such as tingling.

POSSIBLE SIGNS AND SYMPTOMS

Unnaturally deep, fast breathing

Dizziness, weakness

Feeling of a “tight” chest

Muscle spasms and cramps, (often felt as “pins and needles”) typically in the hands and feet

Sweating

Increased heart rate (tachycardia), palpitations

Loss of consciousness is uncommon, but can occur

MANAGEMENT

It is essential to reduce the rate and increase the depth of respiration. Be firm and calm, but reassuring, asking the casualty to concentrate on breathing slowly. The levels of carbon dioxide can be raised further by asking them to hold their breath for as long as possible, or by “re-breathing” their expired air as this has higher carbon dioxide levels. The simplest re-breathing method is to ask the casualty to breath in and out of their cupped hands that are placed around the mouth and nose. Another effective method is to use the non-rebreathing face mask, without turning the oxygen on, taking care not to cover the air holes with your fingers. This has the added benefit of persuading the casualty to take long, slow breaths, as they will think that they are receiving oxygen. Once the breathing rate has slowed sufficiently the mask can be removed. Another method is to use a paper bag, although they are not always available, and some authorities suggest that there is a risk of hypoxia with this method. As the carbon dioxide level rises the symptoms will disappear very quickly, especially the sensory symptoms. It is important to remember that the symptoms are very frightening and distressing for the casualty, so it is therefore essential to constantly reassure them that the symptoms will resolve soon and that nothing serious is happening. If the chest pains remain, or you are in doubt, ring for medical advice.

PREVENTION

Situations of extreme fear or stress can result in a panic attack, and hyperventilation is the main symptom. It is necessary for a healthcare professional to have an understanding of the causes and effects of panic attacks as many patients who attend for dental treatment do suffer from them. When the patient is calm it is helpful to identify the triggers.

The main management method is to use the mind’s cognitive powers to reverse the effects by recognising that no specific threat exists. This can be helped by breathing awareness and allowing the patient to lie in a semi-reclined position. The use of restful music often helps. Talking quietly and calmly to the patient may also be useful, but some people find this an irritating distraction and it is best to ask the person beforehand what method they find works the best for them. Sedation may be required to undertake dental treatment for some patients, and referral for behavioural therapy may also be beneficial.

Wendy delivers CPR, Medical Emergencies and AED training to dental practices throughout Yorkshire and Lincolnshire.

Contact details: tel: 07771590513 email: wendyberridge@hotmail.co.uk

PAFO / CPDme Competition Winners

Fri, 02 Mar 2012 03:59:19 GMT

CPDme Competition Winners

Announcing the winners of the competition on the PAFO website.

Our recent competition run in association with CPDme has come to a close and the winners are:

Christopher McGonigall - Private Sector EMT from West Sussex

and

Els Freshwater - HPC Registered Emergency Care Practitioner from Hampshire.

they both WIN A 12 MONTH MEMBERSHIP TO CPDme - Congratulations

www.pafo.co.uk

---------------------------------------------------------------------------------------------------------------------------

Editor's Note: Please visit the PAFO website (www.pafo.co.uk) for other competitions and discounts.

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Wed, 29 Feb 2012 18:27:47 GMT

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