Hands-Only CPR, AED Save St. Louis Blues’ Bouwmeester In ‘Cardiac Episode’

Teammates, trainers and medical staff saved the life of St. Louis Blues defenseman Jay Bouwmeester Tuesday night after he became unresponsive on the bench after returning from the ice.

The team described the event as a “cardiac episode”, or abnormal heartbeat in a news release days ago.
But one thing is crystal clear: credit team work, a super fast response, “hands-only” CPR, and the use of an AED, or automated external defibrillator, to saving his life.
What’s also clear is that the NHL’s requirement that teams have an AED near the bench and medical personnel close by was also lifesaving.
In dramatic video posted online after Bouwmeester collapsed on the bench, hands-only CPR was rapidly begun, along with application of an AED to his chest delivering electricity to shock his heart into a normal rhythm.

Bouwmeester was transported to the hospital where he is reportedly doing well at this time.
After the players returned to their locker rooms, the game was postponed for obvious reasons.

Bouwmeester, 36, has a reputation for being in top physical condition and was a major force in the Blues’ first Stanley Cup championship last spring.
“While sudden cardiac events in athletes are uncommon, the outcome may be disastrous, said Bert Mandelbaum, M.D., Co-Chair of Medical Affairs, Cedars Sinai Kerlan-Jobe Institute, Co-Director of Sports Medicine, Cedars Sinai Department of Orthopedic Surgery, Associate Chief Medical Officer, Major League Soccer, Chief Medical Officer, LA Galaxy, and Team Physician, U.S. Soccer. “Prevention, preparation and preparedness are the key features that helped to prevent a sudden cardiac death in this situation. The whole medical team should be congratulated on the implementation of the state-of-the-art protocol in saving lives.”
The Value of an AED and Hands-Only CPR
Cardiac arrhythmias or abnormal heartbeats can strike suddenly. Ventricular tachycardia and ventricular fibrillation are the 2 major cardiac arrhythmias that can be deadly if not treated immediately.
Time to defibrillation (shocking the heart) is critical because of the immediate need to restore blood flow to the brain. After 3-5 minutes without adequate blood flow, brain cells become deprived of oxygen, leading to irreversible cell death. This results in a condition known as anoxic brain injury, which depends on the duration of oxygen deprivation. This results in not only global cognitive deficits, but paralysis and muscle weakness.
But also critical to Bouwmeester’s “save” was the immediate initiation of “hands-only” CPR, not requiring mouth-to-mouth breathing. The American Heart Association (AHA) endorses “hands-only” CPR as first line in any victim of cardiac arrest. In fact, since 2012, the Hands-Only Mobile Tour is responsible for training over 84,000 persons in 22 states. The use of training kiosks has also been instrumental in their nationwide effort.
There are more than 356,oo out-of-hospital cardiac arrests (OHCA) annually in the U.S, of which over 90% are fatal, according to 2018 data from the AHA. Learning to perform hands-only CPR, along with the use of an AED can make the difference between life and death.
“Sudden Cardiac Arrest is the leading cause of death for student athletes,”said Holly S. Andersen, M.D., Attending Cardiologist at New York Presbyterian Hospital, Director of Education and Outreach, Ronald O. Perelman Heart Institute. “The difference between life and death is knowing what to do. Everyone should know how to save a life with hands-only CPR. It is not ok to wait for the defibrillator—every minute without CPR, the chance of survival decreases by 10 %.”
“70 % of cardiac arrests happen in the home so if you are going to do it, you’re likely going to do it on someone you love,” adds Andersen.
https://www.forbes.com/sites/robertglatter/2020/02/13/hands-only-cpr-and-aed-save-st-louis-blues-defenseman-jay-bouwmeester-after-cardiac-episode/#5a2e791a16c9

Sepsis hospitalizations cost Medicare $41.8B in 2018 and number likely to grow

Sepsis hospitalizations cost Medicare $41.8 billion in 2018 alone, a new study from the Department of Health and Human Services shows.
The rate of Medicare beneficiaries hospitalized with sepsis has increased by 40% over the past seven years, the HHS study found. The researchers analyzed more than 9.5 million inpatient admissions between 2012 and 2018, making for one of the largest ever studies into the impact of sepsis.
The growing sepsis infection rates isn’t related to ballooning Medicare enrollment, the study says, as enrollment grew by 22% even as infection rates grew by 40%.

“Sepsis is a lethal and costly health threat affecting Americans’ lives and our economy, yet many Americans may never have heard of it,” Robert Kadlec, M.D., HHS assistant secretary for preparedness and response, said in a statement.
“Any infection can lead to sepsis, including infections caused by influenza or emerging diseases like coronaviruses, which makes sepsis a significant concern in public health emergencies,” Kadlec said.

A study released last month by the University of Pittsburgh estimates that sepsis is responsible for one in every five deaths worldwide, double previous projections. And while high-income countries have plenty of work to do to address sepsis rates, middle- and low-income countries disproportionately bear the burden of the disease, the Pitt study found.
HHS’ analysis dug into sepsis’ impact on outcomes for Medicare beneficiaries and found that 10% of those with non-severe sepsis died while hospitalized or within a week of discharge, and 60% died within three years of contracting the infection.
Of those diagnosed with severe sepsis, or septic shock, 40% died in the hospital or within a week of discharge, and 75% died within three years, according to the study.
Mortality risks were highest among beneficiaries with comorbid chronic conditions, HHS said.
Medicare patients were more likely to arrive at the hospital with the infection, rather than contracting it while hospitalized, the study found. However, two-thirds had a medical encounter in the week before their hospitalization, emphasizing the need for earlier detection.

The study suggests the cost burden of sepsis isn’t likely to decrease any time soon. HHS projects that in 2019 the cost for inpatient and skilled nursing care related to sepsis could exceed $69 billion.
Costs increased by 12% to 14% every two years, the study found.
Centers for Medicare & Medicaid Services Administrator Seema Verma said in a statement that the study highlights the “urgent need” for continued action to mitigate sepsis, and said the agency is moving full speed ahead with efforts to eliminate regulatory hurdles that can inhibit access to lifesaving drugs.
“This groundbreaking study sheds light on the sepsis-related challenges faced by patients, providers, and taxpayers alike,” Verma said.
“CMS continues to clear away regulatory obstacles and financial disincentives that have long inhibited the development of life-saving antibiotics capable of treating sepsis patients,” she added. “Patients suffering from sepsis deserve to see America’s full innovative potential mobilized to address this devastating condition.”
https://www.fiercehealthcare.com/hospitals-health-systems/sepsis-hospitalizations-cost-medicare-41-8b-2018-number-s-likely-to-grow

Good blood supply is good for memory

Memory performance and other cognitive abilities benefit from a good blood supply to the brain. This applies in particular to people affected by a condition known as “sporadic cerebral small vessel disease.” Researchers of the German Center for Neurodegenerative Diseases (DZNE) and the University Medicine Magdeburg report on this in the journal Brain. Their study suggests that blood perfusion of the so-called hippocampus could play a key role in age- and disease-related memory problems.

Inside the human brain there is a small structure, just a few cubic centimeters in size, which is called the “hippocampus” because its shape resembles a seahorse. Strictly speaking, the hippocampus exists twice: once in each brain hemisphere. It is considered the control center of memory. Damage to the hippocampus, such as it occurs in Alzheimer’s and other brain diseases, is known to impair memory. But what role does blood supply in particular play?
A team of scientists headed by Prof. Stefanie Schreiber and Prof. Emrah Duezel, both affiliated to the DZNE and the University Medicine Magdeburg, investigated this question. The researchers used high-resolution magnetic resonance imaging (MRI) to examine the blood supply to the hippocampus of 47 women and men aged 45 to 89 years. The study participants also underwent a neuropsychological test battery, which assessed, in particular, memory performance, speech comprehension and the abilty to concentrate.
A double supply line
“It has been known for some time that the hippocampus is supplied by either one or two arteries. It also happens that only one of the two hippocampi, which occur in every brain, is supplied by two vessels. This varies between individuals. The reasons are unknown,” explained Schreiber. “Maybe there is a genetic predisposition. However, it is also possible that the individual structure of the blood supply develops due to life circumstances. Then the personal lifestyle would influence the blood supply to the hippocampus.” In the cognition tests, those study participants in whom at least one hippocampus was doubly supplied generally scored better. “The fact that the blood supply is fundamentally important for the brain is certainly trivial and has been extensively documented. We were therefore particularly focused on the hippocampus and the situation of a disease of the brain vessels. Little is actually known about this.”
Patients benefited in particular
Of the study subjects, 27 did not manifest signs of brain diseases. The remaining twenty participants showed pathological alterations in brain blood vessels, which were associated with microbleeding. “In these individuals, sporadic cerebral small vessel disease had been diagnosed prior to our investigations,” said Dr. Valentina Perosa, lead author of the current study, who is currently doing postdoctoral research in Boston, USA. These individuals exhibited a broad spectrum of neurological anomalies, including mild cognitive impairment. “The healthy subjects generally scored better on cognitive tests than the study participants with small vessel disease. Among the participants with disease, those with at least one hippocampus supplied by two arteries reached better scores in cognition. They particularly benefited from the double supply. This may be due to a better supply not only of blood but also of oxygen. However, this is just a guess,” said Perosa.
Starting point for therapies?
“Our study shows a clear link between blood supply to the hippocampus and cognitive performance,” Schreiber summarised the results. “This suggests that brain blood flow might play a key role in the declining of memory performance, whether caused by age or disease.” Such findings help to understand disease mechanisms and can also be useful for the development of novel treatment options, she indicates: “At present we can only speculate, because we don’t know, but it is possible that lifestyle has an influence on the formation of the blood vessels that supply the hippocampus. This would then be a factor that can be influenced and thus a potential approach for therapies and also for prevention. This is a topic we intend to investigate.”

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More information: Valentina Perosa et al, Hippocampal vascular reserve associated with cognitive performance and hippocampal volume, Brain (2019). DOI: 10.1093/brain/awz383

https://medicalxpress.com/news/2020-02-good-blood-memory.html

China cleans, locks away banknotes to stop virus spread

China is disinfecting and isolating used banknotes as part of efforts to stop the spread of the new coronavirus that has killed more than 1,500 people, officials said Saturday.

Banks use ultraviolet light or high temperatures to disinfect yuan bills, then seal and store the cash for seven to 14 days—depending on the severity of the outbreak in a particular region—before recirculating them, China’s central bank said at a press conference.
The virus, which has infected more than 66,000 people in China and spread to more than two dozen other countries, has sparked a rush to disinfect public places and minimise contact between people.
Pharmacies across the country sold out of disinfectants and surgical masks in just days after a lockdown was announced in late January on Wuhan city, where the COVID-19 illness is believed to have emerged.
Office buildings have installed packets of tissue in elevators that tenants are encouraged to use when pressing buttons, while ride-hailing company Didi exhorts drivers to disinfect their cars daily.
‘Emergency issuance’
Fan Yifei, deputy governor of China’s central bank, said Saturday that banks have been urged to provide new banknotes to customers whenever possible.

The central bank made an “emergency issuance” of four billion yuan in new notes to Hubei province, the epicentre of the outbreak, prior to the recent Lunar New Year holiday, Fan added.
The measures are intended to “secure the public’s safety and health when using cash”, Fan said.
But it is unclear how wide an impact the central bank‘s disinfection work will have, with increasing numbers of Chinese people preferring mobile payments over cash in recent years.
In 2017, nearly three quarters of Chinese respondents told an Ipsos survey they could survive a whole month without using more than 100 yuan in cash.
According to the World Health Organization, COVID-19 can be spread through contaminated objects in addition to droplets and direct contact with infected patients.
https://medicalxpress.com/news/2020-02-china-banknotes-virus.html

Egypt confirms first coronavirus case in Africa

Egypt’s health ministry on Friday announced the first confirmed case of the novel coronavirus in Africa.
The sufferer was not Egyptian, the ministry said in a statement, without specifying the nationality.
“The ministry has taken preventative measures and is monitoring the patient… who is stable,” said health ministry spokesman Khaled Megahed.
Egyptian authorities had notified the World Health Organization and the patient been placed in quarantined isolation in hospital.
The death toll from the epidemic virus has neared 1,400 cases, almost exclusively in China where it was first identified.
Deep trade links with China and often overstretched healthcare systems have raised concerns about the capacity of African countries to respond to an outbreak.
Earlier this month, Egypt suspended all flights on its national carrier to China. They will remain grounded until the end of the month.
Three hundred and one Egyptians were evacuated from Wuhan, epicentre of the virus in China, and have remained in quarantine for 14 days.
https://medicalxpress.com/news/2020-02-egypt-coronavirus-case-africa.html

China’s Xi urges more policing as virus toll rises

Chinese President Xi Jinping has called for tightened control over online discussion and increased policing to ensure “positive energy” and social stability, state media said Saturday, as the country struggles to contain the deadly new coronavirus.
Xi’s remarks were made public as the authorities have faced rare bouts of public anger over the handling of an epidemic that has killed more than 1,500 people and infected some 66,000 across the country.
Censors had allowed some online criticism of local officials in central Hubei — the epicentre and origin of the crisis — but calls for freedom of speech and political reform were scrubbed after the death of a whistleblowing doctor from the virus.
The government must “strengthen the management and control of online media,” and “crack down on those who seize the opportunity to create rumours” on the internet, Xi said in the February 3 speech published by state media.
Simultaneously, “it is necessary to increase use of police force and strengthen the visible use of police,” Xi said, calling for a crackdown on behaviour that “disrupts social order” including hoarding medical supplies.
Xi urged party members to “dare to criticise” those who had failed to carry out the Communist Party central committee’s instructions, and warned “those who fail to perform their duties shall be punished according to discipline and law.”
Local officials in Hubei have already begun to feel the force of Xi’s orders.
On Thursday, the political chiefs of Hubei and its capital, Wuhan, were sacked and replaced by Xi loyalists with security backgrounds.
The province’s top two health officials have also been fired.
Xi also called for the government to emphasize effective actions it has taken and “vividly describe touching deeds” from the frontlines of the fight against the virus.
“Let positive energy fill the cyberspace from start to end,” Xi said in the speech, given earlier this month at a meeting of the Politburo Standing Committee, China’s ruling council.
Xi initially kept a low profile in the early weeks of the crisis but has stepped up his public rhetoric in recent days on what he has called a “people’s war” against the virus.
https://news.yahoo.com/chinas-xi-urges-more-policing-virus-toll-rises-115750208.html

Hundreds march in Hong Kong against potential coronavirus quarantine clinics

Hundreds of anti-government protesters marched in multiple Hong Kong neighborhoods on Saturday against government plans to potentially turn some buildings into coronavirus quarantine centers, demanding full closure of the mainland China border.

The protests – which escalated in June over a perceived tightening of Beijing’s grip over the city, which Beijing denies – have lost their intensity in recent weeks as panic over the virus kept most people indoors.
But anger has been brewing over Chief Executive Carrie Lam’s refusal to completely shut the border with mainland China, where the new fast-spreading coronavirus is believed to have originated, with some medical staff going on strike and small-scale protests emerging in various locations in support.
On Saturday, hundreds rallied in the northern neighborhoods of Tai Po and Tin Shui Wai as well as in Aberdeen on the Hong Kong island, chanting “Liberate Hong Kong, Revolution of our times” and “Oppose pneumonia clinic”. Most protesters wore surgical masks and many were dressed in all black.
Some buildings in those neighborhoods had been designated as potential quarantine sites.
“The government didn’t listen to public demands of a complete border closure, and now they want to set up epidemic clinics in 18 districts. Doing that is like creating more wounds rather than trying to stop the bleeding,” Tin Shui Wai resident Chan Mei-lin said.
Television footage showed police in riot gear making several arrests and using pepper spray in Tin Shui Wai.
Three weeks ago, a group of protesters set alight the lobby of a newly built residential building in Hong Kong that authorities had planned to use as a quarantine facility, prompting the government to abandon the plan.
The government has closed most border points with China and has made quarantine compulsory for anyone coming into the city if they had been in mainland China over the past 14 days.
But Lam has said a full closure was “inappropriate”, “impractical” and “discriminatory”.
Over 1,500 people in mainland China have died from the flu-like virus, which can be transmitted from person to person, while more than 66,000 have so far been infected. In Hong Kong, there have been 56 confirmed cases and one death.
https://www.reuters.com/article/us-china-health-hongkong-protests/hundreds-march-in-hong-kong-against-potential-coronavirus-quarantine-clinics-idUSKBN20908G