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FROM ABC TO CAB: BIG CHANGE IN CPR

In October, 2010, the American Heart Association released updated guidelines to mark the 50th anniversary of modern cardiopulmonary resuscitation (CPR). Anyone can help to save a life by attempting CPR when a person does not have a heartbeat or is not breathing. The American Heart Association recommended in the past that rescuers follow the ABC method – airway (open it); breathing (mouth-to-mouth); compressions (chest wall compressions).

The newly revised guidelines replace ABC with CAB.

First: Ensure that someone calls 911. Try to get the person to respond. If no response, roll him/her onto the back (if not already in that position).

Second: Begin CPR

C: Chest compressions: 100 per minute. Push hard enough to compress the sternum about 2 inches in adults and children, and 1-1/2 inches in infants.

A: Airway: Tilt the head back and lift the chin.

B: Breathing/ventilations: Pinch the nose shut, cover the victim’s mouth with yours to create an airtight seal, and give two breaths lasting about one second each. Breathe deeply enough to see the chest rise.

RATE: 30 compressions to 2 ventilations

When done correctly, a single rescuer can only do an efficient job for about two minutes. Switch rescuers every two minutes until professional medical assistance arrives. If a rescuer cannot perform or is unwilling to perform mouth-to-mouth breathing, doing chest compressions alone may save a person’s life.

Note: This information is not intended to cover all instances where CPR is needed. Factors such as number of rescuers, whether an event is witnessed or not, mechanism of injury, length of time victim is unresponsive, availability of defibrillator, and speed of professional medical response may affect the methodology. Please refer to the following sites for detailed information:

WebMD: New CPR Guidelines: Chest Compressions First:
www.webmd.com/news/20101015/new-cpr-guidelines-chest-compressions-first

American Heart Association: 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care:
www.heart.org/HEARTORG/CPRAndECC/Science/Guidelines/Guidelines_UCM_303151_SubHomePage.jsp

Check with your local Red Cross or hospitals for CPR training.


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Can Cows Get Rabies?

Any mammal can get rabies. In the United States, cats, cattle, and dogs are the most commonly reported rabid domesticated animals. The most common wild animals that get rabies are raccoons, skunks, bats, foxes, and coyotes.

Rabies is passed in the saliva of an infected animal, usually when the animal bites another animal or a person. Rabies is caused by a virus that travels along the nerves from the site of the bite to the brain, and then into the salivary glands. With late treatment or no treatment, rabies is almost universally fatal to animals and humans.

Vaccinating pets such as dogs and cats is vital for both the animal’s health and the owner’s health. A dog that gets into a fight with a rabid raccoon or skunk is covered with that animal’s saliva. Unvaccinated dogs with such exposure are often euthanized or kept in quarantine for six months. Even vaccinated pets are watched closely for 45 days.

The International Society of Infectious Diseases reported ten different animal/human contacts with rabies in the US during September 2010, including:

* In Minnesota a rabid dog (one of 41 rabid animals found in just nine months including three cows) was euthanized, and eight people who had contact with the dog had to get rabies shots.

* In Georgia, a college student picked up a sick bat crawling on a sidewalk. The bat tested positive for rabies and the student had to be treated.

* A dog in North Carolina carried a dead raccoon home that tested positive for rabies. The dog had never been vaccinated and the county health authorities euthanized it.

* A cat in Texas brought home a dead bat that tested positive for rabies. The cat had been vaccinated.

Anyone who has contact with an animal proven to have rabies must be treated. Today’s treatment for rabies exposure starts with a dose of human rabies immune globulin injected into the bite site, followed by four doses of rabies vaccine injected into the upper arm.

Be sure to tell children to stay away from stray animals, and to never touch a sick animal, such as a bat or raccoon. Report wild animals that with unusual behavior the health department; for example, nocturnal animals out during the day, or shy animals such as foxes showing aggression. Make certain your own animals are up-to-date with their rabies vaccinations. And most importantly, immediately wash any animal bite thoroughly with soap and water, and seek medical care without delay. Rabies can be prevented if treated in time.

For more information: www.cdc.gov/rabies/  Read More 
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Flu News

On June 11, 2009, Dr. Margaret Chan, Director General of the World Health Organization put the world on high alert because of Swine Flu. She announced that we were experiencing a global pandemic of a new strain of flu. On October 24, 2009, President O’Bama declared Swine Flu a national emergency because the rapid increase in flu-related illnesses threatened to overwhelm the nation’s healthcare resources.

Fast forward to August 10, 2010 when Dr. Chan announced the world has exited the pandemic flu stage and entered what is called the post-peak phase, i.e., “Disease levels in most countries have dropped below peak levels. The post-peak period signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.”

In this phase, the new pandemic flu takes on characteristics of seasonal flu. In fact, H1N1 Swine Flu is one of the three components of the 2010/2011 flu vaccine. Other components are H3N2 – the most widely circulating flu in recent years, and a type B flu. This year’s flu vaccine should be available in health clinics and physician offices in October.

Did the world and the United States overreact to Swine Flu? I don’t think so. I’ve written widely about flu, including articles for nurses, and two juvenile school and library books (Lerner: 2011: USA Today Health Reports: Influenza, and 2007, Influenza). The most deadly epidemic in human history was not the plague, smallpox, or HIV. It was the 1918/19 Spanish Flu pandemic that killed untold millions of people in 18 months.

Scientists discovered that H1N1 Swine Flu was composed of viral RNA from four influenza viruses. To this day, no one is sure how these four viruses came together. But young people had little resistance. The vaccine was delayed for many months. No one could foresee that we lucked out this time and that H1N1 Swine Flu would turn out to be much more benign that first predicted.

For the 2010-2011 flu season, the CDC recommends that all individuals six months and older should be vaccinated. See the recommendations at: www.cdc.gov/flu/professionals/acip/primarychanges.htm. In general, the only exceptions are those allergic to eggs or to the thimerosol used in multi-dose vials. Single-dose vials are available for those with thimerosol allergies.  Read More 
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WHOOPING COUGH UPDATE

California is in the midst of an outbreak of whooping cough unlike any in the past half-century. Cases in 2010 increased 500% from 2009. Other states with significant increases in whooping cough include Texas, Ohio, Michigan, and Arizona.

According to the CDC, an estimated 13,000 people get whooping cough (pertussis) each year. The disease is on the rise, especially among infants under six months old who are not yet fully immunized, and among adolescents whose immunity may have waned since childhood. Pertussis is caused by the bacteria Bordetella pertussis. Vaccinations prevent whooping cough, but immunity fades over time.

Pertussis is very contagious. Its symptoms are similar to those of a cold at the beginning of the illness. In a week or two, however, severe coughing begins. The coughing is violent, prolonged, and may cause a whooping sound on inhalation. Because pertussis is a bacterial disease, it responds well to antibiotics.

In the past ten years doctors have developed Tdap – a booster vaccine for adults that protects against tetanus, diphtheria, and pertussis. Tdap is recommended for adults and pregnant women, and is often given to families and caregivers of newborns. Everyone needs a tetanus booster every ten years. When it’s time for your next tetanus booster, ask your doctor if Tdap is right for you. For more information, check the CDC website at: http://www.cdc.gov/Features/Pertussis/. You can also click on a link to hear the whooping sounds of patients with pertussis.
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Food Allergies in Children

About three million children in the United States suffer from food allergies. According to the CDC, the prevalence of childhood food allergies increased by 18% in the past ten years. Between 6% to 8% of children under age four have documented food allergies.

Just eight foods account for 90% of childhood food allergies: milk, eggs, wheat, soy, fish, shellfish, peanuts, and tree nuts (i.e. almonds, walnuts) Less commonly, fruits and vegetables including citrus fruits, strawberries, and tomatoes may cause mild allergic reactions, while seeds such as sesame seeds may cause more serious reactions.

Symptoms of a food allergy reaction can be sudden and severe and may include one or more of the following:

• Hives, eczema, rash
• tingling and/or swelling in the tongue and throat
• difficulty breathing, coughing, wheezing
• abdominal cramps; may involve vomiting or diarrhea
• loss of consciousness
• dizziness

Fortunately, most children outgrow allergies to soy, milk, wheat, and eggs, sometimes in just a few months. Allergies to fish and shellfish, peanuts and tree nuts, are likely to persist into adulthood.

Every child with food allergies needs an action plan. See a sample plan at: www.foodallergy.org/downloads/FAAP.pdf. It includes a list of symptoms, tells when to give medications, lists emergency contacts, and contains directions for epinephrine injections. The plan, signed by the child’s physician, should be displayed at home, and kept on file with daycare providers and schools. Family members and older children should learn how to use epinephrine autoinjectors.

For my complete article on this topic written for nurses, go to the Nursing Spectrum/ Nurse Week site at: http://ce.nurse.com/CE555/Food-Allergies-More-Common-Than-Ever-Among-Children/
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A Killer Tan

The other day on television, the hostess was admiring a model’s “killer tan,” saying how good she looked in a bright pink sundress.

Killer tan is an expression that means exactly what it says, tans can kill. More than one million Americans each year are diagnosed with skin cancer. If they’re lucky, it’s “only” basal cell carcinoma or squamous cell carcinoma – potentially disfiguring but seldom fatal. But melanoma – the most deadly form of skin cancer – can and does kill.

While melanoma is not as common as – say breast, lung, or prostate cancer – the incidence of melanoma has been steadily increasing for the past thirty years. In contrast, many forms of cancer have been declining. In fact, melanoma is now the second most common cancer among teens and young adults between 15 and 29 years old. Melanoma is not an equal opportunity cancer. It is largely a disease of light skinned people, although it can strike people of all skin colors. The risk of getting melanoma is 1 in 50 for whites, 1 in 200 for Hispanics, and 1 in 1,000 for African Americans.

Cancer is largely a disease of damaged DNA. In the case of skin cancer, ultraviolet radiation damages the DNA within cells. When DNA is so damaged that it cannot repair itself, or it cannot commit cellular suicide (a process called apoptosis), the mutated cells live on to split and pass their mutations to the next generation. Having even one blistering sunburn as a child or adolescent increases the risk for melanoma.

But sun is not the only source of radiation. Many young people turn to tanning beds for their killer tans. Some in the tanning industry deny that ultraviolet radiation from tanning beds is harmful. Yet last year, the World Health Organization’s International Agency for Research on Cancer moved tanning beds to Group 1 – carcinogenic to humans. Also in this highest-risk category are arsenic, asbestos, cigarettes, mustard gas, and plutonium!

Tanned skin is damaged skin. While UV radiation is not the only cause of melanoma, it is the only cause that is completely preventable. So take care of yourself and the young people in your charge by following this advice: Slip-slop-slap . . . and wrap. Slip into a long-sleeved shirt. Slop on the sunscreen every two hours. Slap on a wide-brimmed hat. And wrap UV-blocking sunglasses around your face.

For more information: American Academy of Dermatology, www.aad.org; American Cancer Society, www.cancer.org; American Melanoma Foundation at www.melanomafoundation.org; the CDC at www.cdc.gove/cancer/skin; and the Skin Cancer Foundation, at www.skincancer.org.
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