ISSN-1059-6518
By Frank Hubbell, DO
Illustrations by T. B. R. Walsh
Unfortunately, heart attacks and premature death due to heart disease are very familiar problems, not only in the USA, but also, around the world. Very common calls for EMS and for emergency departments in hospitals, they are universal issues. Heart problems occur in all environs, from urban to rural to austere. If you have a heart, you are at risk of heart disease.
US Data from the Center for Disease Control – 2104 
Cardiovascular Disease (CVD):
CVD includes:
coronary artery disease (CAD)
hypertension (HTN),
congestive heart failure (CHF)
heart failure
dysrhythmias (irregular heart beat)
valvular disease
stroke – cerebrovascular disease (CVA)
Since 1900, CVD has been the #1 killer in the US except for 1918 (Spanish flu).
600,000 Americans die per year from heart disease.
380,000 Americans die from an Acute Myocardial Infarction – “heart attack.”
1 in 4 Americans or 25% of all deaths in US are due to CVD.
1 in 4 (80 million) Americans have some form of CVD.
Men have a higher incidence of CVD until age 65, then women have a higher incidence.
An estimated 720,000 Americans will have a heart attack in 2014.
Of that number, 515,000 people will have their first heart attack in 2014, and
205,000 people will have a recurrent heart attack.
Cardiovascular Disease Terminology:
Arteriosclerosis: A disease of the arteries with thickening, hardening, and loss of elasticity in the arterial walls.
Atherosclerosis: The most common form of arteriosclerosis, marked by cholesterol-lipid-calcium deposits in arterial linings.
Coronary Artery Disease (CAD): Narrowing of coronary arteries sufficient to prevent adequate blood supply to the heart muscle.
Angina Pectoris: Pain around the heart caused by deficiency of blood supply to the heart.
Acute Myocardial Infarction (AMI): The condition caused by partial or complete occlusion of one of the coronary arteries. Infarct refers to a blood vessel that has been occluded by a blood clot, emboli, resulting in ischemia (lack of blood flow and oxygen) to the myocardial cells distal to the infarction.
Acute Coronary Syndrome (ACS): A collection of symptoms that can indicate a possible myocardial infarction, but before a definitive diagnosis has been made. This includes angina pectoris and acute myocardial infarction.
Clinical Death: Patient without a pulse.
Biological Death: Occurs within 10 minutes of clinical death due to lack of oxygen to the brain.
Sudden Cardiac Death (SCD):
SCD occurs when the heartbeat stops abruptly and unexpectedly, unassociated with any immediate illness or injury.
Most common underlying cause of SCD is a heart attack that results in ventricular fibrillation (V-fib).
80 % of SCD occurs at home; 60% are witnessed.
Approximately 95% of SCD victims die before reaching the hospital.
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DROWNING
/in Airway, Drowning, Environemtal Injuries, Level of Consciousness/by WMN EditorsISSN-1059-6518
By Frank Hubbell, DO
Illustrations by T.B.R. Walsh
The Setting:
A small group of kayakers set off for their first run of the season down a local white water river in the early spring. There is still some snow on the banks of the river and ice covering the water in the shaded bends of the river. The water is a perfect height, class 2 – 3, and very cold.
All is going well until the lead boat goes around a bend in the river, sweeps wide, and rolls. The kayaker pops out of his boat and is immediately swept under the sheet of ice by the current. The kayaker right behind him heads straight for the sheet of ice. As the front of his boat hits the edge of the ice, he leans back, and his boat slides up onto the ice. He slides all the way to the edge of the ice at the riverbank.
Quickly exiting his boat, he begins looking though the ice for his friend. A minute or so later he can see his friend under the ice, wedged between the ice and the river bottom. By jumping up and down on the ice, he finally breaks through and is able to pull his friend out of the river, up onto the ice, and over to the riverbank.
His friend is unconscious, not breathing, but he does have a pulse. The “rescuer” gives him two quick breaths and his friend begins to cough and breathe on his own. Within two to three minutes the once ice-trapped victim is conscious, cold, and very shaken.
Worldwide:
It is estimated that approximately 400,000 people drown worldwide each year.
This makes drowning the 3rd leading cause of unintentional injury death worldwide, accounting for 7% of all injury-related deaths.
Motor vehicle accidents are the number 1 cause of unintentional injury death, and poisoning is number 2.
It needs to be noted that the global estimates significantly underestimate the actual number of deaths by drowning as few countries maintain any sort of statistics on mortality and morbidity.
(Unintentional injury death is a death that was preventable.)
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HEART DISEASE and HEART FACTS
/in Asprin, cardiac, Diabetes, Disease/by WMN EditorsISSN-1059-6518
By Frank Hubbell, DO
Illustrations by T. B. R. Walsh
Unfortunately, heart attacks and premature death due to heart disease are very familiar problems, not only in the USA, but also, around the world. Very common calls for EMS and for emergency departments in hospitals, they are universal issues. Heart problems occur in all environs, from urban to rural to austere. If you have a heart, you are at risk of heart disease.
US Data from the Center for Disease Control – 2104
Cardiovascular Disease (CVD):
CVD includes:
coronary artery disease (CAD)
hypertension (HTN),
congestive heart failure (CHF)
heart failure
dysrhythmias (irregular heart beat)
valvular disease
stroke – cerebrovascular disease (CVA)
Since 1900, CVD has been the #1 killer in the US except for 1918 (Spanish flu).
600,000 Americans die per year from heart disease.
380,000 Americans die from an Acute Myocardial Infarction – “heart attack.”
1 in 4 Americans or 25% of all deaths in US are due to CVD.
1 in 4 (80 million) Americans have some form of CVD.
Men have a higher incidence of CVD until age 65, then women have a higher incidence.
An estimated 720,000 Americans will have a heart attack in 2014.
Of that number, 515,000 people will have their first heart attack in 2014, and
205,000 people will have a recurrent heart attack.
Cardiovascular Disease Terminology:
Arteriosclerosis: A disease of the arteries with thickening, hardening, and loss of elasticity in the arterial walls.
Atherosclerosis: The most common form of arteriosclerosis, marked by cholesterol-lipid-calcium deposits in arterial linings.
Coronary Artery Disease (CAD): Narrowing of coronary arteries sufficient to prevent adequate blood supply to the heart muscle.
Angina Pectoris: Pain around the heart caused by deficiency of blood supply to the heart.
Acute Myocardial Infarction (AMI): The condition caused by partial or complete occlusion of one of the coronary arteries. Infarct refers to a blood vessel that has been occluded by a blood clot, emboli, resulting in ischemia (lack of blood flow and oxygen) to the myocardial cells distal to the infarction.
Acute Coronary Syndrome (ACS): A collection of symptoms that can indicate a possible myocardial infarction, but before a definitive diagnosis has been made. This includes angina pectoris and acute myocardial infarction.
Clinical Death: Patient without a pulse.
Biological Death: Occurs within 10 minutes of clinical death due to lack of oxygen to the brain.
Sudden Cardiac Death (SCD):
SCD occurs when the heartbeat stops abruptly and unexpectedly, unassociated with any immediate illness or injury.
Most common underlying cause of SCD is a heart attack that results in ventricular fibrillation (V-fib).
80 % of SCD occurs at home; 60% are witnessed.
Approximately 95% of SCD victims die before reaching the hospital.
Read more
CHIKUNGUNYA
/in Bites and Stings, Disease, Environemtal Injuries, Infection, Parasites/by WMN EditorsMakonde for “that which bends up”
Chikungunya is NEW to the Caribbean Islands
By Frank Hubbell, DO
Haiti: A 19-year old female presents at a rural clinic with a high fever, 104F, a fine, erythematous rash on her feet and lower legs that does not blanch with pressure, and body aches and pains, that have been quite painful for the past 4 days.
The remainder of her physical exam is normal.
Living in a rural community, she does not have screens on her windows, and she does not sleep under mosquito netting. As a result, she is commonly bitten by mosquitos.
Recently, there has been an outbreak of both dengue and chikungunya in the area.
CHIKUNGUNYA
A single-stranded RNA virus of the Genus Alphavirus, Family Togaviridae,
the virus targets the cells that make up blood vessels. It is the destruction of these cells that causes the bleeding into the skin and the non-blanching hemorrhagic rash, thus the name hemorrhagic fever.
The reservoir in nature is primarily humans.
The vector that spreads the virus from infected human to human is the Aedes mosquito; A. aegypti and A. albopictus.
The Aedes mosquito can also spread:
Dengue – infects blood vessels- hemorrhagic
Eastern Equine Encephalitis – infects the brain- encephalopatic
West Nile Virus – infects the brain- encephalopatic
Yellow Fever Virus – infects blood vessels- a lethal hemorrhagic illness
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THE ACUTE ABDOMEN
/in Abdominal, Constipation, Diarrhea, Digestive problems, Nausea/by WMN EditorsISSN-1059-6518
Volume 27 Number 1
The Acute Abdomen—a Rapid Review:
By Frank Hubbell, DO
Abdominal pain can be one of the most difficult disorders to pin down and make an accurate diagnosis. We have done extensive articles in the past regarding the acute abdomen, but we felt it was time to do a condensed review of the topic.
There are approximately 2000 medical conditions that can cause abdominal pain. The intention of this article is to do a quick review of a systematic way to enable you to sort out the myriad of problems that can cause an acute abdomen, how to determine the severity of the problem, and finally, how to treat the problem.
SUMMARY OF ACUTE ABOMINAL PAIN
Etiologies of Abdominal Pain:
What are the various underlying causes of abdominal pain?
Constipation – by far the most common cause of abdominal pain and discomfort
Food Poisoning – also very common, associated with vomiting and diarrhea
Infection – peritonitis from an acute appendicitis or cholecystitis (infected gallbladder)
Bleeding or Perforations – a bleeding ulcer or diverticulitis
Ruptures – acute aortic aneurysm, ruptured appendix, or gallbladder
Obstructions – gallstones, kidney stones, or intestinal blockage
Gynecological – menstrual cramps or ectopic pregnancy
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