Ann Acad Med Singap
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Sudden cardiac death claims 1,000 lives per day in the United States and cardiovascular disease remains the number one cause of death in the United States. Morbidity and mortality will be reduced when a coordinated response to out-of-hospital cardiac arrest has been achieved nationwide. The implementation of an integrated system, the chain of survival which includes early access via a universal Emergency Medical Service (EMS) number, trained individuals to provide Cardiopulmonary Resuscitation (CPR), widespread early defibrillation and utilisation of automated external defibrillators, and early advanced care will yield survival rates in excess of 30%. The potential for saving 100,000-200,000 lives per year is achievable provided the chain of survival concept is adapted.
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This study reviews the records of all cardiac life support training courses conducted at the Ministry of Health's Life Support Training Centre situated in Singapore General Hospital over a six period from 1985 to 1990. A total of 1,789 persons were trained in Basic Life Support (BCLS), 65 as BCLS Instructors, 267 in Advanced Cardiac Life Support (ACLS), 276 in Emergency Cardiac Care (ECC) and 24 in Emergency Cardiac Defibrillation (ECD). These courses have involved a total of 1111 doctors, 1248 nurses and 62 ancillary staff. ⋯ The ECD programme trained emergency ambulance nurses in the use of semi-automatic electrical defibrillators. The marked increased in yearning for cardiac life support skills amongst medical and nursing staff has been a major factor in the proliferation of life support training programmes at the Centre. Nurturing this enthusiasm is the key to ensuring that the programmes continue to expand for the benefit of both inpatients and the out-of-hospital lay public.
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Ann Acad Med Singap · Jan 1992
Transient hypoalgesia under physical exercise--relation to silent ischaemia and implications for cardiac rehabilitation.
A series of studies with humans as well as experiments carried out on animals could show that physical exercise leads to temporary hypoalgesia. Reduced sensitivity to pain is not only demonstrable after long-distance exercise (such as marathon run) but also after intensive physical exercise on a laboratory ergometer. Pain threshold elevation is most pronounced during maximal exertion, but hypoalgesia remains present also after exercise is stopped demonstrating that a systemic analgetic effect is induced by the exercise process. ⋯ Stress-induced hypoalgesia plays also a role in the coronary heart disease. The activation of endogenous analgetic mechanisms leads to a part of the myocardial ischaemia provoked by exercise being silent under exercise. Completely asymptomatic myocardial ischaemia patients display a generalized hypoalgesia which is demonstrable independent of an exertion stimulus and which indicates a central set-point change in the antinociceptive system.