The Silent Killer - Debunking the Myths

Have you ever heard a story that sounded somewhat like this? --

"He/ she was quite well, wasn't even sick or anything only for him/her to just slump and that was the end".


Recently, I heard one of such stories about a mother of three, who seemed apparently well, then she just "fainted" and never woke up. It was later revealed she died of complications of poorly managed hypertension. Hypertension has gained notoriety in some circles as ‘’the silent killer”.


Now, this is not to say that every case of sudden death, is as a result of hypertension, but to point out that hypertension is a serious condition and can be deadly if not diagnosed and treated properly.


Blood pressure is measured with an instrument called sphygmomanometer. Blood pressure is typically recorded as two numbers, written as a ratio like this: 120/80mmHg


Let's explore what this means:

Systolic blood pressure -

The top number, which is also the higher of the two numbers, (in most cases) measures the pressure in the arteries (the blood vessels that carry blood from the heart to other parts of the body) when the heart beats (when the heart muscle contracts).

 Diastolic blood pressure -

The bottom number, which is also usually the lower of the two numbers, measures the pressure in the arteries between heartbeats (when the heart muscle is resting between beats and refilling with blood).


Hypertension, also called HIGH BLOOD PRESSURE, is a sustained elevation of systemic arterial blood pressure to a level likely to induce cardiovascular damage or other adverse consequences.  Hypertension has been defined as a systolic blood pressure (the top number) above 140mmHg or a diastolic blood pressure (the bottom number) above 90mmHg.

A single high reading does not necessarily mean that you have high blood pressure. However, it is possible for blood pressure to rise quickly and severely enough to be considered a hypertensive crisis. A hypertensive crisis may be an hypertensive urgency or emergency.

If while monitoring your blood pressure yourself you get a reading of 180 or higher on top or 110 or higher on the bottom, and are having any of these symptoms: chest pain, shortness of breath, back pain, numbness / weakness, change in vision, difficulty speaking) do not wait to see if your pressure comes down on its own. Seek emergency medical assistance immediately..

So, let's separate fact from fiction.

Myth #1 - Hypertension is caused by taking too much salt, so if I control my salt intake I can’t become hypertensive.

Fact - The majority (80-90%) of patients with hypertension have essential hypertension, ( also known as primary hypertension ) which can be ameliorated only by life-long pharmacological therapy.  With essential hypertension, the exact cause of hypertension is unknown.  However, it has been associated with multiple risk factors which include.

•  Fetal factors: Low birth weight is associated with subsequent high blood pressure.
• Obesity:  Fat people have higher blood pressures than thin people. There is a risk, however, of overestimation if the blood pressure is measured with a small cuff.
• Genetic factors:  High blood pressure tends to run in families and children of hypertensive parents tend to have higher blood pressure than age-matched children of people with normal blood pressure..
  
  
• Alcohol intake: Most studies have shown a close relationship between the consumption of alcohol and blood pressure level.

• Sodium intake: A high sodium intake has been suggested to be a major determinant of blood pressure differences between and within populations around the world. Populations with higher sodium intake have higher average blood pressures than those with lower sodium intake.
  
  Studies of the restriction of salt intake have shown a beneficial effect on blood pressure in hypertensives. In some people, sodium can increase blood pressure. But controlling sodium means more than just staying away from table/cooking salt.There is some evidence that a high-potassium diet can protect against the effects of a high sodium intake.

• Insulin resistance: An association between diabetes and hypertension has long been recognized and a syndrome has been described of hyperinsulinaemia (high levels of insulin in the blood), glucose intolerance, reduced levels of HDL cholesterol, hypertriglyceridaemia and central obesity (all of which are related to insulin resistance) in association with hypertension. This association (also called the 'metabolic syndrome') is a major risk factor for cardiovascular disease.Stress: Whilst acute pain or stress can raise blood pressure, the relationship between chronic stress and blood pressure is uncertain.

Myth #2 - Every time I go to the doctor, my blood pressure is high, but that’s just because I’m nervous. I’m sure my blood pressure is OK at home.


Fact - Some people may experience what’s called “white-coat hypertension”, that is, a temporary rise in their blood pressure when they’re at the doctor’s office. Even though there are factors that can affect your blood pressure, you should never ignore several readings that indicate you may have high blood pressure.


Myth #3- If you have high cholesterol, you automatically have high blood pressure.


Fact - High blood cholesterol doesn’t automatically lead to high blood pressure, but many of the same lifestyle habits that may increase blood cholesterol levels also may cause elevated blood pressure. Try and cut down on oils and fried foods intake.

Myth #4 - These days everyone has high blood pressure. It’s just a fact of life, and I don’t need to worry about it.


Fact- These are stressful times, and stress may add to your risk factors for high blood pressure. That’s why it’s so important to have your blood pressure checked. Also, high blood pressure is the No. 1 modifiable(controllable)  risk factor for stroke, and they say, prevention is better than cure.

Stay connected for more myths and facts on hypertension.

Are you an adult? When last did you check your blood pressure? Please get it done today!!!

by Dr Olutomiwa Ogunbona.
Nigerian Flying Doctor 

Flying Doctors Host Workshop for Industry Safety Leaders

On the 14th of May, 2015, the FDN (De Flight Medics Ltd) team hosted a workshop for 60 company doctors, HSE professionals and safety leaders to discuss 'Emergency Medicine For Industry in Africa'


We have realized that there are very specific and unique challenges faced by industry in Africa, particularly in remote areas. These will be addressed in our white paper due for publication in the next few days. We will focus on the work of flying doctors and medevac medics in Africa.

Why is work in Africa different?

There are many factors that make working in industry in Africa unique due to it's remoteness and topographical challenges, some of these are listed below.

1. Emergency Services:  Many of the public emergency services such as fire fighting service, police, coast guard and ambulances may not work as effectively in Africa as they do in developed countries. Therefore many companies must make private provisions for these normally public services

2. Infectious Disease: The prevalence of infectious disease is higher in Africa than in many other countries. Therefore specific protocols must be developed by companies to mitigate against the effect of infectious diseases.

3. Medical Services: Many countries in Africa have weak healthcare infrastructure. In an emergency the distances that need to be traveled to reach definitive care are often far longer than in the West. Therefore, companies must think more carefully about how geography influences their emergency care plans.

There were three main topics addressed over the course of the workshop namely:  

1. A safer environment for the energy sector - The Proactive approach
2. Challenges of managing health in the Offshore/Remote site location in the Oil and Gas Industry - Recent Developments in Nigeria. 
3. Emergency Transport in Nigeria -Any hope for Nigeria.

Over the next few hours some of Nigeria's most prominent safety leaders debated these issues in small groups and then presented their results. The results of these discussions will be released over the next few days in our white paper titled 'Emergency Medicine for Industry in Africa'. It became very apparent that the Flying Doctors are a much needed and appreciated service.


Dr Olutomiwa Ogunbona

Aeromedical Evacuation: A Personal Outlook

Aeromedical Evacation often shortened to Medevac is the timely, efficient movement and en route care provided by highly trained medical personnel to ill, wounded patients, neonates and infants from an area with inadequate medical facility to one with better equipped facility.[1]

The United States Army is arguably the first set of people to use this lifesaving technique in Burma towards the end of the World War II using the Sikorsky R-4B helicopter. The British also used it in Sinai Peninsula when a Royal Aircraft Factory BE2 flew out a soldier in the Imperial Camel Corp who had been shot in the ankle.[2]

In modern times, aeromedical evacuation has gone way beyond just evacuation in times of war and conflict to evacuation from construction sites, remote sites, oil rigs, drills, mining sites to even neonatal and infant transport for better medical specialist care.[3]

In Nigeria, aeromedical evacuation is very new. Initially it was exclusive to  expatriates in the Oil and Gas sector to repatriate them to their home countries for better medical care and attention. However, today such services are available and accessible commercially. I was privileged to be on one in my home country.

The patient to be evacuated, Mr I.I, a 45 year old Nigerian male with a background history of hypertension and type II diabetes mellitus not regular on medications who had presented with a recent history of right sided hemispheric stroke possibly ischaemic and was stabilized in a hospital in his country home. His vitals as at the time of contacting the aeromedical evacuation team was a blood pressure of 150/90 mmHg, temperature of 37.1 C, Pulse of 90/minute regular, synchronous with no radio-radial or radio-femoral delays, respiratory rate of 18cycles/min and an SpO2 of 96-100%. The patient was conscious, alert oriented in time. place and person with a Glasgow Coma Score of 15/15. He was to be airlifted from Port Harcourt to Lagos for specialist care.

The first thing that caught my attention was the high level of commitment of the flight physicians on call. It was an early morning evacuation but the response time was 23 minutes. The team comprised an anaesthetist[4], a senior flight physician[5], myself, the paramedics, the pilot, co-pilot and the cabin crew. The anaesthetist was given a clear role as the lead physician.

He read out the medical history of the patient to be evacuated, possible aetiology, various modes by which such patients could present, the complications, risks of flying such patients at various altitudes, safety precautions to be taken and look-out signs on such patients. He stated that all such details have been explained to the relatives of the patients and they have signed a consent form with the legal team before we proceeded with this evacuation.

Simultaneously, I could see the flight engineers on the aircraft. I later found out that they were checking all the medical equipments were fully functional, the batteries fully charged and that the Air Transport Stretchers were comfortable for a non-ambulant patien

Just as we boarded, the lead physician took a few minutes off to repeat a summary of the patient to the pilot, co-pilot and cabin crew. Then we were cleared for take-off.  Aboard, we took turns to refresh one another on various topics in Advanced Cardiac Life Support. It was a 45 minutes flight.

On ground at the Port Harcourt Airport, the patients was at the tarmac with a land ambulance, had an anaesthetist, 2 physicians and a few paramedics. The lead physician again lead us to the patient, introduced us one after the other to the team on ground, I was asked to do a Pre-flight assessment of the patient. This included documenting the vital signs of the patient, performing and documenting general physical examination as well as systemic examination. Then the lead physician who was discussing with the on ground physicians and relatives came over to do a run through of yet another general physical examination but picked out only the affected systems for examinations. He then explained to the patient the risk associated with flying him, possible complications that could arise and the steps that have been taken but to forestall and control. 

He was then loaded into the air ambulance using a vacuum stretcher. He had his face mask connected, Intravenous fluid was set at 15drops/minute. One of paramedics were assigned to monitor the vitals of the patient every 10 minutes.

On ground at the Lagos airport, the receiving hospital had sent a land ambulance with paramedics to transport the patient over. The lead physician again briefed them on the clinical state of the patient after doing his Post-flight assessment.

We were then ushered to the airport lounge for a debrief and brunch.

Dr Olutomiwa Ogunbona is a staff of Flying Doctors Nigeria. www.flyingdoctorsnigeria.com/

The author takes full responsibility for the article. All correspondence should be directed at the author via email at tommyogunbona@gmail.com while drtommyflyingdoctors@gmail.com should be put in copy.

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[1] en.wikipedia.org/wiki/Medical_evacuation

[2] en.wikipedia.org/wiki/Medical_evacuation

[3] Emergency Pre-hospital Care. Dr Ola Orekunrin

[4] Dr Wale Raji

[5] Dr Ola Orekunrin, Founder Flying Doctors Nigeria

Medical Practice at a Flying Doctor's Remote Site Clinic

Leading the team of medical personnel under the auspices of Flying Doctors Nigeria, our primary medical service is to respond quickly to any medical emergencies that may ensue from oil and gas exploration process. We also run a clinic where ailments like malaria, Respiratory Tract Infections e. t. c and some Chronic Medical conditions are attended to, to forestall complications. 
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Exploration and Production as parts of upstream sector of oil and gas are the major activities embarked on in this field.

The oil and gas exploration site where we attend to patients is a marginal field still at the early production facility (EPF) phase located about ten minutes from the residential camp.
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As a resident doctor in conjunction with other medical personnel, we do embark on a routine patrol with our well equipped Ambulance from the residential camp where the Clinic is located to the exploration site. 
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Indigenous contractors and also Expatriates from Europe and Asia are the Clients who have been benefiting from our medical coverage. Weekly up to date reports of medical emergencies vis-à-vis clinic attendance are relayed to our head office for expertise feedback.

Since inception of my practice on site, there has not been any overwhelming medical emergency necessitating the need for medical evacuation. However there have been cases of referral to a nearby hospital from the site clinic for further management. 
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The major challenges encountered on the field ranges from intermittent unrest on the part of host community to a complete disconnect from the larger society.
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Remote site medical coverage in oil and gas is a worthwhile experience that will forever linger in my memory.

Dr Wale Amerijoye

Flying Doctors Nigeria.

Every Second; A Night in the Middle East

This is a column that will be featured on our blog every month titled 'EVERY SECOND' and it is going to be a  series of  brief personal accounts by our flying doctors on some of the evacuations we have undertaken.
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This is a personal account by Dr Tolu Taiwo, one of the doctors of Flying Doctors Nigeria team.
           

 

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One of our first international evacuations this year was a really hectic one. We had to transfer a critically ill, elderly patient via air ambulance from Lagos to the Middle-East under strict intensive care. All hands had to be on deck, from the trauma physicians, support staff to the cabin crew, to ensure the patient was successfully taken home alive. Even the equipment were not left out as they worked full time - the monitors, infusion pump, ventilator, oxygen tanks and the rest – while the required drugs and infusions were continuously administered.
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Matters were only made more arduous as we could not fly directly to the destination since we were not allowed to fly over Libya considering it was still a no-fly zone. The implication was that we had to take a longer route and stop over at Khartoum, Sudan, adding more precious hours to the already critical journey.

                                   

But, all’s well that ends well, as we delivered the patient to the family alive. We could heave a sigh of relief with a sense of fulfillment as we rested for the night to fly back to Lagos the following morning. Mission accomplished in the Middle-East!  

Every Second Counts; An Account of a Flying Doctor's Nigerian Evacuation

This is another concise report of a Flying Doctor from our team of Flying Doctors Nigeria on one of our evacuations in this second quarter of 2013.
                 

The statement of the mission was simple and succinct: TRANSFER THE CRITICALLY ILL PATIENT SAFELY TO RECEIVING HOSPITAL AS QUICKLY AS POSSIBLE.

The index patient is a Nigerian, well schooled and highly experienced with a penchant for acquiring knowledge of any subject of Human Endeavour.

On receiving the emergency call, our team was immediately assembled, equipments were checked and double-checked, these include; airway management devices, drugs, intravenous fluids, equipments for emergency resuscitation (ALS), patient transfer equipments (stretcher /special vacuum mattress). International passports with appropriate visa availability also crossed-checked. The aircraft (fixed-wing) challenger jet, that we were using as an air ambulance for our medvac with experienced and polite crew members made ready on red alert.

An advance-party (experienced flying doctor Nigeria health personnel) sent ahead to ensure co-ordination of the stabilization of the patient prior to evacuation by air.

Primary survey on ground revealed a non intubated patient, breathing spontaneously but with difficulty. However, patient suffered an acute exacerbation of his condition while being secured for the flight but was treated successfully with aminophyline and hydrocortisone injected intravenously.

The Flying Doctors’ Senior Flight Physician (my humble self) was also in attendance until patient was fully handed over and admitted into the I.C.U. before signing-off after yet another challenging but successful air ambulance Medevac.


An account by;

DR RAJI A. VICTOR MBBS,AFMC,ALS. (Senior flight physician FDN)

At the Speed of Life: The Importance of Rapid Response

                   

 Chances are very good that if you have never had to use the services of an air ambulance or medical transport you might never have heard of it. In a nutshell, an air ambulance is an aircraft that has had its interior specially configured so it can operate as a mobile hospital complete with intensive care unit. 

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Also an air ambulance can be seen as a specially outfitted aircraft that transports injured or sick people in a medical emergency or over distances or terrain impractical for a conventional ground ambulance. 

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Like ground ambulances, air ambulances are equipped with medical equipment vital to monitoring and treating injured or ill patients. Common equipment for air ambulances includes medications, ventilators, ECGs and monitoring units, CPR equipment, and stretchers. A medically staffed and equipped air ambulance provides medical care in flight which is referred to as medical evacuation (MEDEVAC)
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Air ambulance services have established their usefulness in other countries, but their role in Nigeria is developing slowly.
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With the awareness of the importance of air ambulance services, the services will be provided to different types of patients, with different ailments and accidents at different locations. This will bring about the reduction of the mortality rates of the patients in question.

If you ever found yourself in either a remote location or in an area of Nigeria that doesn’t offer the specialized medical emergency care you or your family need, this is when the expertise of an air ambulance comes to the forefront of your mind. 
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Timely response via Air ambulance is very important in Nigeria because we have cities that simply don’t have good roads that are good enough to accommodate a traditional ambulance all the time.
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Also, our bigger cities seem to be overcrowded which brings about traffic. Traffic can cause the death of a patient in a critical condition. Immediately a patient overwhelms the level of medical care at any healthcare centre, such a patient needs timely response to get to the other healthcare centre that suits his condition. The transfer needs to be done at the speed of life. Every second that leads to a minute matters in this process.

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The importance of timely response in Nigeria via Air Ambulance cannot be over emphasized. It cuts the issue of traffic and any form of road transport delay.
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Even though the services of air ambulances are offered 24 hours a day, seven days a week, 365 days a year, it is better to be prepared. Being prepared could be as simple as contacting a potential service provider like “Flying Doctors Nigeria”, speaking with the medical specialist and describing not only your current health issues – if any – but also the location to which you are traveling. Doing this will not only save you precious time in the event of an emergency but it will help you know how long it could take for a provider to reach you in the event of an emergency evacuation. While it is unlikely that you will need a medical evacuation, it’s better to be prepared.