Thursday, 26 April 2007

Cardiopulmonary Resuscitation Update in Sports Emergencies

Oxford UK, 28 November 2005. New guidelines for the resuscitation of adults and children have been published today (28th November) in the international journal Resuscitation, announced the European Resuscitation Council (ERC) and Elsevier Ltd.

The guidelines are aimed at all healthcare workers; a section on basic life support also provides information for laypeople and first responders. The recommendations made by the ERC are based on a comprehensive, evidence-based review of resuscitation science that was undertaken over the last two years by experts from all over the world. These experts debated their findings in a Consensus meeting held in Dallas in January 2005 and their conclusions, also published today, form the basis for establishing best practice worldwide.

The last CPR guidelines were published in 2000; since then, science has moved forward and our understanding of the evidence has improved. The new CPR guidelines focus on a ‘back-to-basics’ approach and are easier for lay-people and healthcare professionals to learn. The steps to successful resuscitation are described by the links in the revised Chain of Survival. Early recognition of the patient who is very ill will enable medical assistance to be called immediately, providing an opportunity for early treatment and the prevention of cardiac arrest. In the event of cardiac arrest, early chest compressions and breathing may keep enough blood going to the heart and brain to buy time until the heart can be restarted by an electric shock (defibrillation). Once the heart has been restarted new treatments aim to improve the chances of the patient making a full recovery.

In comparison with the 2000 guidelines, the 2005 guidelines recommend giving more chest compressions (30 compressions for every 2 breaths instead of the traditional 15 compressions for every 2 breaths). The ratio of 30:2 applies to all adults and children (except for newborn babies) — this should make it easier for everyone to learn and remember. Advances in defibrillator technology (the device that gives an electric shock to restart the heart) enables healthcare workers and trained lay-people to give an electric shock earlier and more effectively to a person in cardiac arrest.

It's almost 2 years since the International Resuscitation 2005 guidelines are available. The European Resuscitation Council and American Heart Association guidelines are available on their websites. Athletes, coaches and sports officials are encouraged to undergo the basic life support training in the event of collapse of a participant during sports. Sports event organisers are advised to ascertain that medical services covering sporting events have AED equipment and trained personnel.

Wednesday, 25 April 2007

Knee Contusion

A young lady came in this morning with a swollen knee complaining that she could not kneel down and pray as her knee hurts. She informed me that she slipped after cleaning the floor the previous day.
She had normal range of movement but the bruised area (see photo) was tender and swollen. I advised her to use a pillow to support the knee during prayer, apply Arnica Comp gel and use a Cox-2 selective NSAIDS for 5 days. She was also encouraged to use to use the RICE treatment. The bruising would probably get worse after a day or two and then subside within 1-2 weeks.

Monday, 23 April 2007

Fractured Clavicle

Mohamed came in last Saturday holding onto his right elbow with a deformed 'collar-bone' (see photo) after a fall from his motorbike. He was in severe pain and requested for immediate 'painkiller' injection. I examined him and found that he had a fracture of the midshaft of his clavicle (commonest site) with the proximal part displaced upward. We splinted the left upper limb with a triangular bandage. His peripheral pulses were normal and his ribs and lungs were not injured. I referred him to my Orthopaedic colleague to reassess the need for surgery due to the displacement and overlap. Usually, non-displaced fractures of the midshaft are treated non-surgically with a triangular or figure of eight bandage (see how to apply) and NSAIDS.

In a retrospective study, 132 patients with united fractures of the middle third of the clavicle and a follow-up of up to 30 months after conservative management were reviewed. Of the patients, 34 (25.8%) were dissatisfied with the result of their management possibly due to shortening of the clavicle.J Shoulder Elbow Surg. 2006; 15(2):191-4

A small study in Belgium suggests that semi-professional athletes may benefit from surgical plate fixation of the fractured clavicle with a possible early return to sports (45 days)at the expense of a significant risk for complications (e.g. infection, non-union, refracture) which would not be considered acceptable in patients with lower functional demands. Acta Orthop Belg. 2005; 71(1):17-21

The patient actually had surgery done and was having full function of his right shoulder within 2 weeks. He was advised to return to his surgeon for removal of the plate after 1 year.

Thursday, 19 April 2007

Nike + iPod Sports Kit

Nike and Apple has come out with a gadget and software which gives athletes another excuse to run. The Sport Kit2 allows your Nike+ shoe to talk to your iPod nano. The sensor uses a sensitive accelerometer to measure your activity, then wirelessly transfers this data to the receiver on your iPod nano.

What do you need?: Get in gear.

A pair of Nike+ shoes, an iPod nano, and the Nike + iPod Sport Kit (see photo).

How it interacts?:Rock ’n’ run.

With a sensor in your shoe and a receiver on your iPod nano, your run takes on a whole new dimension. See the minutes tick by. Watch the miles unfold. Hear real-time feedback. All to your favorite music — including the one song that always gets you through the home stretch.

Review your run and interact with your trainer:Stay in sync.

Sync up after you cool down. Just as seamlessly as it syncs your music, photos, and calendars, iPod nano also syncs your run. Simply connect iPod nano to your Mac or PC, and your workout data syncs to both iTunes and, where you can see your runs, set goals, and discuss with your trainer or coach. You could also utilise a running site by Nike.

Here's how the Sports Kit2 is advantages for our workout:-

Any mere pedometer can show you stats while you run. But thanks to the Nike + iPod sensor and receiver, iPod nano also transfers your workout data to the Internet as soon as you sync. Connect your iPod, and iTunes takes over, automatically syncing all your run data and sending it to

Remember each run. Analyze your performance. Break your last record. Stay in tune with your goals. keeps stats on every step. Check your speed, distance, and calories burned — by run, by week, or by month — all from a graphical interface as intuitive as it is stunning.

3.Compete keeps you connected with runners from every corner of the web. And that’s where the real race begins. Use to challenge anyone, anywhere to a virtual race. Run on your own time, on your home turf, then log on to to retrieve your results. Users have cloked more than 20,000,000km globally and is increasing every second.

1. You will need a pair of Nike shoes and an iPod before you start.

What's the price? US$29 for the kit; (RM138 at Nike, One Utama)

Tuesday, 17 April 2007

Leg Contusion after kick!

A futsal player came in walking this morning. He showed me his swollen right leg and I thought it was just a contusion (soft tissue injury). He was able to do heel-raises and even hop on the injured leg!

After careful examination, I found a defect in his right tibial bone (as he received the kick from the midline outward). I took a marker to delineate the defect (see picture). I gave him some NSAIDS, Arnica Comp gel and told him to apply RICE treatment. He was also sent for an X-ray but it came back normal. He was told to return for a review in 1 week's duration.

He should have been wearing his shin guard!

Thursday, 12 April 2007

National Sports Science and Sports Medicine Conference 2007

The Perak Sports Council and Ipoh Hospital will be hosting the National Sports Science and Sports Medicine Conference 2007 in collaboration with National Sports Council, Olympic Council of Malaysia and University Malaya and Malaysian Association of Sports Medicine. The theme for this conference is "Science of Sports". Sports scientists, coaches, trainers, athletes, physiotherapists, doctors and paramedics are encouraged to attend. The details are available here.

Date: 15th-17th June 2007
Venue: Bangunan SUK Negeri Perak, Ipoh, Perak

Catch your early bird discounts before 15th May 2007. Do not miss the opportunity to visit the historical and beautiful Ipoh city!

Saturday, 7 April 2007

Rt Big Toe Gouty Arthritis

Mr Lim came in walking on his heel with a painful and swollen base of the right big toe (see photo) yesterday. He could not remember having any falls or trauma to the toe but had a little too much beer, seafood and peanuts for the past week.

I was keen to find out whether he had any insect bites or previous injury but he had none. I took a blood sample for his uric acid levels and sent him off with an NSAIDS for 5 days. Had to give him some gastric preventive medication i.e. Proton-Pump Inhibitors to prevent any gastric side-effects. Also warned him not to take NSAIDS on his own as it could cause hypertension or heart problems if given indiscriminately.

True enough his serum uric acid levels came back elevated. He was advised to avoid excessive intake of protein and beer. If he had recurrence in his condition, he may have to be on medication to lower the uric acid levels e.g. cholchicine or allupurinol.

Tuesday, 3 April 2007

Forefoot contusion after supper!

The local council is going to get a complaint from this patient. He was walking back from 'Mamak' (a spicy, not so fancy, local fast-food) when he accidentally stepped into a pothole in Subang Jaya last Saturday.

He had a painful swelling on the dorsum of his right foot (see photo) and could only walk on his inner side of his foot. He had a painful gait when he walked into my clinic yesterday. I was getting a bit worried as he could not put weight on the side of the foot. After examination, I felt that he could be spared from an X-ray as most of the pain came from the superficial swelling and not the 5th metatarsal (common site of injury for such falls). I once had a 50 year old colleague who fractured her 5th metatarsal in the same manner walking along the pavement! Her risk was higher as she was having Osteoporosis.

Told him to do the RICE treatment (see first-aid) and gave him some Arnica gel and oral NSAIDS. He was advised to avoid excessive walking for another 5 days and return for a review if pain and swelling persisted.