The atrial fibrillation patient website AFib Matters has been launched in Italian and Spanish by the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC).
Italian version: www.fibrillazioneatriale.org
Spanish version: www.fibrilacion-auricular.org

In a major scientific breakthrough, a drug used to treat Parkinson

Clear challenges arise when people with an implanted device approach or reach the end of their life. What many people want in that situation is care and treatment to maintain their comfort and quality of life for whatever time they have left . Receiving treatment (for example electric shocks from an implanted defibrillator) as they are dying may provide no benefit but may cause them pain and may cause distress both to them and to those who care about them.
So as to provide the best care for people in the last days, weeks or months of their life it is important to consider deactivation of some of these devices. This requires informed and sensitive discussion with patients and those close to them. Healthcare professionals caring for such people may be faced with practical questions about the exact nature and purpose of each device, how the device can be deactivated and what arrangements are in place in their locality to provide the equipment and the expert support and advice needed. It is important also that healthcare professionals know what actions should be taken when someone has died with an implanted device in place.
Quite distinct from those circumstances, an implanted device may lead to uncertainty when someone with one in place suffers cardiac arrest, and cardiopulmonary resuscitation (CPR) is attempted. Those involved may not have detailed information about the implanted device and may be unsure whether they should modify their approach to CPR.
Dr David Pitcher, President of the Resuscitation Council (UK) says,

When the patient showed up in the emergency department, he was hurting. He’d taken a nice long soak in a warm tub, and a few hours later his fingers swelled enough to trap his ring. Now that finger was painful and swollen. The ring needed to come off, since restricted blood flow can lead to tissue death in the finger, which is about as fun as it sounds.

Ordinarily, this wouldn’t be much of a problem. ER personnel are used to removing rings. ‘It’s not uncommon at all,’ says Dr. Bret Nicks, an emergency room physician at Wake Forest Baptist Medical Center in Winston-Salem, N.C., who says he and his colleagues see traumatic injuries from working with heavy machinery such as cars or even the odd softball misfire. A published review of the problem also names ‘infection, skin disorders, allergic reactions, bee sting, and pregnancy’ as causes for trapped rings.

Usually they can be removed using lubrication, elevating the hand or the nifty string trick. And if that fails, out comes the ring cutter. But as two physicians describe, this patient’s ring was made of titanium.

Titanium rings are growing in popularity because they’re very strong, light, hypoallergenic and less expensive than rings made of precious metals like gold or platinum. But that strength can also make them more difficult to remove. A normal ring cutter won’t necessarily work, says Dr. Andrej Salibi, a plastic surgeon at Sheffield Teaching Hospitals in the U.K. and co-author of the letter. Jewellers who work with titanium say the commercially pure grades are much softer and easier to cut than aircraft grade, an alloy that also includes aluminum and vanadium; the exact type of titanium in this patient’s ring isn’t known. And of course the degree of difficulty can be boosted by the thickness of the ring.

In this case, the ring cutter failed, and the fire department came in with its own specialized cutting gear. The ring wouldn’t budge. The patient was admitted to the hospital and spent the night with his hand elevated. The next morning one of the physicians suggested they try something else, namely bolt cutters, which are often on hand in hospitals.

It worked! But ‘the other problem is that once you cut it, you have to take it off,’ says Salibi. And that takes a lot of force. So using some large, heavy-duty paperclips, the two physicians pulled the ring apart. The man’s finger was fine. The doctors say bolt cutters are preferable to dental saws or diamond-tipped saws, which aren’t likely to be lying around the hospital and require more manpower. npr