Junior Paramedic / Public Health

PUBLIC HEALTH

Dengue

Dengue fever and dengue hemorrhagic fever are acute febrile diseases found in the tropics with a geographical spread similar to malaria. Caused by one of four closely related virus serotypes of the genus Flavivirus, family Flaviviridae, each serotype is sufficiently different that there is no cross-protection and epidemics caused by multiple serotypes (hyperendemicity) can occur. Dengue is transmitted to humans by the Aedes aegypti mosquito. This mosquito tends to bite just after dawn and just before sunset.

Signs and Symptoms of Dengue

This infectious disease is manifested by a sudden onset of with severe headache, muscle and joint pains myalgias and arthralgias - severe pain gives it the name break-bone fever or bonecr usher disease and rashes ; the dengue rash is characteristically bright red petechia and usually appears first on the lower limbs and the chest - in some patients, it spreads to cover most of the body. There may also be gastritis with some combination of associated abdominal pain, nausea, vomiting or diarrhea.

Some cases develop much milder symptoms, which can, when no rash is present, be misdiagnosed as a flu or other viral infection. Thus, travelers from tropical areas may inadvertently pass on dengue in their home countries, having not been properly diagnosed at the height of their illness. Patients with dengue can only pass on the infection through mosquitoes or blood products while they are still febrile.

The classic dengue fever lasts about six to seven days, with a smaller peak of fever at the trailing end of the fever (the so-called "biphasic pattern"). Clinically, the count will drop until the patient's temperature is normal.

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Cases of DHF also show higher fever, haemorrhagic phenomena, thrombocytopenia and haemoconcentration. A small proportion of cases lead to dengue shock syndrome (DSS) which has a high mortality rate.

Treatment of Dengue

The mainstay of treatment is supportive therapy. The patient is encouraged to keep up oral intake, especially of oral fluids. If the patient is unable to maintain oral intake, supplementation with intravenous fluids may be necessary to prevent dehydration and significant hemoconcentration. A platelet transfusion is rarely indicated if the platelet level drops significantly or if there is significant bleeding. But the transfusion is recommendable on platelet count falling below 20,000 without hemorrhage/bleeding or approx 50,000 with hemorrhage/bleeding. Internal bleeding indicated by dark color of stools, other bleedings indicated at surface as red rashes all over or most of the body parts.

It is very important to avoid Aspirin and non-steroidal anti-inflammatory medications. These drugs are often used to treat pain and fever, but in this case, they may actually aggravate the bleeding tendency associated with some of these infections. If dengue is suspected, patients should receive instead acetaminophen preparations to deal with these symptoms.

Malaria

Malaria is a vector-borne infectious disease that is widespread in tropical and subtropical regions, including parts of the Americas, Asia and Africa. Each year, it causes disease in approximately 400 million people and kills between one and three million, most of them young children in Sub-Saharan Africa. Malaria is commonly-associated with poverty, but is also a cause of poverty and a major hindrance to economic development.

Malaria is one of the most common infectious diseases and and enormous public-health problem. The disease is caused by protozoan parasites of the genus Plasmodium. The most serious forms of the disease are caused by Plasmodium falciparum and Plasmodium vivax, but other related species can also infect humans. This group of human-pathogenic Plasmodium species is usually referred to as malaria parasites.

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Malaria parasites are transmitted by female Anopheles mosquitoes. The parasites multiply within red blood cells, causing symptoms that include symptoms of anemia, as well as other general symptoms such as fever, chills, nausea, flu-like illness and in severe cases, coma and death. Malaria transmission can be reduced by preventing mosquito bites with mosquito nets and insect repellents, or by mosquito control by spraying insecticides inside houses and draining standing water where mosquitoes lay their eggs.

No vaccine is currently available for malaria; preventative drugs must be taken continuously to reduce risk of infection. These These prophylactic drug treatments are often too expensive for most people living in endemic areas. Most adults from endemic areas have a degree of long-term recurrent infection and also of partial resistance; the resistance reduces with time and such adults may become susceptible to severe malaria if they have spent a significant amount of time in non-endemic areas. They are strongly recommended to take full precautions if they return to an endemic area. Malaria infections are treated through the use of antimalarial drugs, such as quinine or artemisinin derivatives, although is increasingly common.

Signs and Symptoms

Symptoms of malaria include fever, shivering, arthralgia (joint pain), vomiting, anemia caused by hemolysis, hemoglobinuria, and convulsions. There may be the feeling of tingling in the skin, particularly with malaria caused by P. Falciparum. The classical symptom of malaria is cyclical occurrence of sudden coldness followed by rigor and then fever and sweating lasting four to six hours, occurring every two days in P.vivax and P.ovale infections, while every three for P. malariae. P.Falciparum can have recurrent fever every 36-48 hours or a less pronounced and almost continuous fever. For reasons that are poorly understood, but which may be related to high intracranial pressure, children with malaria frequently exhibit abnormal posturing, a sign indicating severe brain damage. Malaria has been found to cause cognitive impairments, especially in children. It causes widespread anemia during a period of rapid brain development and also direct brain damage. This neurolgic damage results from cerebral malaria to which children are more vulnerable.

Chronic malaria is seen in both P. vivax and P. ovale, but not in P. falciparum. Here, the disease can relapse months or years after exposure, due to the presence of latent parasites in the liver. Describing a case of malaria as cured by observing the disappearance of parasites from the bloodstream can therefore be deceptive. The longest incubation period reported for a P. vivax

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infection is 30 years. Approximately one in five of P. vivax malaria cases in temperate areas involve overwintering by hypnozoites.

Treatment of Malaria

Active malaria infection with P.falciparum is a medical emergency requiring hospitalization. Infection with P.vivax, P.ovale or P.malariae can often be treated on an outpatient basis. Treatment of malaria involves supportive measures as well as specific antimaliral drugs. When properly treated, someone with malaria can expect a complete cure.

Cholera

Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period, from less than one day to five days, and produces an enterotoxin that causes a copious, painless, watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not promptly given. Vomiting also occurs in most patients.

Treatment of cholera

Cholera is an easily treatable disease. The prompt administration of oral rehydration salts to replace lost fluids nearly always results in cure. In especially severe cases, intravenous administration of fluids may be required to save the patient's life.

Left untreated, however, cholera can kill quickly following the onset of symptoms. This can happen at a speed that has incited fear and paralyzed commerce throughout history. Although such reactions are no longer justified, cholera continues to be perceived by many as a deadly and highly contagious threat that can spread through international trade in food.

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Avian Influenza (Bird Flu)

Avian influenza virus usually refers to influenza A viruses found chiefly in birds, but infections can occur in humans. The risk is generally low to most people, because the viruses do not usually infect humans. However, confirmed cases of human infection have been reported since 1997.

Although avian influenza A viruses usually do not infect humans, rare cases of human infection with avian influenza viruses have been reported since 1997. More recently, more than 200 confirmed cases of human infection with avian influenza A (H5N1) viruses have been reported since 2004. The World Health Organization (WHO) maintains of avian influenza A (H5N1). Most cases of avian influenza infection in humans are thought to have resulted from direct contact with infected poultryor contaminated surfaces. However, there is still a lot to learn about how different subtypes and strains of avian influenza virus might affect humans. For example, it is not known how the distinction between low pathogenic and highly pathogenic strains might impact the health risk to humans.

Symptoms of Avian Influenza in Humans

The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications.

Antiviral Agents for Influenza

Four different influenza antiviral drugs (amantadine, rimantadine, oseltamivir, and zanamivir) are approved by the U.S. Food and Drug Administration (FDA) for the treatment and prevention of influenza. All four have activity against influenza A viruses. However, sometimes influenza strains can become resistant to these drugs, and therefore the drugs may not always be effective. For example, analyses of some of the 2004 H5N1 viruses isolated from poultry and humans in Asia have shown that the viruses are resistant to two of the medications (amantadine and rimantadine).

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JUNIOR PARAMEDIC SUBJECTS

THE RESCUER & CPR

Universal Precautions

Good rescuers practice universal precautions when providing medical care to victims. Universal precautions are steps used to reduce the risk for victims to infect rescuers. Practicing universal precautions requires personal protective equipment , such as gloves or eye protection.

To protect yourself, you should make sure your first aid kit is adequately stocked with the personal protective equipment necessary to practice universal precautions.

Staying Safe

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Safety is an ongoing concern that must never leave your thoughts.

There is a primal instinct in many people to dash to the rescue of those in need. Regardless of the dire circumstances of whatever terrible accident or injury you may witness, it's urgent that you keep your wits about you and stay safe.

Safety is an awareness of your surroundings and a healthy fear of unstable situations. By it's very nature, an emergency is an unstable situation. If everything were truly under control, nothing bad would've happened in the first place.

If, for example, you see a person hit by a vehicle in a pedestrian crossing, do not rush headlong into the street to see if they're injured. You will no doubt find yourself lying next to them after being struck by the next car barreling down the road.

In its 2010 CPR Guidelines, the American Heart Association changed the order of ABC's. ABC is still the best way to remember the beginning, so here is a new way to think of the ABC's and still follow the CPR Guidelines: - A: Awake? - B: Breathing? - C: Continue Care

Determine if the Victim is Awake

A is for Awake. Is the victim awake, yes or no?

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If our victim is not awake, try to wake him. Give him a brisk shake of the shoulders or rub your knuckles on his breastbone and shout something. Anything will work. Try "Hey you ok!" . It doesn't matter what you say, as long as you say it nice and loud to give him a chance to wake up.

Not waking up? Make sure someone is calling 911 / 177 (if no one else is there to help, then you should call 911 / 177 before you do anything else). Now, move on to B: Breathing.

If she is awake, let's talk to her. If the victim can't talk, is she choking? If she is choking, do the Heimlich Maneuver .

If the victim wants an ambulance or wants to go to the hospital, make the call. If she's talking but not making sense and she's confused, call 177/911 immediately and start thinking about w hy she might be confused .

Is the Victim Breathing?

B is for Breathing. If your victim is not breathing, start CPR . Remember to tell someone to call 177 / 911 if you haven't already.

Start CPR by pushing on the middle of his chest, right between the nipples. Push hard and fast, at least 2 inches deep and at least 100 times per minute (sing Stayin' Alive or Another One Bites the Dust in your head and push with the beat).

If you've never taken a CPR class -- or you don't remember all the steps that well -- then just keep pushing fast and hard until somebody shows up to help ( Hands Only CPR ).

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If you feel comfortable with CPR, then follow the steps: 30 chest compressions, followed by two rescue breaths, and repeat. Here are the steps to help you remember: Adult CPR Child CPR (before puberty) Infant CPR (under a year old)

But the Victim Is Breathing!

Think your victim is breathing? Take another look. Is he gasping for air kind of slowly, like a fish out of water? If so, start CPR just like if he wasn't breathing (how to do CPR on gasping victims ). So you've decided that your victim is breathing fairly normally. Someone called 177 / 911 when you realized your victim wasn't waking up (nobody's calling 911? Call now).

Take a breath (your victim is, so you can) and move on to C: Continue Care.

Continue to Care for the Victim

C is to Continue Care. You have a victim who won't wake up ( unconscious ) but is breathing. 911/ 177 has been called and an ambulance is on the way. If the 911/ 177 operator tells you what to do, follow the operator's instructions.

If you're on your own, here are some tips to follow until the ambulance gets there: - If the victim is face down and unconscious, roll her on her back, face up. - If the victim has fluid, blood, vomit or food in his mouth, roll him on his side with his arm under his head. - putting pressure on the wound. - If the victim stops breathing, start CPR. - Gather the victim's medications if available.

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BLOOD PRESSURE Stroke and Heart Attack

Blood pressure refers to the force exerted by circulating blood on the walls of blood vessels, and constitutes one of the principal vital signs.

The pressure of the circulating blood decreases as blood moves through arteries, arterioles, capillaries, and veins; the term blood pressure generally refers to arterial pressure, i.e., the pressure in the larger arteries, arteries being the blood vessels which take blood away from the heart.

Blood pressure is always given as two numbers - systolic pressure (when the heart beats) and diastolic pressure (when the heart relaxes). When the measurements are written down, both are written one above or before the other with the systolic being the first number.

Normal Blood Pressure - Blood pressure reading below 120/80 is considered normal.

High Blood Pressure - Blood pressure of 140/90 or higher is considered high blood pressure. If one or both numbers are usually high, you have high blood pressure.

Low Blood Pressure - Blood pressure that is too low is known as hypotension. The similarity in pronunciation with hypertension can cause confusion.

High Blood Pressure Range

Systolic pressure(mm Hg)

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Diastolic pressure (mm Hg)

Stages of High Blood Pressure

210

120

Stage 4

180

110

Stage 3

160

100

Stage 2

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140

90

Stage 1

Normal Blood Pressure Range

Systolic pressure(mm Hg)

Diastolic pressure (mm Hg)

Pressure

Range

130

85

High Normal Blood Pressure

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120

80

Normal Blood Pressure

110

75

Low Normal Blood Pressure

Low Blood Pressure Range

Systolic pressure (mm Hg)

Diastolic pressure (mm Hg)

Pressure

Range

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90

60

Borderline Low blood Pressure

60

40

Too Low Blood Pressure

50

33

Dangerously Low Blood Pressure

What should my blood pressure be according to my age?

This chart shows the average blood pressure range by age.

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Age 15 to 19 Systolic Range Diastolic Range Age 20 to 24 Systolic Range Diastolic Range Age 25 to 29 Systolic Range Diastolic Range Age 30 to 34 Systolic Range Diastolic Range Age 35 to 39 Systolic Range Diastolic Range

Age 40 to 44 Systolic Range Diastolic Range Age 45 to 49 Systolic Range Diastolic Range Age 50 to 54 Systolic Range Diastolic Range Age 55 to 59 Systolic Range Diastolic Range Age 60 to 64 Systolic Range Diastolic Range

Min 105

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73 Min 108 75 Min 109 76 Min 110 77 Min 111 78

Min 112 79 Min 115 80 Min 116 81 Min 118 82 Min 121 83

Average 117 77

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Average 120 79 Average 121 80 Average 122 81 Average 123 82

Average 125 83 Average 127 84 Average 129 85 Average 131 86 Average 134 87

Max 120 81 Max 132

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83 Max 133 84 Max 134 85 Max 135 86

Max 137 87 Max 139 88 Max 142 89 Max 144 90 Max 147 91

Calculate your predicted maximum heart rate by using the calculation: 220 - (age) = Age Predicted Maximum Heart Rate, or see our Target Heart Rate Calculator and Chart

The Signs and Symptoms of High Blood Pressure

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Signs of high blood pressure include, headache dizziness, pounding in ears, and a bloody nose. These symptoms typically don't occur until high blood pressure has reached an advanced and even a possibly life threatening stage.see other Signs of High Blood Pressure

What causes high blood pressure?

For most people who suffer with hypertension, there is no obvious cause why their blood pressure is high. This condition is called essential hypertension and it is especially important that it is kept under control. More information on What causes High Blood Pressure?

Measuring your blood pressure.

Healthcare professionals use a stethoscope and a manual sphygmomanometer to measure your blood pressure. Typically they take the reading above your elbow. The sphygmomanometer has a bladder, cuff, bulb, and a gauge. When the bulb is pumped it inflates the bladder inside the cuff, which is wrapped around your arm. This inflation will stop the blood flow in your arteries. The stethoscope is used to listen for sound of the heartbeat, and no sound indicates that there is no flow. As the pressure is released from the bladder, you will hear the sound of the blood flowing again. That point becomes systolic reading. The diastolic reading is when you hear no sound again, which means that the blood flow is back to normal.

Blood pressure 100 plus your age

Medical research shows that as we age blood pressure rises slightly to accommodate an increased demand of oxygen and nutrients. It is completely natural for the first number (systolic ) to be 100 plus our age . A recent study by a group of UCLA researchers came very close to corroborating Dr. Piette's guide for blood pressure of 100 plus your age for men, subtracting 10 for women, and this is after this rule had been in use for five or more decades. Are we now being taught that Dr. Piette's guide for blood pressure is wrong merely for drug companyprofit?

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Symptoms of a heart attack

The heart requires blood to bring oxygen, and nutrients to its muscle tissue. The narrowing of the arteries due to blockage can cause high blood pressure. If this blockage occurs in the arteries of the heart, coronary arteries, heart muscle damage can occur, resulting in a heart attack

Some heart attacks are sudden and intense, however most heart attacks start slowly with mild pain and discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Shortness of breath may occur, as well as nausea, or lightheadedness. It is vital to get help immediately if any of these symptoms occur.

Symptoms of a stroke

The brain requires unobstructed blood flow to nourish its many functions. Very high, sustained blood pressure will eventually cause blood vessels to weaken. Over time these weaken vessels can break, and blood will leak into the brain. The area of the brain that is being fed by these broken vessels start to die, and this will cause a stroke . Additionally, if a blot clot blocks a narrowed artery, blood ceases to flow and a stroke will occur.

Symptoms of a stroke include sudden numbness or weakness of the face, arm or leg, especially on one side of the body, confusion, trouble speaking, or seeing, sudden severe headache. If you or someone with you has one or more of these signs, don't delay, call 911.

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You are at risk for cardiovascular disease if:

a) You smoke - Cigarette smokers are at greater risk than pipe and cigar smokers, butall forms of tobacco are proven to be detrimental to the hearts health.

b) You have diabetes .

c) You are overweight - Persons that have an excess of body fat are at a higher risk than persons of normal weight.

d) Your diet is high in saturated fats.

e) Family History - Children of parents that developed heart disease before the age of 55 have a higher risk of developing heart disease.

f) You exercise less than 30 minutes per day - Inactivity puts a person at higher risk of developing heart disease.

g) You are over 40 or a post-menopausal woman - Risk of heart disease increases over the age of 45 in males, over 55 in females.

h) You consume more than two alcoholic drinks per day.

i) You have high blood pressure or need medication to control your blood pressure.

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j) You have high cholesterol levels or need medication to control your cholesterol level.

If you answered yes to one or more of the above, you should talk to your doctor about how you can reduce your risk through lifestyle modifications. Your doctor will determine if preventative therapies such as ASPIRIN 81mg are right for you.

Medications for reducing high blood pressure

There are several types of blood pressure medications and if one doesn't work, then ask your doctor to switch to another until your blood pressure becomes stable.

Adalat -A dihydropyridine calcium blocker. It is mostly used for treating hypertension and Angina Pectoris. Other conditions that benefit from Adalat are Raynaud's phenomenon, Tetanus and Angina Pectoris. Brand names of the drug include Procardia and Nifedical. Get more information on Adalat

Aldactone - While regularly prescribed for high-blood-pressure patients, the drug can also be prescribed along with other drugs. However, the drug is useful only for controlling, rather than curing, high blood pressure. Get more information on Aldactone

What is Angina?

Angina is a form of heart disease where the blood flow to the heart is restricted by a blockage in one or more of the arteries that carry blood into the heart. Usually, the first sign Angina is a pain in the chest, not unlike a squeezing or pressing sensation.

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