Table of Contents

2. Table of Contents • Blood Pressure • Hypertension • Hypotension • Heart Rate • Heart Rate and Fitness • First Aid and Cardio Pulmonary Resuscitation • Techniques of Implementation of CPR • Cholesterol • Normal Value Cholesterol • Diabetes • Types of Diabetes • Blood Sugar Permissible Limits

3. Blood Pressure: Meaning, Types, Risks and Prevention . • Blood Pressure (B.P.): • is the pressure that the blood exerts on the walls of the blood vessels while circulating. • An optimal amount of blood pressure is essential for : • i) the return of the blood to the heart after making its way through more than 60,000 miles of long blood vessels of the body. • ii) the exchange of nutrients and waste products between the various cells of the body and blood capillaries. • iii) the filtering and purification of the blood in the kidneys and lungs.}

4. Blood Pressure: Meaning, Types, Risks and Prevention . • Blood Pressure is usually measured in the Brachial artery of the arm using an instrument known as Sphygmomanometer. • Normal Values of Blood Pressure : • Systolic B.P. For age 20 to 60 years: 120 + 1/5. For ages above 60: 135+1 for each year above 60. • Diastolic B.P : At age 25 year: 80. For ages above 25 to year: 80+1 for every 5 years beyond the age of 25 years. • Temporary conditions which lead to an increase in B.P. are; • i) Mental stress, ii) constipation, iii) cold weather, iv) after eating, v) after drinking coffee, tea & alcohol, vi) bathing or showering, vii) exercising, viii) smoking, ix) urinating.

5. Blood Pressure: Meaning, Types, Risks and Prevention . • Types of Blood Pressure : • There are two types of Blood Pressure • i) Hypertension ( High blood pressure ) • ii) Hypotension (Low blood pressure ) • Hypertension ( High blood pressure) : • It means a persistent systolic pressure of 140 mm of Hg or more or a persistent diastolic pressure of 90 mm of Hg .}

6. Blood Pressure: Meaning, Types, Risks and Prevention . The H.B.P is classified as follows: When a person has got High B.P., it only means that now heart has to exert greater force to pump almost the same quantity of blood within the same time due to which B.P. becomes elevated than normal.{

7. Blood Pressure: Meaning, Types, Risks and Prevention . •  Causes of Hypertension : • 1.Heredity • 2. Mental Tension • 3. Excess intake of salt • 4. Obesity • 5. Sedentary life • 6. Smoking • 7. Alcohol • 8. Diet having saturated fats • 9. Use of fried and too much oily foods • 10. Excess intake of Sugar • 11. Tea, Coffee, Cold drinks. • Many of the above factors lead to narrowing and hardening of the arteries (atherosclerosis) because of deposition of Cholesterol in the walls of the arteries. • As old age approaches the artery walls harden and loose much of the elasticity.{

8. Blood Pressure: Meaning, Types, Risks and Prevention . • Common Symptoms Hypertension : • 1.Lack of sleep • 2. Headache , especially throbbing pain, which is associated with anger and working under stress • 3. Dizziness • 4. Flushed face on exertion • 5. Excessive craving for salt • 6. Obesity • 7. increased irritability and tendency to become angry or violent • 8. Hurry and impatience and always racing against time. • A rapid or sudden increase in B.P. to very high levels (usually 240/130 mm of Hg or more ) leads to severe headaches, blurring of vision, drowsiness, vomiting and breathlessness. This requires emergency treatment.{

9. Blood Pressure: Meaning, Types, Risks and Prevention . • Types of Hypertension: • There are two types of Hypertension: • 1. Essential (or Primary ) Hypertension • 2. Secondary hypertension . • 1. Essential Hypertension: • Essential hypertension is blood pressure that is consistently higher than normal when no cause for the high blood pressure can be found. • Many experts think essential hypertension is genetic.

10. Blood Pressure: Meaning, Types, Risks and Prevention . • 1. Essential Hypertension: • Factors that can increase blood pressure, such as: • the amount of blood pumped by the heart, • size and condition of the arteries, • water and salt content of the body, • condition of the kidneys, nervous system or blood vessels. • hormone levels in the body. • Other factors can include stress, being overweight, smoking, alcohol use, a diet high in salt, heredity, gender, age and race.}

11. Blood Pressure: Meaning, Types, Risks and Prevention . • 1. Essential Hypertension: • What are the symptoms?: • A mild headache, • tiredness, • shortness of breath, • confusion, • dizziness, • visual changes, • nausea and vomiting, • anxiety, • perspiration, • nose bleeds, • pale or red skin and an angina-like pain in the chest. • Rarely, the first symptom is a stroke.{

12. Blood Pressure: Meaning, Types, Risks and Prevention . • 2. Secondary Hypertension: • This is caused by some disease or disorder in the body like: • 1. Disease of the kidney and endocrine glands, especially the adrenal glands • 2. Long standing diabetes mellitus • 3. Long term use of oral contraceptives containing estrogen • 4.Use of steroids for many years (steroids are a group of drugs commonly used for treatment of asthma, some skin disorders etc.) • 5. Inborn defects of the “ aorta “ .{

13. Blood Pressure: Meaning, Types, Risks and Prevention . • Risks associated with Hypertension : • 1. Heart Attack (pain in the chest) • 2. Stroke (Brain hemorrhage) • 3. Heart failure • 4. Effect on kidneys (kidney failure) • 5. Effect on eyes{

14. Blood Pressure: Meaning, Types, Risks and Prevention . • Management or Control of Hypertension: • 1.Weight reduction • 2. Reduction of salt intake • 3. Aerobic exercise • 4. Stretching exercises • 5. Avoid saturated fats • 6. Intake of Calcium , potassium and magnesium in proper proportions • 7. High intake of fibers (soluble fibers ) • 8. Consume Vitamin C , Vitamin B3 (Niacin) and Vitamin E for lowering B.P. • 9. Intake of food items like garlic, honey , lemon juice , onion to be increased • 10. Use of relaxation techniques for lowering B.P. • 11. Intake of water in large quantities especially in empty stomach in the morning • 12. Adopt a positive outlook towards life.{

15. Blood Pressure: Meaning, Types, Risks and Prevention . •  Hypotension • The term "hypotension" is usually used only when blood pressure has fallen so far that enough blood can no longer reach the brain, causing dizziness and fainting. • Causes and symptoms: • Postural hypotension is the most common type of low blood pressure. • In this condition, symptoms appear after a person sits up or stands quickly. • In normal people, the cardiovascular system must make a quick adjustment to raise blood pressure slightly to account for the change in position. • For those with postural hypotension, the blood pressure adjustment is not adequate. • It also happens to diabetics when nerve damage has disrupted the reflexes that control blood pressure. • Many people have a chronic problem with low blood pressure that is not particularly serious. This may include people who require certain medications.

16. Blood Pressure: Meaning, Types, Risks and Prevention .  Hypotension: • Treatment • For those people with postural hypotension, a medication adjustment may help prevent the problem. • These individuals may find that rising more slowly, or getting out of bed in slow stages, helps the problem. • Low blood pressure with no other symptoms does not need to be treated.

17. Blood Pressure: Meaning, Types, Risks and Prevention . • Heart Rate • Heart Rate is the number of heart beats per unit time, usually per minute. • The heart rate is based on the number of contractions of the ventricles (the lower chambers of the heart). • The heart rate may be too fast (tachycardia) or too slow (bradycardia).

18. Blood Pressure: Meaning, Types, Risks and Prevention . • Blood Flow/Cardiac Output = Heart Rate x Stroke Volume. • Heart rate for a human being at rest is about 70 beats per minute. • During vigorous exercise, heart rate can increase dramatically (the rule of thumb given for maximal heart rate is 220 minus your age). This will result in an increase in blood flow.

19. Blood Pressure: Meaning, Types, Risks and Prevention . • Controllable Risk Factors of Heart rate : • Coronary artery disease, • heart attack, • diabetes, • high cholesterol, • high blood pressure, • smoking, • drugs or alcohol abuse, • excess weight, • high fat diet sedentary, • lifestyle, • stress, • certain medication (over-the-counter and prescription, including decongestants and diet and herbal supplements), • heart surgery (may also be a non– controllable risk factor).

20. Blood Pressure: Meaning, Types, Risks and Prevention . • Non- Controllable Risk Factors: • Family history of heart disease, • congenital heart disorders (heart problem present at birth, usually involving the heart chambers or valves), • advancing age, • gender (males are more susceptible).

21. Blood Pressure: Meaning, Types, Risks and Prevention . • Factors affecting heart rate: • 1. Anxiety • 2. Dehydration • 3. Ambient temperature • 4. Altitude • 5. Elapsed time after meals can increase heart rate, sometimes markedly.

22. Blood Pressure: Meaning, Types, Risks and Prevention . • Heart Rate Reading: • The heart rate is the pulse one feels at the periphery. • When the blood is pumped in the arteries they expand and the same pulse is felt throughout the arteries. • There are two suitable points through which one can check the pulse. • 1. In the radial artery at the thumb side. • 2. at the carotid artery which is located in the neck, at either side of the windpipe. • Two fingers have to be placed at these points and the count can be noted for 15 seconds or 30 seconds and can be multiplied by 4 or 2 respectively to get the heart rate for one minute.

23. Blood Pressure: Meaning, Types, Risks and Prevention . • Heart Rate and Fitness: • In addition to following a healthy diet and incorporating important heart nutrients, you must also exercise to maintain the health of your heart. • Exercise can help you prevent as well as reverse heart disease.

24. Blood Pressure: Meaning, Types, Risks and Prevention . The target heart rate chart below shows the target heart rate zones for men, by age

25. Cardio - Pulmonary Resuscitation (CPR)

26. Cardio - Pulmonary Resuscitation (CPR) • It is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest. • CPR can be utilized in many other emergency situations and some of them are; • 1. Heart attacks • 2. Strokes (when blood flow to a part of the brain has suddenly stopped) • 3. Choking on something that blocks the entire airway • 4. Near drowning incidents (when someone is under water for too long and the breathing has stopped) • 5. A very bad neck, head or back injury • 6. Severe electrical shocks (touching a live wire of high intensity ) • 7. Suffering from sickness of a serious nature • 8. Excessive bleeding • 9. Severe allergic reactions.

27. Cardio - Pulmonary Resuscitation (CPR) • CPR is performed in hospitals or in the community by laypersons or by emergency response professionals. • CPR involves physical interventions to create artificial circulation through rhythmic pressing on the patient's chest to manually pump blood through the heart, called chest compressions, • and usually also involves the rescuer exhaling into the patient (or using a device to simulate this) to inflate the lungs and pass oxygen in to the blood, called artificial respiration. • Its purpose is to maintain a flow of oxygenated blood to the brain and the heart, thereby delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage.

28. Cardio - Pulmonary Resuscitation (CPR) • Techniques of Implementation of CPR • For administering CPR, a primary assessment has to be made with regard to the gravity of the condition of an ill or injured person using the ABCDS sequence as shown below:

29. Cardio - Pulmonary Resuscitation (CPR) A stands for: Assessment of the scene, Alerting EMS (call first) & opening the blocked airway.

30. Cardio - Pulmonary Resuscitation (CPR) Bstands for: Breathing Check & Rescue Breathing

31. Cardio - Pulmonary Resuscitation (CPR) C stands for: Circulation Check & Chest Compression

32. Cardio - Pulmonary Resuscitation (CPR) D stands for: Defibrillation, either by EMS or by an Automated ExternalDefibrillator

33. Cardio - Pulmonary Resuscitation (CPR) • 5. S stands for: Serious bleeding management, Shock management & Spinal injury Management • The Emergency Medical Services of the local area have to be informed immediately of the incident while continuing to monitor the patient’s condition with ABCDS and to administer treatment to the emergency problems while waiting for the Emergency Medical Services.

34. Cardio - Pulmonary Resuscitation (CPR) • During the primary assessment of the patient the following procedure has to be adopted: • It’s important to Look, Listen and Feel for Agonal Breathing. Individuals in cardiac arrest do not breathe. Some may gasp irregularly, which seems as if the patient is breathing. It’s important not to confuse agonal breaths with normal breathing. • There are several reasons why a person might to stop breathing: • 1. Submersion and near drowning • 2. Stroke • 3. Foreign body obstructing (choking ) the airway • 4. Smoke inhalation or suffocation • 5. Drug overdose • 6. Electrocution • 7. Injuries • 8. Heart attack or sudden cardiac arrest • 9. Lightening strike • 10. coma. • If the heart beat, breath and chest movement are not found, then begin the CPR.

35. Cardio - Pulmonary Resuscitation (CPR) • PROCEDURE: • The rescuer should put his mouth over the patient’s open mouth and start blowing to force air into the lungs (actually, it is advisable for rescuer to use a special mask so that the mouths actually do not touch) . • This rescue breathing will aid in the movement of oxygen into the lungs. • In the rescue breathing the unused oxygen from the breath can be used since the air contains 21% of oxygen and only 5% is used for the breath. • After about two breaths, use both hands (one placed over the other) to press on the patient’s chest for a number of times in a row to move the blood out of the heart that has stopped beating.

36. Cardio - Pulmonary Resuscitation (CPR) • This is termed chest compression and it helps to supply oxygen to the vital organs especially the brain. • The brain cells will die if oxygen is not supplied to them soon. • Continue the combination of rescue breathing and manual chest compressions with the mouth and pressing on the chest. • If the patient has a heartbeat, the rescue breath can be continued for many hours. • This may improve the chances of reviving the heart. CPR can be learned by undergoing special training which will be a boon for present day society as medical emergencies have increased drastically.

37. CHOLESTEROL

38. CHOLESTEROL • Cholesterol is a soft, wax-like fatty substance found in all parts of the body. • It is a white crystalline substance found in animal tissues and various foods, normally synthesized by the liver. • Our body needs a little bit of cholesterol to work properly. • But too much cholesterol can be harmful as it forms a fatty plaque which can clog your arteries, reduce their circumference and lead to heart disease. • Some cholesterol is considered "good" and some is considered "bad”. • Cholesterol has to be transported through the blood and the carriers are called Lipoproteins.

39. CHOLESTEROL • There are two different types of lipoproteins • 1. Low Density Lipoproteins (LDL) • 2 High Density Lipoproteins (HDL) . • Lipoproteins are a combination of fat and proteins. • LDL has more fat, less proteins, is called bad cholesterol, forms plaque in the arteries and is the cause of heart diseases. • By contrast, HDL has more protein, less fat, is termed good cholesterol, and it carries cholesterol to the liver and out of the body. • HDL avoids the formation of plaque and heart diseases. • Different blood tests are needed to individually measure each type of cholesterol.

40. CHOLESTEROL • Normal Value: The normal values of cholesterol are Total Cholesterol: • Desirable: Under 200 milligrams per deciliter (mg/dL), • Borderline high: 200 to 239 mg/dL , • High risk: 240 mg/dL and higher • Low Density Lipoproteins (LDL, bad cholesterol) • Optimal: Less than 100 mg/dL, • Near/Above optimal: 100 mg/dL to 129 mg/d, • Borderline high: 130 mg/dL to 159 mg/dL, • High: 160 mg/dL to 189mg/dL, • Very high: 190 mg/dL.

41. CHOLESTEROL • High Density Lipoproteins (HDL, good cholesterol) • Low: Less than 40mg/dL. • High: Above 60 mg/dL (may lower the rate of Heart diseases) Women tend to have a higher HDL due to Estrogen (needs to be over 50 mg/dL), • Triglycerides: • Normal: less than 150 mg/dL, • Border line high: 150 mg/dL to 199 mg/dL, • High: above 200 mg/dL

42. CHOLESTEROL • Abnormal results: • In general, a total cholesterol value over 200 mg/dL may mean you have a greater risk of heart disease. • However, LDL levels are a better predictor of heart disease, and they determine how your high cholesterol should be treated. • High Cholesterol levels may be caused by: • Biliary cirrhosis familial hyperlipidemias, high fat diet, hypothyroidism, nephrotic syndrome & uncontrolled diabetes. • Low cholesterol levels may be caused by: • Hyperthyroidism, liver disease, malabsorption (inadequate absorption of nutrients from the intestinal tract) malnutrition. • Experts recommend that you have a complete cholesterol and triglycerides analysis every 5 years starting at age 20. • The total cholesterol test is usually done as part of a lipid profile, which also checks for LDL, HDL, and triglycerides.

43. CHOLESTEROL • Risk Factors: • Overweight and obesity, • hypertension and diabetes (type II), • family inheritance excessive bleeding, • hematoma and infection. • Special considerations • Any acute illness can raise or lower your total cholesterol number. • If you have had an acute illness in the 3 months before having this test, you should have it repeated in 2 or 3 months. • Even a flare up of arthritis can affect your cholesterol level.

44. CHOLESTEROL • Other conditions associated with high cholesterol: • Pregnancy & Removal of ovaries. • Prevention of high cholesterol: • Eating healthy diet, • keep body weight under normal range, • maintain normal levels of hypertension and diabetes, • do not smoke, • exercise every day for 30 minutes, • monitor cholesterol levels regularly.

45. DIABETES

46. DIABETES • Diabetes: • is caused by the non-functioning of one of the organs in the body, the pancreas. • The pancreas is an elongated, tapered organ located across the back of the abdomen, behind the stomach. • The endocrine tissue of this organ secretes the hormone insulin which regulates the level of glucose in the blood, oxidizes it and releases energy. • The deficiency of insulin or the inability of body cells to use the available insulin causes the accumulation of glucose in the blood causing the symptoms of diabetes.

47. DIABETES • Mechanism of Diabetes: • After taking food, the concentration of glucose in the blood rises. • Insulin prevents the glucose concentration from rising above the normal or physiological limit. • Thus, the most important and obvious function of insulin is to control the concentration of glucose in the blood. • If insulin is absent or inadequate, the glucose in the blood can’t enter various cells and also can’t be converted into glycogen. • Consequently, blood glucose level rises. • When this blood passes through the kidneys, excess sugar (beyond the capacity of the kidneys to stop) spills into the urine.

48. DIABETES • TYPES OF DIABETES • Most cases of diabetes are due to two major types, • Insulin-dependent diabetes Mellitus (IDDM) also known as Juvenile diabetes or Type I, • Non-insulin-dependent diabetes Mellitus (NIDDM) or Type II. • Type I is due to the inability of body cells to use available insulin.

49. DIABETES • TYPES OF DIABETES • IDDM (Type I) Diabetes • More common in childhood and young adulthood, Patients are underweight; • Patients are prone to frequent infection; • Patients require lifelong insulin support. • Complications like diabetic coma are common if insulin is inadequate. • Accounts for 3-7% of diabetic cases.

50. DIABETES • TYPES OF DIABETES • NIDDM (Type II) Diabetes • More common in later life, generally after 40 years; Frequently associated with obesity. • Generally asymptomatic; Mostly Hereditary; • Treated usually with diet control, exercise and oral drugs when needed; • Diabetic coma is rare; • Accounts for about 90-95% of diabetic cases.