Chapter 6 Emergency Care and Transportation of the Sick and Injure

Physiology

the functions of the body or any of its parts

Pathophysiology

describes how normal physiologic processes are affected by disease

Topographic anatomy

superficial landmarks of the body

*Surface of the body has many definite visible features that serve as guides to the structures that lie beneath them

Anatomic position

position of reference in which the patient stands facing you, arms at the side, with palms of the hands forward

*common starting point for health care providers

*directional terms from patient's perspective

Planes of the body

anatomic planes

3 main axes of body: coronal (frontal), transverse (axial), sagittal (lateral)

planes help you identify the location of internal structures, relationships between and among organs

Coronal plane or frontal

divides the body into a front and back portion

transverse plane or axial

divides the body into a top and bottom portion

Sagittal Plane or lateral

divides the body in left and right, but not equal portions

midsagittal plane

Type of Sagittal plane

body is divided into EQUAL left and right

nose and navel found along line midline

Skeletal System

divided into 2 portions: axial and appendicular

Skeleton

physiology does...

1)Gives the body its recognizable form

2)protects vital organs

3)allows motion of body

4)storage of calcium

5) helps with creation of various type of blood cells

206 bones make up

Ligaments

Tendons

cartilage

connects bone to bone

connects muscle to bone

cushion between bones

Axial Skeleton

Skull, facial bones, thoracic cage (chest or rib cage), vertebral column

*forms foundation to which arms and legs are attached

Appendicular skeleton

arms, legs, their connection points, pelvis

Axial Skeleton

SKULL

composed to 2 groups of bones: cranium (4) and facial bones (14)

Axial Skeleton

Cranium bones

composed of a number of thick bones fused together to form a shell above eyes and ears, holds and protect brains

Occiput bones (most posterior portion)

temporal bones (lateral portions)

parietal bones

frontal bone (forehead)

foramen magnum (grand opening)

large opening at the base of skull, how the brain connects to the spinal cord

Axial Skeleton

Facial bones

maxillae - non moveable jawbone

zygomas-cheek bones

mandible-lower moveable portion of jaw

orbit- eye socket, made up of maxilla & zygoma

nose- very short bones, and flexible cartilage

Axial Skeleton

Spinal Column

central supporting structure of body

33 vertebrae (singular- vertebra)

numbered top to bottom

spine divided into five sections

Intervertebral disk

the cushion inbetween vertebrae

trunk forward- FLEX

trunk back-Extend

SPINAL COLUMN

Cervical spine (cervical vertebrae 7)

C1-C7 neck form

skull rests on and attaches to both first (atlas) and second vertebra (axix)

move separately, allowing head to turn

SPINAL COLUMN

Thoracic spine (thoracic vertebrae 12)

next 12. one pair of ribs is attached to each of thoracic vertebrae

SPINAL COLUMN

lumbar spine (lumbar vertebrae 5)

next 5 vertebrae

SPINAL COLUMN

sacrum (sacral vertebrae 5)

fused together to form one bone --->Sacrum

joined to pelvis

SPINAL COLUMN

coccyx (coccygeal vertebrae 4)

tailbone

last 4 vertebre

fused together

tailbone

Spinal cord EMT note

you must use extreme caution in caring for patients with any spinal injury to prevent further spinal cord injury

Axial Skeleton

Thorax (chest)

contains heart, lungs, esophagus, great vessels

formed by 12 thoracic vertebrae T1-T12, 12 ribs

midline of chest- sternum

Axial Skeleton

Thorax (chest)

STERNUM

location trachea enters chest

made up: manubrium

body

xiphoid process (narrow, cartilaginous tip)

Appendicular Skeleton

Joint (articulation) & joint vocab

*where bones come into contact

*consists: end of bones, fibrous joint capsule, snyovial membrane and ligaments

*degree to which joint can move determined by how the ligaments hold the bone ends an by the configuration of the bones themselves

joint capsule-fibrous sac hold bone ends together

articular cartilage- end of bones in moving joints

synovial fluid-thick lubricant

synovial membrane- inner lining of joint capsule

Joint

Symphysis

joints that that have slight, limited motion in which bone ends are held together by fibrous tissue

Joint

Saroilliac

joint surrounded by tough, thick ligaments, little motion

Joint

ball-and socket-joint

allows rotation and bending

example-shoulder

wrist (modified)

joint

hinge joints

no rotation possible

finger joints, elbow, knee

motion is flexion (bending) and extension (straightening)

EMT note

when a joint is forced beyond its limits, either bones that form will break, or supporting capsule and ligaments will be disrupted

Appendicular Skeleton

Upper extremities

extend from the shoulder girdle to fingertips, composed of arm, forearms, hand, and fingers

joints:shoulder, elbow, wrist, fingers

Appendicular Skeleton

Upper extremities

Shoulder Girdle

3 bones come together allowing arm to move: clavicle (collar bone), scapula (shoulder glade), and humerus

Appendicular Skeleton

Upper extremities

arm p. 184

humerus (supporting bone from shoulder to elbow)

ulna (larger proximal forearm helps to form elbow joint-medial, little finger side)

radius (larger distal forarm, lies on lateral-thumb side

Appendicular Skeleton

Upper extremities

Wrist

modified ball and socket joint

formed by ends of the radium and ulna, other small bones

8 bones in wrist called CARPALS

Appendicular Skeleton

Upper extremities

Hand

anterior surface- palm

back-dorsal surface

metacarpals (palm)

fingers- phalanges (thumb, 2, four digits, 3)

Appendicular Skeleton

Upper extremities

Pelvis

closed bony ring

consists of:

sacrum

ilium (PICTURED)

ischium

pubis

pubic symphysis (the left and right pubis joined)

acetabelum-where ilium, ishium and public bones met

emt note, pelvis

pressure on the pubic symphysis during examination can reveal fractures in pelvis

*these fractures can lead to life threatening bleeding

Appendicular Skeleton

lower extremities

thigh (femur), knee, leg (fibula, tibula)

femoral head- round structure, connects femor to pelvic girdle by ball-and-sock joint

femer-thigh bone, strongest, longest in body

greater/lesser trochanter

knee- patella (knee cap)-joint connects lower and upper

tibia- lies anterior of leg, larger bone, can palpatate entire surface

fibia- lies on lateral side, palpate head of fibia lateral knee joint

ankle

hinge joint, flexon and extension

foot

contains 7 tarsal bones, five metatarsal

bottom is plantar surface

top is dorsom

toes- formed by 11 phalanges

Musculoskeletal system

refers to the bones and voluntary muscles of the body

protects vital organs

physiology:

1) ability to move

2) able to manipulate environment by contracting and relaxing

3 types of muscles

skeletal (voluntary)l- attaches to the bones of the skeleton

smooth- within blood vessels and intestines (intestines)

cardiac- only within heart

skeletal muscle (p. 187)

voluntary- under direct control of brain

stimulated to contract or relax

striated

principle of antagonistic pairs (bicup and tricep)

bicups

anterior aspect of the humerus

moves the lower part of the arm toward the head

helps slow movement of triceps extending arm

triceps

called three- headed muscles of the arm, three bundles of muscles

homeostasis

a balance of all systems in body

Respiratory System

process of breathing, structures of body that contribute to respiration

*primary purpose is to provide a pathway for air to reach the alveoli

*provide body with O, elimiate CO2

*controls the PH of blood

Respiratory System

*"airway", passage above the larynx (voice box)-dividing line btn upper/lower airway

*located anteriorly and at midline

*consists of:

nose- filter, humidify air

mouth-oral cavity-air enters more directly, less moist

tongue

jaw-mandible

pharyx-composed of nasopharynx, oropharynx,

larynx-voice box-complete arrangement of tiny bones, cartilage, musles, 2 vocal cords. if foreign object --> violent coughing (spasms)

Epiglottis (upper airway)

protects opening of the trachea, thing leaf-shaped flap

Lower Airway

Adams apple- thyroid cartilage, part of the anterior part of the larynx

cricothryoid membrane-felt depression in the midline of the neck inferior to adams apple

Cricoid cartilage-below thyroid cartilage

Trachea- (windpipe), rings of cartilage open in back keep from collapsing, ends at the carina and divides into 2 smaller tubes Bronchi

Lower Airway

lungs

*held in place by trachea, arteries, veins, pulmonary ligaments

*right lung has 3 lobes

*left has 2 lobes

*have no musle

alveoli

*tiny, grapelike sacs at the end of the bronchioles

*exchange of O and CO2 occurs

*functional units of respiratory system

*walls contain pulonary capillaries that carry CO2 from the body to the lungs and the O from the lungs to the body

pluerua

*covers each lung

*smooth glistening tissue

pleural space

*normal conditions, space does not exist

*when blood or air leaks, surfaces separate

*when chest wall expands, lung is filled with and made to expand by the force exerted thru these closely applied pleural surfaces

Muscles of breaching

*breathing requires little muscle effort

*use accessory muscle groups (abs, pectoral) to assist if resistance in airway

diaphragm

*primary muscle

*voluntary (can hold breath) and involuntary (sleep)

*performs automatic function-concentration of CO2 to high, automatic regulation of breathing continues

*dome-shaped divides thorax from the abdomen

inhalation

diaphragm and intercostal muscles contract

diaphragm moves down, enlarging thoracic cage

intercostal moves ribs up

chest cavity enlarges, air rushes into lungs

*called negative pressure breathing

exhalation

*diaphram and intercostal muscles relax

*thorax decrease

*chest cavity decreases, air is compressed

*pressure is increased and pushed out thru trachea

*called passive

respiration vs ventilation

*respiration is the process of gas exchange

*ventilation is simple movement of air between the lungs and the environment, requiring chest rise and fall

Respiration

as blood travels, it gives O and nutrients to tissues and cells

O passes from the the blood to the capillaries to tissue cells

CO2 and cell wast pas from tissue cells thru capillaries to the blood

brain stem controls breathing

exhaled air contains 16 % O, 3-5 % CO2, rest nitrogen 79%

Diffusion

molecules move from an area with ah higher concentration of molecules (the air) to an area of lower concentration (blood stream)

O and Co2 pass rapidly across these thing tissue layer by diffusion

Ventilation

*medulla oblongata primarily responsible, stimulated by high CO2 levels

Tidal volume

amount of air that is moved into or out of lungs during single breath 500ml in adult

Residual volume

the air that remains in the lungs after maximal expiration

minute volume

measure used to assess amount of air that moves in ad out of the lungs in 1 min

measures the depth

minute volume = respiratory rate x tidal volume

this calc helps determine if a patient is breathing adequately

*min volume to low-- need ventilatory assistance

*evaluate the amount of air being moved with each breath

normal breathing characteristics

normal rate, depth (tidal volume)

regular rhythm or pattern of inhalation/exhalation

clear, audible breath sounds on both sides of chest

reg rise and fall movement both sides

movement of the abdomen

adults 12 to 20 breaths/min

children 12 to 40 breaths/min

inadequate breathing patterns

labored breathing (occurs when air movement is impaired)

agonal gasps: ocassional gasping breaths, cardiac arrests-- need chest compressions & ventilation

muscle retractions able clavicles, btn ribs, below the rib cage

pale or blue skin (cyanotic)

cool, damp,skin

tripod position (leaning forward, leaning into arms)

Circulatory system

cardiovascular system

entirely closed

consists of :

systemic circulation

pulmonary circulation

flow of blood through heart and lungs

inferior and superior vena cava

right atrium

right ventricle

pulmonary artery

lungs

pulmonary vein

left atrium

left ventricle

aorta (hearts blood supply)

systemic circulation

portion of circulatory system outside of the heart and lungs

pulmonary circulation

the flow of blood from the right ventricle thru the pumoney arteries and all of their branches and capillaries in the lungs and back to the left atrium thru the venules and pulmonary veins; also called the lesser circulation

heart

*hollow muscle organ appropriately the size of a fist

*myocardium (cardiac muscle)

upper- atrium

lower- ventricle

left side- pumps blood into body, high pressure

right side-supplies blood to the lungs, low-pressure pump

own electrical system

*can tolerate interruption of blood supply for only seconds before heart attack

heart

circulation

blood supply from AORTA-->branches into coronary arteries which supply the heart muscle with oxygenated blood

right side of heart receives blood from the veins of the body

left side receives oxygenated blood from the lungs thru the pulmonary veins

*flow of blood thru the four heart chambers is governed by one-way valves

Normal heart rate

resting adult 60-100 beats/min

at each beat- 70 to 80 mL of blood is ejected

in one min- 5 to 6 ml circulated thru all vessels

Heart rate (HR) number heart beats per minute

stroke volume (SV) amount of blood moved in one beat

cardiac output (CO) amount of blood moved in 1 minute

CO= HR x SV

Heart

Electrical conduction system

*contractions produce pumping action

*a network of tissue that conducts an electrical current

*2 processes: deploarization and reploarization

*when injured, heart will not beat properly, low blood pressure, loss of consciousness, cardiac arrest

Arteries

Carry blood from heart to body tissues

aorta is main artery leaving back left of the heart, carries O -rich blood to body

pulmonary artery from heart carries O depleted blood to lungs

arteries brand into smaller arteries ARTERIOLES

Pulse

*palpated easily at neck, wrist, or groin

*felt most easily where larger arteries near skin can be pushed against a solid structure like a bone or muscle

*forceful pumping of blood out of left ventricle and into major arteries

capillary vessels

fragile divisions of the arterial system that allow contact btn the blood and the cells of the tissues

Veins

*blood returns to heart

*have much thinner walls than arteries and larger in diameter

two major vessels: superior and inferior vanae cavae

Spleen

*all blood passes thru and is filtered

*assists in immune response

*most frequently injured abdominal organ, can lead to several internal bleeding

*blunt trauma -under flexible lower ribs

blood composition

Plasma-yellow fluid carries blood cells and nutrients

red blood cells- contain hemoglobin, color, carries oxygen

white blood cells- bodys immune defense mechanisms again infection

platelets- disc-shaped, initial formation of blood clot (stop bleeding)

(p 204) in body:

adults blood- adults 6L

children 2 to 3L

infants 300 mL

Blood Pressure BP

Cardiovascular pressures (chart pg 204)

pressure the blood exerts against the walls of the arteries

SYSTOLE: left ventricle contracts, high point of pressure wave

DIASTOLE: ventricle relaxes, fills with blood, low point

high and low points of wave measured with sphygmomanometer (blood pressure cuff)

shock

*hypoperfusion

*state of inadequate circulation

*Perfusion- circulation of blood in an organ or tissue in adequate amounts to meet the cells current needs

*loss of blood pressure is an indication that blood is no longer circulating efficiently to every organ

*cells, tissues, organs may die

inadequate circulation

"stroke forumla" as blood pressure fails, pulse increases in an attempt to keep cardiac output costantat 5-6L/min. shock=fails

MAP= CO (HR x SV) x SVR

mean arterial pressure

co cardiac output

SVR systemic vascular resistance

functions of blood

30 percent of blood in heart arteries and capillaries

heart, arteriels= high pressure

veins=low pressure

blood from artery- gush

blood from vein- flows in a steay stream

Nervous system

anatomically :

Central NS (brain, spinal cord)

Peripheral NS (nerves outside of above)

functioning

somatic- regulates activites over which there is voluntary control (walking)

autonomic- body systems non-voluntary including digestion

brain CNS

controlling organ of body

cerebrum: largest, gray matter 3/4 volume

cerebellum: little brain, body movements

brain stem: controlling center body functions necessary for life (cardiac, consciouness, respiratory

cerebrospinal fluid- if leaking from nose/ears-->skull fracture

spinal cord: an extension from the brain stem, transmit messages btn brain and the body

PNS

Somatic nervous system-

Autononic nervous system-

sympathetic nervous system- emergency functions, fight or flight

parasympathetic -slows down body, non emergency functions

sensory nerves

the nerves that carry sensations such a touch, smell, heat, cold and pain from the body to the central nervous system

*goes to the brain.

motor nerves

carry information FROM the brain to the muscles of the body

*each muscle has its own mtor nerve

integumentary system

in order

epidermis-outermost layer, holds pigment

dermis- special structures- sweat glands, oil glands, hair folicles, blood vessels

subcutaneous tissue-composed largely of fat, helps anchor the skin to muscles below , loss of this layer causes wrinklees

digestive system

abdomen

*disgesting- mouth- anus

2nd major body cavity

formed by quadrants

LUQ

Somach, portio of colon, spleen

LLQ

sigmoid portions of colon

RUQ

liver, gall bladder, portion of colon

RLQ

appendix, 2 portions of large intestine

pancreas- lies in both top quadrants

bladder- lies in both lower quadrants

small intestines- all four quadrants

digestive path

mouth- mechanically breaks down food

esophagus-moves food from mouth to stomach

stomach-performs chanical and chemical breakdown of food, food in, chyme out

small intestine-major site for cheical creakdown of food

large intestine-water absorptions, formation of feces, bacterial digestion of food

anus-last portion of large intestine, shincter to control release of feces

liver-production of bile, detox blood, primary organ for the storage of sugar or starch for immediate use

pancreas-insulin and glucagon are produced

gallbladder-storage of bile

lymphatic system

spleen, lymph nodes, lymph

supports the circulatory and immune system

relys on movements of body (no pumps)

respiratory compromise

V/Q ventilation/perfusion mismatch

inability of the body to move gas effectivley, which can result in hypoxia, hypercarbia

when ventilation (movement of air btn lungs and environment)- most common is airway blocked by tongue, or contraction of muscles during asthma attack

respiratory (gas exchange) is impaired by atmosphere, high altitudes, in pneumonia

affects of respiration compromise

O levels fall, CO2 rises

body increases respiratory rate

blood becomes acidic