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electrical conduction of the heart

The flow of electrical current causes smooth, coordinated heart contractions; they produce pumping action of the heart

Depolarization

electrical charges on the surface of the muscle cell change from positive to negative

Repolarization

the heart returns to its resting state, and the positive charge is restored to the surface

Where do the electrical impulses begin?

Electrical impulses begin high in the atria in the sinoatrial node, travel to the atrioventricular node and bundle of His, and then move through the Purkinje fibers to the ventricles

Three types of muscle

skeletal, cardiac, smooth

Skeletal muscle

Voluntary muscle/Striated muscle (characteristic stripes): Movement of the body like waving or walking/ Skeletal muscle is attached to the bones of the skeleton

Smooth muscle

Found within blood vessels and intestines

Cardiac muscle

found only within the heart and is able to create and conduct its own electrical impulses

Ligaments

Connect bone to bone

Tendons

Ropelike structures that connect muscles to bones

Cartilage

Smooth connective tissue that covers the ends of bones at mobile joints

Anatomy of lower airway: delivers oxygen to alveoli

Trachea (windpipe): conduit for air entry into the lungs; divides at the carina into two main stem bronchi, right and left

Bronchioles: dilate and constrict as oxygen passes through them

Small bronchioles connect to alveoli: site of oxygen and carbon dioxide exchange

Thyroid cartilage (adam's apple): forms the anterior part of the larynx

Cricoid cartilage: immediately below the thyroid

Cricothyroid membrane

Anatomy of upper airway

Nose, Mouth (Oral Cavity), Jaw (mandible), Tongue, Pharynx, and Larynx (Voice Box)

The Larynx

Does not tolerate any foreign or liquid material and any contact will result in a violent episode of coughing

The nose and mouth lead to the?

Oropharynx (throat)

The pharynx is composed of the?

nasopharynx, oropharynx, laryngopharynx

The nostrils lead to the?

Nasopharynx (above the roof of the mouth and soft palate)

The mouth leads to the?

oropharynx

Two passages that are located at the bottom of the pharynx are?

the trachea (windpipe) and the esophagus (carries food to the digestive system)

The two lungs are held in place by

trachea, arteries and veins, pulmonary ligaments

Right lung's lobes

The right lung has upper, middle, and lower lobes

Left lung's lobes

The left lung has upper and lower lobes

Anatomy of the lung

Coronal plane

front and back

Transverse (axial) plane

Top and bottom

Saggital (lateral)

Left and right

Midsagittal (midline)

Left and right (equal halves)

Blood flow through the heart

Super Vena Cava --> Rt atrium --> Tricuspid --> Rt ventricle --> Pulmonic valve --> Lungs --> Lt atrium --> Mitral valve --> Lt ventricle --> aortic valve --> aorta --> Body

The right (slower pressure) side of the heart pumps blood from the body through the lungs

The left (high pressure) side of the heart pumps oxygen-rich blood to the rest of the body

Arteries

carry blood away from the heart

Veins

Blood vessels that carry oxygen-poor blood back to the heart

Central pulses

Carotid artery pulse (at the upper portion of the neck)

Femoral artery pulse (in the groin)

Peripheral pulses

Radial artery pulse (at the wrist at the base of the thumb)

Brachial artery pulse (on the medial aspect of the arm, midway between the elbow and the shoulder)

Posterior tibial artery pulse (posterior to the medial malleolus) - in the inside of the ankle)

Dorsalis pedis artery pulse (on the top of the foot)

White blood cells

Fights infection

Red blood cells (hemoglobin)

transports oxygen

Plasma

Transports carbon dioxide

Plasma (water)

transports wastes and nutrients

Platelets

clotting (coagulation)

Chemicals within the plasma

controls (buffer) pH

Organs in the right upper quadrant (RUQ) of abdomen

Liver, gallbladder, and a portion of the colon

Organs in the left upper quadrant (LUQ) of abdomen

stomach, spleen, and a portion of the colon

Organs in the right lower quadrant (RLQ) of abdomen

contains two portions of the large intestine (cecum and ascending colon); the appendix is attached to the lower cecum

Organs in the left lower quadrant (LLQ) of abdomen

contains the descending and sigmoid portions of the colon

Cardiac output (CO)

the amount of blood moved in 1 minute

HR x SV = CO

Stroke volume (SV)

the amount of blood moved by one beat

Functions of blood

perfusion, transporting oxygen, transporting carbon dioxide, transporting wastes and nutrients, and clotting

Liver

Production of bile

Assists with carbohydrate, protein and fat metabolism of nutrients within the bloodstream

Manufactures proteins for immune regulation and clotting

Detoxification of blood

Elimination of waste

Pancreas

Exocrine: enzymes for protein, carbohydrate and fat breakdown

Endocrine: (islets of Langerhans) produces insulin and glucagon to regulate the amount of glucose in the blood

Bile ducts

Connects the liver to the intestine

The major function of bile is the digestion of fat

Gallbladder

stores and concentrates the bile produced in the liver

urinary system

Eliminates nitrogenous wastes from the body.

Regulates water, electrolyte and acid-base balance of the blood.

Diffusion

Movement of molecules from an area of higher concentration to an area of lower concentration.

Ventilation

the physical act of moving air into and out of the lungs

Oxygenation

the process of loading oxygen molecules onto hemoglobin molecules in the bloodstream

Respiration

the actual exchange of oxygen and carbon dioxide in the alveoli as well as the tissues of the body

Inhalation

The active, muscular part of breathing

The diaphragm and intercostal muscles contract, allowing air to enter the body and travel to the lungs. The chest expands

Thoracic cage expands and air pressure within the thorax decreases, creating a vacuum

When air pressure outside equals air pressure inside, air stops moving. Gases, such as oxygen will move from an area of higher pressure to an area of lower pressure until the pressures are equal.

Activated Charcoal

Action: absorbs toxic substances in digestive tract

Indications: most oral poisonings

Contraindications: decreased LOC; overdose of corrosives; causatics (substances such as acid or an alkali), or petroleum substances

Side effects: nausea, vomiting, constipation, black stools

Dose: adult dose is 1-2 g/kg of body weight (divide weight in lb by 2.2)

Spinal column (total 33 bones)

Cervical spine (first 7)

Thoracic spine (next 12)

Lumbar spine (next 5)

Sacrum (5)

Coccyx (4)

Aspirin (Bayer, Acetylsalicylic or ASA)

Action: anti-inflammatory

Indications: Relief of mild pain, headache, muscle aches; chest pain of cardiac origin

Contraindications: hypersensitivity; pre-existing liver damage; bleeding; asthma (relative)

Dose: Adult dose is 160-325 mg for chewable and tablet

Side effects: nausea, vomiting, stomach pain, bleeding, allergic reaction

MDI medications (Albuterol, Proventil, Ventolin)

Action: stimulates nervous system, causing bronchodilation (increase flow to lungs)

Indications: Asthma/difficulty breathing with wheezing

Contraindications: hypersensitivity, tachycardia, chest pain of cardiac origin

Dose: Adult dose is 1-2 inhalations; wait 5 mins before repeating dose

Side effects: hypertension, tachycardia, anxiety, restlessness

Epinephrine (EpiPen)

Action: stimulates nervous system, causing bronchodilation

Indications: Anaphylactic reaction

Contraindications: chest pain of cardiac origin, hypothermia, hypertension

Dose: 0.3 mg for adult; 0.15 mg for children

Side effects: hypertension, tachycardia, anxiety, restlessness

Naloxone (Narcan, EVZIO, auto-injector)

Action: Reverses respiratory depression secondary to Opioid overdose

Indications: Opiod poisoning

Contraindications: hypersensitivity

Dose: Adult dose is 2 mg Intramuscular or IN

Side effects: nausea, vomiting

Nitroglycerin (Nitrostat, Nitromist)

Action: Dilates blood vessels

Indications: chest pain of cardiac origin

Contraindications: hypertension, use of sildenafil (Viagra) or another treatment for erectile dysfunction

Dose: 0.3-0.4 mg SL; 0.4 mg spray

Side effects: Headache, burning under tongue, hypertension, nausea

Oral glucose

Action: Provides glucose for cellular use

Indications: low blood glucose (hypoglycemia)

Contraindications: decreased LOC, nausea, vomiting

Dose: 1/2-1 tube

Side effects: vomiting, nausea

Acetaminophen (Tylenol)

Action: analgesic and fever reducer

Indications: relief of mild pain or fever, headache, muscle aches

Contraindications: hypersensitivity

Dose: 500-1,000 mg every 4 hours as needed; dose is weight-based for children

Side effects: allergic reaction

Diphenhydramine (Benadryl)

Action: Antihistamine (blocks histamine)

Indications: mild allergic reaction

Contraindications: Asthma, glaucoma, pregnancy, hypertension

Dose: 25-50 mg

Side effects: sleepiness (can stimulate children), dry mouth and throat

Ibuprofen (Advil, Motrin, Nuprin)

Action: nonsteroidal anti-inflammatory that reduces inflammation and fever

Indications: mild pain or fever, headache, muscle aches

Contraindications: hypersensitivity

Dose: adult dose is 200-400 mg every 4-6 hours; dose is weight-based for children

Side effects: nausea, vomiting, stomach pain, bleeding, allergic reactions

Exhalation

diaphragm relaxes (moves up)

The size of the thoracic cage decreases, then air in the lungs is compressed into a smaller space

Air pressure becomes higher than the outside pressure, and the air is pushed out through the trachea

Tidal volume

the amount of air (in mL) that is moved in or out of the lungs during one breath

Residual volume

the air that remains in the lungs after maximal expiration

Minute volume

the volume of air moved through the lungs in 1 minute; calculated by Tidal volume X respiratory rate

Dead space

the portion of the tidal volume that does not reach alveoli and thus does not participate in gas exchange

Metabolism (cellular respiration)

The biochemical processes that result in production of energy from nutrients within the cells.

Respiration

the process of exchanging oxygen and carbon dioxide. Occurs by diffusion, in which a gas moves from an area of greater concentration to an area of lower concentration

External Respiration (pulmonary respiration)

the process of breathing fresh air into the respiratory system and exchanging oxygen and carbon dioxide between the alveoli and the blood in the pulmonary capillaries

Surfactant

A liquid protein substance that coats the alveoli in the lungs, decreases surface tension and keeps the alveoli expanded to make gas exchange easier

A low level in the premature infant contributes to respiratory distress syndrome

anaerobic respiration

Respiration in the absence of oxygen. This produces lactic acid, and can't meet the metabolic demands of the cell

aerobic respiration

Respiration that requires oxygen, where cells convert glucose into energy

Ventilation/Perfusion Ratio and Mismatch

Air and blood flow must be directed to the same place at the same time (ventilation aka air flow, V and perfusion aka blood flow, Q must be matched)

When ventilation is compromised but perfusion continues, blood passes over some alveolar membranes without gas exchange taking place. Carbon dioxide is recirculated within the blood stream, which could lead to hypoxemia

When blood flow is compromised, less oxygen is absorbed in the blood stream and less carbon dioxide is removed

Intrapulmonary shunting

blood entering the lungs from the right side of the heart bypasses the alveoli and returns to the left side of the heart in an unoxygenated state

Respiratory compromise

The inability of the body to move gas effectively.

Epiglottis

A flap of tissue that seals off the windpipe and prevents food from entering.

Pharynx

throat; passageway for food to the esophagus and air to the larynx

Composed of the nasopharynx, oropharynx, and laryngopharynx

nasopharynx

filters out dust and small particles, humidifies air as it enters the body

oropharynx

entrance for respiratory and digestive system

what is in the lower airway

trachea (esophagus and epiglottis), bronchi, bronchioles, alveoli, cricoid cartilage, cricothyroid membrane

what does the Coronary artery supply?

Supplies the heart

What does the Carotid artery supply?

supplies the head

What does the hepatic artery supply?

Supplies the liver

What do the renal arteries supply?

Supplies the kidneys

what do the mesenteric arteries supply?

Supplies the digestive system

what do the Pulmonary arteries supply?

Carrie's oxygen poor blood to the lungs

Snoring breath sounds

These suggest an obstruction or narrowing of the lower airways

Wheezing breath sounds

These suggest an obstruction or narrowing of the lower airways.

Wheezing is a high-pitched whistling sound that is most prominent on expiration.

Crackling breath sounds (rales)

Wet, crackling breath sounds that indicate fluid in the lungs

Rhonci breath sounds

Congested breath sounds that suggest mucus in the lungs

Stridor breath sounds

high-pitched, harsh sound caused by a spasm or swelling of the larynx or an obstruction in the upper airway

Spleen

filters out old red blood cells, produces some white blood cells, and removes pathogens and antigens your body has already attacked and killed

Factors that impair ventilation

blocked airway

impairment of the breathing muscles

obstructed airway (asthma)

chest trauma

change in altitude

change in atmosphere

allergic reaction

impairment of movement of gas in cell membranes

What are the pump failure types of shock?

Cardiogenic shock

Obstructive shock

what are the poor vessel types of shock?

Anaphylactic shock

Psychogenic shock

Neurogenic shock

Septic shock