SBVAC Week 2 Anatomy and Physiology Terms (Revised)

Anatomy

Study of the body and its parts and their relationships to one another.

Physiology

The way a living organism or body part functions

Homeostasis

Maintaining stable equilibrium

What is the normal anatomical position?

Standing, facing forward, arms at sides and palms facing up

All Anatomical Planes

Transverse, Coronal/Frontal, Sagittal, Mid-axillary, Mid-clavicular

Transverse Plane

Divides the body from top and bottom (head-waist and legs)

Coronal/Frontal

Divides the body from front and back

Sagittal

Divides the body into left and right

Mid-axillary

Divides the body in half by your armpit area (middle)

Mid Clavicular

Line down the middle of your clavicular bones

Supine

Position lying on spine, face-up

Prone

Lying flat on chest, face down

Left/Right Lateral Recumbent

Lying on the side

Recovery Position

Left lateral recumbent, laying on left side

Trendelenburg (“shock position”)

Supine with legs raised 6”-12” above head, not used anymore

Fowler’s

Sitting upright in a 90 degree angle

Semi-Fowler’s

Sitting 45 degrees

Tripoding

Bent over with hands on knees, like after running

Superior

Closer to head

Inferior

Closer to feet

Anterior/ventral

Towards the front

Posterior/dorsal

Towards the back

Medial

Closer to the midline

Lateral

Further from the midline

Distal

Farther from the core (original point of limb)

Proximal

Closer to the core (original point of limb)

Superficial

Towards the surface

Deep

Farther from surface

Flexion

Decreasing angle at a joint (Think of contracting)

Extension

Increasing angle at a joint (Think of resting)

Adduction

Moving towards midline/body

Abduction

Moving away from the midline/body

Body Cavities and Separation

Thoracic and Abdominal/Peritoneal, separated by the diaphragm

Retroperitoneal and Pelvic

What organs are in the Thoracic Cavity?

Lungs, trachea, heart, great vessels

Describe the four quadrants of the GI System

Umbilicus divides the cavity into 4 quadrants:

Right Upper: Liver, gallbladder, stomach, pancreas

Left Upper: Spleen, most of stomach, pancreas

Right Lower: Appendix

Left Lower: Small/Large Intestine (Also in all other quadrants)

What organs are in the Retroperitoneal Cavity?

Kidneys, descending aorta (heart), inferior vena cava

What organs are in the Pelvic?

Reproductive Organs and Bladder

Functions of the Skeletal System

Support and Structure, Protection, Movement, Production of Red Blood Cells (RBC), Mineral Storage

What does the Skeletal System consist of? What connects bone-to-bone and muscle-to-bone? How many bones does an adult have?

Ligaments: Connect bone-to-bone

Tendons: Connect muscles to bone

Two Divisions:

Axial Skeleton: Bones of head and trunk

Appendicular Skeleton: Bones of appendages

There are 206 bones in the body made of cartilage!

List out all parts of the skull?

Cranial Bones:

• Frontal

• Parietal

• Occipital

• Temporal

• (FPOT)

Maxilla:

• Upper Jaw Bone

Mandible:

• Lower Jaw Bone

Zygomatic:

• Cheekbone

Foramen Magnum:

• Opening at skull base where brain connects to spinal cord

Describe all vertebrae that the spinal column consists of? What specific vertebrae are important?

33 vertebrae that protect the spinal cord

• C 1-7 (Cervical)

• T 1-12 (Thoracic)

• L 1-5 (Lumbar)

• Sacrum (5 fused vertebrae)

• Coccyx (4 fused vertebrae)

C1 and C2 are the Atlas and Axis. They support and allow skull movement.

C 3,4, and 5 protect the phrenic nerve and “keep the diaphragm alive”

What does the Rib Cage Consist of?

Sternum

• Manubrium, body, xiphoid process

Ribcage: 12 pairs of ribs

• True Ribs 1-7: connect directly to sternum vial costal cartilage

• False Ribs 8-10: connect indirectly to sternum through 7th rib by cartilage

• Floating Ribs 11-12: do not connect to sternum, only to spine

What bones are part of your upper extremities (shoulders, arms, hand)

Shoulder:

• Clavicle, Scapula (shoulder blade), Humerus

Arm:

• Humerus, Radius (Lateral), Ulna (Medial)

Hand:

• Carpals, Metacarpals, Phalanges

What bones are in the Pelvis?

Pelvic Bones (Fused):

• Illium

• Ischium

• Pubis

What bones are in the Lower Extremity (legs and feet)?

Leg Bones:

• Femur

• Patella

• Tibia (anterior) / Fibula (lateral)

Foot:

• Tarsals

• Metatarsals

• Phalanges

What’s the pathway of air flow? (Upper and Lower)

Upper Airway:

• Oro/nasopharynx

• Pharynx

• Epiglottis

• Larynx

Lower Airway:

• Trachea

• Bronchi

• Bronchioles

• Alveoli

• Capillaries

Pathway of Blood through the Heart

• Superior/Inferior Vena Cava

• Right Atrium

• Tricuspid Valve

• Right Ventricle

• Pulmonary Valve

• Pulmonary Artery (Deoxygenated)

• Lungs

• Pulmonary Vein (Oxygenated)

• Left Atrium

• Mitral/Bicuspid Valve

• Left Ventricle

• Aortic Valve

• Aorta (to systemic circulation)

Pathway of Blood through the Body (Systemic)

• Heart (aorta)

• Arteries

• Arterioles

• Capillaries

• Venules

• Veins

• Heart (vena cavae)

What are the three main cardiovascular vessels and what do they do?

Arteries:

• Carry blood AWAY from the heart’s thick, muscular walls, operate at a higher pressure

Veins:

• Carry blood TOWARDS the heart, less muscular walls, operate at a lower pressure, contain valves to prevent backflow

Capillaries:

• Delivers blood to/from tissues/cells, thin walls, 1 cell thick

What are the six main types of pulses?

• Carotid

• Radial

• Brachial

• Femoral

• Posterior Tibialis (inside ankle)

• Dorsalis Pedis (top of foot)

Blood Pressure

Systolic: The pressure against the walls of the arteries as the left ventricle CONTRACTS

Diastolic: The pressure against the walls of the arteries as the left ventricle RELAXES

Pathway of food through GI tract

• Mouth

• Pharynx

• Epiglottis

• Esophagus

• Stomach

• Small Intestine

• Large Intestine

• Rectum

• Anus

What are the three accessory organs in the digestive system?

Liver

• Produces bile(digest fats), lipoproteins for cholesterol, metabolizes food, detoxifies blood, stores vitamins/nutrients

Gallbladder

• Stores bile, secretes it into the small intestine

Pancreas

• Produces enzymes and secretes hormones

What are the layers of the integumentary system (skin)?

Consists of skin and its appendages (ex. hair and nails)

Layers of the Skin:

• Epidermis: Outer Layer, functions as a barrier

• Dermis: Middle Layer, contains blood vessels, nerve endings, hair follicles, sweat and sebaceous glands

• Subcutaneous: Deepest Layer, contains blood vessels and fat for insulation

How is the nervous system broken down? What is in each part?

Central Nervous System:

• Brain and spinal cord

Peripheral Nervous System:

• Sensory (afferent) nerves

  • Carry info from the body towards the brain

• Motor (efferent) nerves

  • Carry info away from the brain to the body

Define hormones and glands

Hormone: Chemical messengers that act on particular organs to stimulate a response

Gland: A group of cells that produce and secrete hormones

What organs are in your urinary system? What is the order in which urine is excreted from, and what does each organ do?

1. Kidneys:

• In the retroperitoneum; filter blood, remove waste, maintain electrolyte and fluid balance, generate urine

2. Ureters:

• Carry urine from the kidney to the bladder

3. Bladder:

• Can hold up to ~700 mL of urine

4. Urethra

• Carries urine from bladder to outside body

What is the Lymphatic System and what does it consist of?

A network of lymphatic vessels that filters blood and produces antibodies

Spleen, thymus, and bone marrow produce lymphocytes (white blood cells)

Lymph: Fluid containing lymphocytes and waste products

Lymph nodes: small tissue masses along lymphatic vessels that house lymphocytes, may swell during infection

What are the layers of the heart?

Please Excuse My E- 😳

Pericardium:

• Sac-like layer surrounding the heart to reduce friction with each heartbeat

Epicardium:

• Outermost layer of the heart

• Thin layer of connective tissue and fat protecting the heart

Myocardium:

• Thick middle layer of the heart

• Pumping muscle that causes heartbeats

Endocardium:

• Innermost layer of the heart

• Thin Lining covering the inner chambers of the heart and valves

Describe the electrical pathways through the Heart and the important nodes.

Sinoatrial(SA) Node

• Heart’s natural pacemaker

• Sends electrical signals to start heart contractions

Atrioventricular(AV) Node

• Delays the SA electrical signal (ensures atrial contraction and blood pumping)

• Located by the tricuspid valve

Bundle of HIS (atrioventricular bundle)

• Carries the electrical signal to the Purkinje fibers

• Branch of fibers extending from the AV node running down the length of the septum

  • Bifurcating/dividing into the left and right bundle branches which run across respective ventricles

Purkinje Fibers

• Quickly sends electrical signals to the heart’s left and right ventricles, causing contraction

What are Arrhythmias?

Any abnormal electrical activity in the heart. Can range from harmless quirks (Sinus Arrhythmia) to deadly ones. It’s often considered a heart disease

Difference between heart attack and cardiac arrest

Heart Attack: Due to Myocardial Infarction (MI)

• Occurs when blood flow to the heart muscle is blocked, causing tissue damage and death

Cardiac Arrest: Sudden and unexpected loss of heart function

• Can be caused by an MI

What are Electrocardiograms (ECG/EKG)? Describe the components of the PQRST wave. Can we interpret ECG results as BLS providers?

Records the electrical activity (as a waveform) of the heart using electrodes placed on skin

Waveform of heartbeat is:

• P-wave: atrial contraction/depolarization

• QRS complex: ventricular contraction/depolarization

• T-wave: ventricular reset/repolarization

As BLS providers we CANNOT interpret these results, must transmit to a physician or ALS member to interpret

12-lead placement (not too necessary to know, but should take time to memorize)

Place Limb Lead/3-lead on arms and leg:

• Right Arm, Right Arm, Left Leg, Left Leg

• Leg refers to the abdomen

V1 at the 4th intercoastal space (ICS) on the right sternum

V2 at the 4th ICS on the left sternum

V4 at the 5th ICS on the mid-clavicular line

V3 midway between V2 and V4

V5 at the 5th ICS on the anterior axillary line

V6 at the 5th ICS on the mid-axillary line

Can be flipped as a “right sided” 12-lead to visualize right side of heart

ICS are spaces below the numbered ribs, 1 being the top rib.

12-lead vs 3-lead

12-lead: Uses 10 electrodes to generate 12 views of the heart and provides a comprehensive diagnostic picture for ischemia, infarction, and arrhythmia b/c it has more electrodes for imaging

3-lead: Uses 3 electrodes for continuous monitoring, used to track heart rate and rhythm, useful for real-time detection of arrhythmia

Paramedics often run 12-lead AFTER 3-lead flags an arrhythmia as the full view guides diagnosis and indicates what advanced interventions can be used.

Sinus Arrhythmia

Harmless electrical disturbance in the heart where it speeds up during inspiration but slows down during expiration, felt by palpation

What does a normal heart rhythm look like and where does it originate?

Equal spacing between beats and decent height, originates from SA

Ventricular Tachycardia (V-Tach) (Waveform and cause)

Ventricles contract quicker than atrial blood can fill them, causing no pulse.

EKG shows a fast regular rhythm, but with wide QRS complexes, and tachyarrhythmia originates in the ventricles. Without intervention, this will lead to death.

Purkinje cells themselves can become the source of an abnormal electrical impulse: Catecholaminergic polymorphic ventricular tachycardia (CPVT)

Shockable rhythm!

Ventricular Fibrillation (V-Fib) (Waveform and cause)

Fibrillation refers to an irregular and rapid beating of the hearts chambers, which fails to pump blood effectively.

Instead of a coordinated depolarization, the ventricular muscle fibers “quiver” or fibrillate independently

Shockable rhythm! (Disorganized rhythm, Chaotic Pattern)

Pulseless Electrical Activity (PEA) (Waveform and cause)

There is no pulse despite electrical activity in the heart, most likely due to muscle death or weakness. Commonly caused by hypovolemia, cardiac tamponade, and hypoxia.

NOT shockable, electrical activity is present, AED doesn’t help

*Note that a PEA may have different rhythms than the picture

Asystole

There is no electrical activity in the heart, rendering defibrillation ineffective. Continue compressions and take to higher care.

NOT shockable, won’t be of any use

Describe the AHA Out of Hospital Cardiac Chain of Survival

• Activation of Emergency Response

• High-Quality CPR

• Defibrillation

• Advanced Resuscitation

• Post-Cardiac Arrest Care

• Recovery

Age Parameters

Neonate: < 28 days

Infant: <1 year old

Child: Between 1 year old and puberty

Adult: Past Puberty

How to do Compressions and Ventilations

Compressions:

• Push Hard (1/3 patient’s chest)

• Push Fast (100-120 BPM), using feedback device or metronome

• Allow full recoil on chest

Ventilations:

• Open airway with head-tilt-chin-lift and insert OPA

• Give 2 quick ventilations

• Good ventilations produce chest rise and are delivered over 1 second

• Rotate compressors every 5 CPR cycles or 2 minutes

What’s the Compression to Ventilation Ratio for adults and pediatrics with 1 and 2 rescuers?

Adults: 30:2

Infants and Children: 30:2 with 1 rescuer, 15:2 with 2 rescuers

What should you do with a patient with an advanced airway?

Ventilations are ASYNCHRONOUS, breaths can be administered during compressions

iGEL is an advanced airway device that improves CCF

Why does Defibrillation work? (For V-Fib and V-Tach)

Shocking with an AED sends a massive depolarizing current, forcing all myocardial cells into a refractory period at once.

This hopefully allows the SA node to restart an organized rhythm, kind of like putting them in time out.

What are some pad placement considerations?

1. Medical patch: Removed with gloved hand and wipe away any residual moisture

2. Hairy Chest: Shave it or “wax” it with additional pads

3. Pacemaker: Place pads below it

4. Adult Pads for Pediatrics: Apply Anterior and Posterior

5. Wet or in water: Pull out of water and dry chest

Witnessed vs Unwitnessed Cardiac Arrest (Diff. between adult and child)

Witnessed

• In an Adult:

  • Activate emergency response and get AED, initiate 5 CPR cycles

• In Infants/Children:

  • Activate emergency response and get AED, initiate 5 CPR cycles

Unwitnessed

• In an Adult:

  • Activate emergency response and get AED, initiate 5 CPR cycles

• In Infants/Children:

  • Perform 5 CPR cycles, then activate emergency response

Difference in infant/children is b/c cardiac arrest in such patients is more likely due to a respiratory issue, their brain has been deprived of oxygen longer.

What are Advanced Directives?

MOLST and DNR are honored by SBVAC, including:

• Signed eMOLST or MOLST form

• Signed NYS-approved document, bracelet, or necklace

• Properly documented nursing home or nonhospital DNR

We CANNOT perform:

• Compressions

• Ventillation

• Defibrillation

• Intubation or resuscitative medical administration

What does ROSC stand for? What should you do if it occurs?

ROSC: return of spontaneous circulation

If it occurs:

• Deliver supplemental O2, continue rescue breathing if the patient regains pulse without adequate breathing

• Take vitals and BGL

• Acquire a 12-lead EKG, send to ALS for transmission

• Perform a full assessment

5 Reasons to STOP or Not Start CPR

1. Patient is obviously dead

2. ROSC occurs

3. Scene is unsafe

4. Valid DNR or MOLST provided

5. After 20 minutes, consider calling medical control for CPR termination

Obvious Signs of Death (TRI EMS 3D) MEMORIZE this

• Rigor Mortis

  • Stiffening of Body caused by chemical changes after death

• Dependent Lividity:

  • Skin discoloration due to blood pooling due to lower body parts from gravity

• Submersion of over an hour

  • Drowning and submersion underwater for >1 hour

• Decomposition:

  • Natural process of organic matter breaking down after death

• Mass Crush injury to vital Area

  • Catastrophic trauma of head or torso with extreme force, causing immediate and often fatal destruction of vital organs and major structures

• Transection:

  • Completely cut through

• Decapitation:

  • Full or partial separation of head from body

• Evisceration of brain matter

  • Brain tissue (white or gray matter) outside skull

• Incineration

  • Bodily destruction through burning

How do Traumatic Arrests occur and what to do? What is “commotio cordis”?

Possible mechanisms due to falls, MVAs, or blunt trauma

Commotio Cordis: Blunt trauma to chest on uprise of T-wave, causing instant v-fib

When performing CPR, try to maintain spinal stability, use Jaw Thurst manuever, and take SMR precuations, like a backboard

What are considerations for hypothermic patients?

• Check pulse and breathing for 60 seconds

  • Vasoconstriction makes pulse harder to feel

  • Dramatically slowed heart rate and respiration may delay accurate reading

• Shock them with 1 time MAX with AED

  • Heart’s electrical velocity affected by the cold, repeated shocks may damage it further

• Dependent Lividity, Rigor Mortis, and Fixed Pupils are NOT obvious signs of death

  • Cold temperatures affect normal bodily systems to appear as such

• Injuries incompatible with life and chest wall rigidity preventing effective chest compressions ARE signs of death

Describe High-quality Chest Compressions

• 100-120 Compressions/Minute

• 1/3 of chest depth

• Full recoil of chest between compressions

• Limit hands off time to less than 10 seconds

What is CCF? What’s the optimal CCF and how can it be failed to accomplish?

Proportion of CPR where high-quality chest compressions are actually being delivered

• Time compressions are performed

• Also synonymous with minimized hands off time

AHA recommends an optimal CCF of greater than 80%

• Threats to this include:

  • Long pulse checks

  • Prolonged intubation attempts

  • Poorly organized provider/team care

Higher CCF: higher ROSC and survival chances

Reversible Causes of Cardiac Arrest

H’s and T’s

H:

• Hypoxia

• Hypovolemia (severe blood plasma loss of dehydration)

• Hydrogen ion (acidosis)

• Hyper/Hypoglycemia

• Hypo/Hyperkalemia

T:

• Tension pneumothorax

• Tompanade (cardiac)

• Toxins

• Thrombosis:

  • Pulmonary embolism

  • Myocardial infarction

Rescue Breathing rates for Adults and Children

Give rescue breathing if patient breathing isn’t enough for them

Adults: 1 breath every 5-6 seconds

Infants and Children: 1 breath every 2-3 seconds

These rates are the same with anyone with advanced airway from ALS

Describe Dual Sequential Defibrillation (not too important, just take a look)

Delivery of two defibrillation shocks simultaneously from two different defibrillators with pads placed in different positions:

• Anterior Lateral Anterior Posterior

Two shocks may depolarize more myocardium cells

Sequence:

1. Apply AED PADS anterior posterior position, don’t delay compressions

2. Shock 3 times using such placement, if the patient is still in a shockable rhythm after second shock, preemptively set up second pair of pads

3. For fourth shock change time in Anterior Lateral pad placement, vector change

4. Shock using both at same time

What does the decision to transport consist of? What is Plat 10 and the Golden Hour?

Decision to transport:

• Load and go: Unstable patient (high priority)

• Play and stay: Stable patient (low priority)

• Plat 10: 10 minutes between on scene arrival and departure

• Golden Hour: 1 hour between time injury and definitive hospital care

Update ALS about patient condition

• Only applicable if they were called in scene size up

• Briefly summarize patient and what you’ve done so far

• Decide on intercept or straight to hospital