Anatomy & Physiology Study Guide for EMS Students PDF

Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 1 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. C...

Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 1 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. About the Authors Adam Peddicord Co-Founder, Pass with PASS, LLC Adam has been a Paramedic since 1998 and started his fire service career in 1993. He is currently the EMS Coordinator and a Captain/Paramedic at Newport (KY) Fire/EMS Department where he also serves as the Medical Commander of the Newport Police Department SWAT Team. He holds multiples Associate’s Degrees along with a Bachelor’s and Master’s Degree in Nursing and is a board-certified Family Nurse Practitioner. As a Nurse Practitioner, Adam has experience in orthopedics and addiction medicine. Adam has over 20 years of experience in EMS education through the University of Cincinnati and Gateway Community and Technical College. Brandon Schoborg Co-Founder, Pass with PASS, LLC Brandon is currently the EMS Education Manager of a hospital and college based EMT/Paramedic Program in Kentucky. Previously, he was the EMS Education Manager for the Columbus (OH) Division of Fire, Director of EMS Education at Cleveland Clinic Akron General, Assistant Paramedic Program Coordinator at a community college in Kentucky and the Assistant EMS Coordinator, Engineer/Paramedic, and SWAT Paramedic with the Newport Fire/EMS Department in Kentucky for 8 years. He began his teaching career at the University of Cincinnati Clermont College. He completed his paramedic education at the University of Cincinnati in 2010. Brandon has an Associate’s Degree in EMS Paramedic, Bachelor’s Degree in Health Science, and a MBA in Healthcare Management. Copyright 2021 - Pass with PASS, LLC 2 2 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are Disclaimer copyrighted. All procedures listed in the study guide should only be performed by appropriately licensed/certified, authorized, and trained personnel as your local government, state, or country allow. Medication dosages may differ across the country, any medication dosages in the study guide are relatively standardized, however, we encourage you to check your local protocol and/or program’s preferred dosages. Copyright © 2021 by Pass with PASS, LLC. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner. Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Pass with PASS, LLC. Although we make every effort to ensure that the material contained within the study guide is current and accurate, we cannot guarantee accuracy. However, please know, that accurate and current study guides is extremely important to us and we continuously review our guides for quality assurance. Copyright 2021 - Pass with PASS, LLC 3 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are Table of Contents copyrighted. 1. Anatomical Terms & Directions 5 2. Cellular Anatomy 7 3. Musculoskeletal Anatomy 11 4. Integumentary System 19 5. Cardiovascular System 21 6. Respiratory System 38 7. Neurology 54 8. Endocrine System 58 9. Reproductive System 63 10. Gastroenterology 67 11. Anatomical Differences 71 Copyright 2021 - Pass with PASS, LLC 4 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 1 Anatomical Terms & Direction Copyright 2021 - Pass with PASS, LLC 5 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 1: Anatomical Terms & Directions Anatomical Terms & Direction Anterior/Ventral → towards the front Posterior/Dorsal → towards the back Superior → above Inferior → below Superficial → near the surface Medial → inside (towards the body) Lateral → outside (away from the body) Proximal → near the center of the body or point of attachment Distal → away from the center of the body or point of attachment Supine → lying on back Prone → lying on stomach Adduction → movement of a limb toward midline of the body Abduction → movement of a limb away from midline of the body Flexion → act of bending a joint Extension → straightening of a joint Copyright 2021 - Pass with PASS, LLC 6 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 2 Cellular Anatomy Copyright 2021 - Pass with PASS, LLC 7 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 2: Cellular Anatomy Cellular Anatomy Cells Foundation or building blocks of the human body The human body is composed of billions of cells Cells work together to maintain homeostasis Homeostasis → the stability of the body’s normal environment/conditions Contains DNA. Lysosomes The garbage collection site of the cell – breaks down debris and bacteria that has entered the cell. Nucleus Largest structure in the cell, serves as the control center of the cell. Cytoplasm Gel-like material that all cellular components rest in. Think of it as the “floor” of the cell. Cytosol is the fluid portion of the cytoplasm – consisting mostly of water. Golgi Apparatus Assists with formation of carbohydrates (sugars) and protein molecules (enzymes). Endoplasmic Reticulum Network of tubes, vesicles and sacs. Rough endoplasmic reticulum builds proteins/smooth endoplasmic reticulum builds lipids (fats). Mitochondrion The “powerhouse” of the cell – Adenosine Triphosphate (ATP) is produced here. Copyright 2021 - Pass with PASS, LLC 8 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 2: Cellular Anatomy Tissues TISSUES A group of cells that work together are called tissues FOUR MAIN TYPES OF TISSUE Epithelial Epithelial Cover body surfaces – skin, internal organs, makes up the glands Connective Connective Muscle Nervous Binds (connects) different types of tissues together. Three types – loose, dense irregular, dense regular. Muscle Striated → Skeletal or cardiac muscle Nervous Specialized to conduct messages to one another in order to prompt a particular response. Copyright 2021 - Pass with PASS, LLC 9 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 2: Cellular Anatomy Nervous Tissue Body’s principal control system Network of cells, tissues, and organs regulate bodily functions via electrical impulses transmitted through nerves Endocrine system: related to the nervous system, exerts control via hormones Circulatory system: assists in regulatory functions by distributing hormones and chemical messengers Dendrites: Receive chemical messages from other neurons – messages then converted into impulses Synapse: Connects here messages (impulses) to other neurons Synapse: Small gaps that separate neurons (between axon of one neuron and the dendrites of the other) Soma: Central cell body Axon Terminal: Buds at end of axon from which chemical messages (impulses) are sent Axon: Sends Copyright 2021 - Pass with PASS, LLC 10 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 3 Musculoskeletal Anatomy Copyright 2021 - Pass with PASS, LLC 11 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: Musculoskeletal Anatomy Major Bones 206 Total Bones Copyright 2021 - Pass with PASS, LLC 12 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: Musculoskeletal Anatomy The Skull Important Structures of the Skull Cranium → rigid and fixed in space Foramen Magnum → largest opening of the skull, spinal cord exits through this opening; this is site of brainstem herniation Cribriform Plate → inferior aspect of skull (“base”); rough surface, brain can easily be injured. Cribriform Plate Foramen Magnum Copyright 2021 - Pass with PASS, LLC 13 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: Musculoskeletal Anatomy Spinal Cord Meninges: Main job is to protect or “PAD” Pia Mater: innermost layer, directly on CNS Arachnoid Mater: middle layer, web-like (arachnoid = spider) Dura Mater: Outermost layer (“durable”) T h e s Cervical Spine: 7 vertebrae p i n Autoregulation: e h Changes in ICP result in a compensation s 3 3 Increased ICP = Increased BP t This causes ICP to rise higher and o Thoracic Spine: 12 vertebrae t the BP to rise a l v e r t e b Monroe-Kellie Doctrine r a Expanding mass inside cranial e vault; displaces CSF. If pressure increases, brain tissue is displaced Lumbar Spine: 5 vertebrae Sacral Coccyx Spine: 4 vertebrae Spine: 5 vertebrae Copyright 2021 - Pass with PASS, LLC 14 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: Musculoskeletal Anatomy Spine & Vertebrae Anatomy Spinal Cord Nerve Roots Vertebral Body Disc Cervical Spine 7 Vertebrae Sole support for the head → Head weighs 16 – 22 pounds C1 (Atlas) Supports the head, securely affixed to the occiput, permits nodding C2 (Axis) Odontoid Process (Dens), projects upward, provides pivot point so head can rotate Copyright 2021 - Pass with PASS, LLC 15 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: Musculoskeletal Anatomy Thoracic Spine 12 Vertebrae Larger and stronger than cervical spine Larger muscles help to ensure the body stays erect Supports movement of the thoracic cage during respirations Lumbar Spine 5 Vertebrae Largest and thickest vertebral bodies and intervertebral discs Bear forces of bending and lifting above the pelvis Copyright 2021 - Pass with PASS, LLC 16 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: Musculoskeletal Anatomy Sacral Spine 5 fused vertebrae Form posterior plate of pelvis Attaches pelvis and lower extremities to axial skeleton Helps protect urinary and reproductive organs Coccygeal Spine 3 – 5 fused vertebrae Residue elements of a tail Copyright 2021 - Pass with PASS, LLC 17 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 3: Musculoskeletal Anatomy Dermatomes Topographical region of the body surface innervated by one nerve root Sensory deficits occur in the regions that correspond to the particular nerve root Key Locations: Collar region: C3 Little finger: C7 Nipple line: T4 Umbilicus: T10 Small toe: S1 This Photo by Unknown Author is licensed under CC BY Copyright 2021 - Pass with PASS, LLC 18 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 4 Integumentary System Copyright 2021 - Pass with PASS, LLC 19 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 4: Integumentary System The Skin Epidermis Dermis Subcutaneous Copyright 2021 - Pass with PASS, LLC 20 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 5 Cardiovascular Anatomy Copyright 2021 - Pass with PASS, LLC 21 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Key Terms Ejection Fraction: Percentage of blood ejected (%) Normally 67% of ventricular blood is ejected with each contraction Normal “EF” is 55 – 70% Stroke Volume: Volume of blood ejected (mL) 60 – 100mL; average is 70mL Dependent on: Preload (venous return) Cardiac contractility (inotropy and dromotropy) Afterload (systemic vascular resistance) Cardiac Output: Volume of blood that the heart pumps in 1 minute Cardiac Output = Stroke Volume X Heart Rate Copyright 2021 - Pass with PASS, LLC 22 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Cardiac Anatomy Valve Anatomy Chordae Tendineae Papillary Muscle Right Atrium Left Atrium Pulmonic Valve Mitral Valve Tricuspid Valve Aortic Valve Aortic Valve Left Ventricle Right Ventricle Heart Anatomy: Center of chest in mediastinum 2/3 of mass is left of the midline Muscular organ, size of patient’s closed fist Valve Order: “Toilet Paper My A..” Copyright 2021 - Pass with PASS, LLC 23 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Cardiac Anatomy Three Layers of Heart Muscle Endocardium: Innermost layer Myocardium: Middle layer Pericardium or Epicardium: Outer layer “Peri”/”epi” mean “around” or “on top of” Pericardium Protective sac around the heart (most commonly talked about in cardiac tamponade) Visceral → innermost lining of the sac → “visceral to the vasculature” 25mL of pericardial fluid Parietal → second or middle lining of the sac Fibrous → outer most lining, external covering of the parietal pericardium Copyright 2021 - Pass with PASS, LLC 24 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Cardiac Anatomy Two superior chambers, blood Atria: receive incoming Right atrium receives blood from vena cava Left atrium receives blood from pulmonary vein Septum: Interatrial septum → separates the right and left atria Interventricular septum → separates the right and left ventricle Ventricles: Two inferior chambers, larger than the atria, pump blood out of the heart Right ventricle pumps blood to lungs through pulmonary artery Left ventricle pumps blood to the body through the aorta Copyright 2021 - Pass with PASS, LLC 25 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Blood Flow Through the Heart Cardiac Blood Flow 1.Superior and Inferior Vena Cava returns blood to heart 2.Right Atrium → Tricuspid Valve 3.Right Ventricle → Pulmonic Valve → Pulmonary Artery 4.To the Lungs →Pulmonary Vein 5.Left Atrium → Mitral Valve 6.Left Ventricle → Aortic Valve 7.Aorta (largest artery in the body) a.) Coronary Arteries supply heart muscle and are fed off of the aorta 8.Body Copyright 2021 - Pass with PASS, LLC 26 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Coronary Circulation Coronary Arteries: Originate at the opening of the aorta Perfused during diastole During systole, the aortic valve opens up into the aorta, allowing blood to perfuse the aorta and then the rest of the body. When this happens, the aortic valve blocks the openings of the coronary arteries. During diastole, the aortic valve closes for ventricular filling, which allows the coronary arteries to receive the oxygenated blood that is remaining in the aorta. Copyright 2021 - Pass with PASS, LLC 27 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Coronary Arteries Left Coronary Artery Supplies the left ventricle, interventricular septum, part of the right ventricle, and the heart’s conduction system. Two Major Branches Left Anterior Descending Left Circumflex www.texasheart.org Right Coronary Artery Supplies portion of right atrium, portion of right ventricle, and part of conduction system Two Major Branches Posterior Descending Marginal Branch Copyright 2021 - Pass with PASS, LLC 28 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Circulation Collateral Circulation Protective mechanism providing alternative path for blood flow in event of blockage Peripheral Circulation Walls of the arteries and veins are composed of three layers Tunica Intima → Inner most lining of the vessel Tunica Media → Middle layer of the vessel; elastic fibers and muscle → gives vessels strength and allows for recoil; thickest in arteries due to high pressures Tunica Adventitia → Outermost lining; fibrous covering → gives strength to withstand cardiac contraction Tunica Intima Tunica Media Tunica Adventitia Copyright 2021 - Pass with PASS, LLC 29 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Circulation Circulatory System Diastole (first phase) Relaxation/filling phase Systole (second phase) Contraction/pumping phase Copyright 2021 - Pass with PASS, LLC 30 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Cardiac Axis Axis deviation can be a difficult topic to understand as both a paramedic and as a paramedic student. It’s not often tested at the NREMT level, however, it’s still in the initial EMS education standards – so it’s fair game. Simply stated, the cardiac axis tells us which portion (or area) of the heart is requiring the most amount of energy (or depolarization). Think of the above picture as being divided into the four chambers of the heart. Extreme Right Axis Deviation = Right Atrium Right Axis Deviation = Right Ventricle Left Axis Deviation = Left Atrium Normal QRS Axis = Left Ventricle The left ventricle is the “workhorse” of the heart, so it makes sense that “normal axis” is towards the left ventricle as it needs the most amount of depolarization to do it’s job. When the QRS axis is anything other than normal (-30 to +90), we have to consider why that is happening. Left Ventricular Hypertrophy Extreme Right Axis Deviation: Ventricular Left Bundle Branch Block Tachycardia Right Bundle Branch Block Severe Hyperkalemia Inferior MI PVCs Right Axis Deviation: WPW Severe Right Ventricular Hypertrophy Left Axis Deviation Right Ventricular Hypertrophy COPD Pulmonary Embolism Lateral MI Hyperkalemia WPW Dextrocardia Copyright 2021 - Pass with PASS, LLC 31 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Autonomic Nervous System Peripheral Nervous System: Provides nearly every organ with a double set of nerve fibers. Sympathetic: Adrenergic, fibers exit from thoracic and lumbar regions of spinal cord. Parasympathetic: Cholinergic, fibers exit from cranial and sacral portions of spinal cord. body activity Parasympathetic Nervous System: Also called: Cholinergic System / Craniosacral System Function: Maintain vegetative state, normal Neurotransmitter: Acetylcholine Major Nerves: Vagus Nerves (CN X) Deactivating Enzyme: Acetylcholinesterase Catechol-o-methytransferase (COMT) “Para Aces in Vagus” Parasympatholytic: Blocks the effects of the parasympathetic nervous system (Atropine) “Lytic” → blocks Sympathetic Nervous System: Also called: Adrenergic System/Thoracolumbar System Sympathomimetic: Function: “Fight or Flight”, increase body system activities Neurotransmitter: Norepinephrine Deactivating Enzymes: Monoamine Oxidase (MAO) Mimics the effects of the sympathetic nervous system (epinephrine) “Mimetic” → Mimics Copyright 2021 - Pass with PASS, LLC 32 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Sympathetic Nervous System Two Types of Receptors: Alpha-Adrenergic Receptors Alpha 1 Alpha 2 Beta-Adrenergic Receptors: Beta 1 Beta 2 Beta 1 Receptors: “You have 1 heart” Alpha 1 Receptors: Vasoconstriction Pupillary Dilation Decreased Renin Secretion Beta 2 Receptors: “You have 2 lungs” Stimulation Causes: Stimulation Causes: Bronchodilation Increased Heart Rate (Chronotropy) Vasodilation Increased Contraction (Inotropy) Selective Beta 2 Agonist Albuterol Increased Automaticity/Conduction Impulse (Dromotropy) Nonselective Beta 2 Agonist Dopamine Selective Beta-Blocking Agents Beta 1 – cardioselective agents – metoprolol, atenolol Nonselective Beta-Blocking Agents Beta 1 and Beta 2 Blocking – labetalol, nadolol, propranolol Copyright 2021 - Pass with PASS, LLC 33 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Renin Angiotensin Aldosterone System (RAAS) “Angio” = Blood Vessel | “Tensin” = Pressure or Tension Angiotensinogen, synthesized by the liver, secreted into circulation Renin is then released → primary chemical from the kidneys in response to low blood pressure and decreased perfusion Angiotensin → Converted by Renin into Angiotensin I Modified in lungs by Angiotensin Converting Enzyme (ACE) to Angiotensin II This is a 20 minute process and causes systemic vasoconstriction. This lasts for about 1 hour and also causes the release of anti-diuretic hormone (ADH), Aldosterone, and Epinephrine. Baroreceptors detect low blood pressure and are found in the carotid sinus and aortic arch Copyright 2021 - Pass with PASS, LLC 34 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Cardiac Electrolytes & Energy Sodium (Na) Plays a major role in depolarization Most prevalent extracellular cation Calcium (Ca) Myocardial depolarization and contraction Potassium (K) Influences repolarization Most prevalent intracellular cation Adenosine Triphosphate (ATP) Produced by the mitochondria and is the fuel of the cell ATP energy is necessary for the “Sodium – Potassium Pump” to function One ATP is used to “fuel” the transport – at that point, ATP becomes ADP (Adenosine Diphosphate) Sodium Potassium Pump ATP Sodium – Potassium Pump Depolarization must occur in the atria and the ventricles Depolarization = Contraction Cardiac Depolarization Resting Potential → “Polarization” → Potassium In, Sodium Out Action Potential → “Depolarization” → Influx of sodium changes the membrane potential Recovery State → “Repolarization” → Potassium returns to inside the cell, Sodium returns to the outside of the cell Copyright 2021 - Pass with PASS, LLC 35 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Electrophysiology Three Types of Cardiac Muscle Atrial Ventricular → Atrial and ventricular muscle is similar to skeletal muscle with one major difference, intercalated discs. → These discs allow impulses to travel 400 times faster than normal skeletal muscle → Allows cardiac muscle to function as a unit (“syncytium”) → Atria contract together as a unit; ventricles contract together as a unit Specialized Excitatory and Conductive Fibers Heart Sounds Very difficult to hear in the field S1 = first heart sound → “lub” | Closure of the atrioventricular (AV) valves S2 = second heart sound → “dub” | Closure of the semilunar (SL) valves Abnormal Heart Sounds S3 = sounds like “Kentucky”, associated with CHF, increased fluid in the system S4 = sounds like “Tennessee”, increased atrial contraction, associated with CAD Copyright 2021 - Pass with PASS, LLC 36 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 5: Cardiovascular System Cardiac Conduction Impulse Conduction: SA Node sends the impulse inferiorly to the AV Node through the intranodal atrial pathways. AV junction (“gatekeeper”) slows impulse; allows ventricles time to fill. Then, impulse passes through the AV Junction into the AV Node and onto the AV fibers. The AV fibers conduct the impulse from the atria to the ventricles In ventricles AV fibers form bundle of His. Bundle of His divides into left and right bundle branches Intrinsic Rates Sinoatrial (SA) Node: 60 – 100 Atrioventricular (AV) Node: 40 – 60 Purkinjes: 15 – 40 Bradycardia: heart rate < 60 bpm Right bundle branch delivers impulse to apex of right ventricle. Tachycardia: heart rate > 100 bpm Left bundle branch divides into anterior and posterior fascicles which terminate at the Purkinje system. Purkinje system spreads it across myocardium. Copyright 2021 - Pass with PASS, LLC 37 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 6 Respiratory Anatomy Copyright 2021 - Pass with PASS, LLC 38 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Key Terms Perfusion: Ventilation: The process of air movement into and out of the lungs i The circulation of blood through the lung n I r i A t u O r tissues (alveoli) through capillary membrane Diffusion: Blood transition A The process of gas exchange (carbon dioxide and oxygen) O2In CO2 Out Copyright 2021 - Pass with PASS, LLC 39 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Respiratory Anatomy Nasopharynx Oropharynx Trachea Bronchi Lungs Found at end of bronchioles, place of gas exchange/capillaries Vallecula Glottic Opening Alveoli Copyright 2021 - Pass with PASS, LLC 40 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Upper Airway Anatomy Closed Open incisors uvula soft palate palatine tonsils oropharynx Respiratory center is housed in the brainstem, more specifically medulla oblongata the Epiglottis Vocal Cords Glottic Opening Copyright 2021 - Pass with PASS, LLC 41 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Trachea 15 – 20 “C” Shaped Rings 0.6” wide 3.5 – 6” long Lined with cilia and goblet cells Cilia – Lines Trachea Copyright 2021 - Pass with PASS, LLC 42 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Lungs Right Lung 3 Lobes Left Lung 2 lobes Pleura Visceral Pleura → lays on top of the lungs Pleural Space Parietal Pleura → separates rib muscle from pleural space Copyright 2021 - Pass with PASS, LLC 43 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Diaphragm & Phrenic Nerve Diaphragm Inhalation Diaphragm contracts (moves down) Exhalation Diaphragm relaxes (moves up) Phrenic Nerve Originates at C3 – C5 Injury of C3 or above eliminates possibility of phrenic nerve function Impossible for patient to initiate contraction of the diaphragm Hering-Breur Reflex → limits inspiration and prevents over-inflation of the lungs via the vagus nerve; active during normal breathing. Pneumotaxic Center → has an inhibitory effect on the inspiratory center; active in labored breathing; prevents overexpansion of the lungs during rapid breathing. Copyright 2021 - Pass with PASS, LLC 44 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Respiration Respiration → the process of oxygen and carbon dioxide exchange. Pulmonary Ventilation → mechanical process of bringing oxygen into the lungs and removing carbon dioxide. External Respiration → Transfer of (by diffusion) oxygen and carbon dioxide between the inspired air and the pulmonary capillaries. Internal Respiration → Transfer of (by diffusion) oxygen and carbon dioxide between the capillary red blood cells and the tissue cells. Atmospheric Pressure → pressure of gas around us (760mmHg at sea level, 684mmHg at “Mile High Stadium”) Intrapulmonic Pressure: pressure of gas in the alveoli (a little above 760mmHg) Intrathoracic Pressure → pressure in the pleural space (typically below atmospheric pressure, 751 – 754mmHg, but can be higher during coughing or straining during bowel movements) Pulmonary Perfusion Requirements: Adequate blood volume, intact pulmonary capillaries, efficient pumping action by the heart, adequate hemoglobin, adequate carbon dioxide Disruption in Diffusion & Perfusion Disruption in Ventilation Diffusion: Hypoxia Upper & Lower Airway Damaged Alveoli Obstruction due to trauma or infection Chest Wall & Diaphragm Trauma: pneumothorax, hemothorax, flail chest Neuromuscular Disease Perfusion: Alteration in blood flow, changes in hemoglobin, pulmonary shunting Copyright 2021 - Pass with PASS, LLC 45 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Lung Sounds Crackles (rales): fine, bubbling sound heard on auscultation of the lung. Produced by air entering the distal airways and alveoli that contain serous secretions. Rhonchi: abnormal, coarse, rattling respiratory sounds, usually caused by secretions in the bronchial airways. Stridor: abnormal, high-pitched, musical sound caused by an upper airway obstruction (subglottic). Wheezing: form of rhonchi, characterized by a high pitched, musical quality. Produced in the lower airways (bronchioles). Stridor (upper airway/subglottic inspiratory) Rales (inspiratory/expiratory) Wheezes Crackles (expiratory) Rhonchi (end-inspiratory) (expiratory wheezing) Copyright 2021 - Pass with PASS, LLC 46 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Respiratory Patterns Eupnea: normal respirations Tachypnea: increased (fast) respirations Bradypnea: decreased (slow) respirations Apnea: no respirations (not breathing) Cheyne Stokes: abnormal respirations with regular, periodic breathing with intervals of apnea and a crescendo-decrescendo pattern of respirations. Biot’s: abnormal respirations characterized by regular deep inspirations followed by regular or irregular periods of apnea. Apneustic: abnormal rapid respirations associated with deep, gasping inspirations – most often associated with stroke or trauma. Kussmaul’s: rapid and deep respirations – most often associated with diabetic ketoacidosis (DKA) as a compensatory mechanism in an attempt to correct the body’s metabolic acidosis Copyright 2021 - Pass with PASS, LLC 47 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Breathing Normal Breathing → < 5% total body expenditure of energy Abnormal Breathing → up to 30% of total body expenditure of energy What factors would increase the amount of energy needed? Loss of surfactant (smoke inhalation, emphysema) Increased airway resistance (asthma) Decrease in lung compliance (cystic fibrosis) Infant: 25 – 50 breaths per minute Normal Breathing Adult: 12 – 20 breaths per minute Child: 15 – 30 breaths per minute Regular respiratory rate with clear, equal, and bilateral breath sounds Signs & Symptoms: Accessory muscle use Tripod positioning Absent or diminished breath sounds Cyanosis Abnormal breath sounds (see page 20) Respiratory rate → too slow/too fast Low oxygen saturation (hypoxia) Inadequate Breathing Management: Oxygen CPAP Assisting Ventilations Supraglottic Airway or Intubation Target SPO2 94 – 99% Copyright 2021 - Pass with PASS, LLC 48 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Physiology Oxygen in Blood → Physically present in two forms 1.) Physically dissolved in blood 2.) Chemically bound to hemoglobin (Hb) 98% of oxygen is carried in RBCs → called “oxyhemoglobin” The whole point of respiration is to: - Get oxygen to the tissues Eliminate CO2 - Help the body control pH O2In CO2 Out Composition of Air CO2 = 0.03% 6.2% Fick Principle The amount of oxygen the lungs deliver to the body is directly related to the amount of oxygen the body consumes - Adequate oxygen to saturate hemoglobin - RBCs must be circulated to the tissue RBCs must be able to load and unload oxygen 20.84% 78.62% If the body is not perfused with an adequate amount of oxygen, hypoxemia and hypoxia occur Nitrogen Oxygen Carbon Dioxide Water Copyright 2021 - Pass with PASS, LLC 49 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Physiology Hypoxemia → decreased oxygen content of the arterial blood Hypoxia → decreased oxygen content at the tissue level Ventilation (V) / Perfusion (Q) Ratio Measurements used to asses the efficiency and adequacy of the matching of the two variables: alveolar ventilation and pulmonary perfusion V → ventilation (alveolar ventilation) Q → perfusion (pulmonary perfusion) Chemical Control of Respiration Activities of the respiratory centers are determined by changes in: Oxygen concentration (PO2) Carbon dioxide concentration (CO2) Hydrogen concentration (pH) Chemoreceptors are located in the medulla oblongata → have neurons that are sensitive to changes in carbon dioxide and hydrogen levels Normal pH → 7.35 – 7.45 Oxygen Carbon Dioxide 94 99% is target saturation PCO2 normal range = 35 – 45mmHg SPO2 measures the amount of hemoglobin >45mmHg, body begins to “blow off” CO2 that is saturated with oxygen (or carbon to bring the CO2 and pH back to normal monoxide…) levels Hydrogen Hypoxic Drive Low oxygen levels act as the stimulus for ventilation COPD patients, should be maintained at lowest oxygen required to keep SPO2 between 88 and 92% on a routine, non-emergent basis Copyright 2021 - Pass with PASS, LLC 50 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Arterial Blood Gases One of the fiercest enemies of the paramedic student, arterial blood gases. ABGs are the often argued, “Why does this apply to me as a paramedic student…I’m not drawing blood gases in the prehospital setting!?” You’re right, most paramedics are not drawing blood gases in the prehospital setting, but ABGs aren’t going anywhere soon…so as the phrase goes, “If you can’t beat em’, join em’!” When approaching ABG interpretation, try to keep things in their simplest form (I know, simple and ABGs seem like oxymoron's). But seriously, when making an ABG interpretation, you are looking at three values (pH, CO2, HCO3) to determine what is happening with the pH - is it low (acidic), normal, or high (alkalotic) and then determine if the CO2 or the HCO3 correlates with the pH. The most critical step in ABG interpretation is knowing what values are considered normal. pH: 7. 35 – 7.45 Carbon Dioxide, CO2: 35 – 45 Bicarb, HCO3: 22 – 26 Copyright 2021 - Pass with PASS, LLC 51 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Arterial Blood Gases A mnemonic often discussed with ABGs is “ROME” “Respiratory Opposite, Metabolic Equal” ROME refers to the directions that the pH and CO2 or HCO3 move in correlation with one another. Respiratory Opposite: In respiratory-caused conditions, when the pH decreases (< 7.35, acidic) the CO2increases (> 45, acidosis) Conversely, when the pH increases (> 7.45, alkalosis) the CO2 decreases (< 35, alkalosis) Metabolic Equal: In metabolic-caused conditions, when the pH decreases (< 7.35, acidic) the HCO3 decreases (< 22, acidosis) Conversely, when the pH increases (> 7.45, alkalosis) the HCO3increases (> 26, alkalosis) Copyright 2021 - Pass with PASS, LLC 52 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 6: Respiratory System Arterial Blood Gases Respiratory Acidosis: Hypoventilation (retaining too much CO2) Treatment: increase ventilatory rate Respiratory Alkalosis: Hyperventilation (blowing off too much CO2) Treatment: decrease ventilatory rate Metabolic Acidosis: Build up of lactic acid – lactic acidosis, diabetic ketoacidosis, renal failure, sepsis, toxic ingestion Treatment: controlling respiratory rate, IV fluids, sodium bicarbonate Metabolic Alkalosis: Rare, loss of hydrogen ions (vomiting or gastric suction) – consumption of large amounts of baking soda or antacids Treatment: correct underlying condition Example pH 7.28 CO2: 54 HCO3: 24 What is the pH doing? It’s below 7.35 therefore it’s acidic. Now, which of the other values are also acidic? CO2! A normal CO2is 35 – 45, the given value is 54 which is higher than normal and is acidic. The HCO3is within a normal range. Interpretation: Respiratory Acidosis Believe it or not, as paramedic students, we cover ABGs on a surface level – there is much more to ABG interpretation, but a basic understanding of interpretation and the most common causes of abnormalities is what we are most concerned with! Copyright 2021 - Pass with PASS, LLC 53 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 7 Neurology Copyright 2021 - Pass with PASS, LLC 54 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 7: Neurology The Nervous System Body’s principal control system Network of cells, tissues, and organs regulate bodily functions via electrical impulses transmitted through nerves Endocrine system: related to the nervous system, exerts control via hormones Circulatory system: assists in regulatory functions by distributing hormones and chemical messengers Dendrites: Receive chemical messages messages impulses Soma: Central cell body from other neurons – then converted into Axon: Sends messages (impulses) to other neurons Synapse: Connects here Synapse: Small gaps that separate neurons (between axon of one neuron and the dendrites of the other) Axon Terminal: Buds at end of axon from which chemical messages (impulses) are sent Copyright 2021 - Pass with PASS, LLC 55 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 7: Neurology Brain Anatomy Cerebrum: The “actual” brain itself…when you think of “brain” you probably picture the cerebrum. Occipital Cortex: Vision Frontal Lobe: Personality, Motor Cerebellum: Balance and coordination Parietal Lobes: Sensory Reticular Activating System (RAS): Responsible for maintaining consciousness and ability to respond to stimuli. Diencephalon (interbrain): Involuntary actions (temperature, sleep, water balance, stress, emotions), major role in regulating the ANS Frontal Lobe Mesencephalon (midbrain): Pons, Medulla Oblongata (Respirations, blood pressure, heart rate) “We live an die in the brainstem” Temporal Lobe Parietal Lobe Pons: Connection between brain and spinal cord Medulla Oblongata: Center for controlling respiration, cardiac activity, vasomotor activity Occipital Lobe Reticular Activating System: Responsible for maintaining consciousness and ability to respond to stimuli The brain receives ~ 20% of body’s total blood flow per minute Consumes 25% of body’s glucose Blood supply → carotids, vertebrobasilar Cerebellum: Coordinates fine motor movement, posture, equilibrium muscle tone → Circle of Willis Temporal Lobe: Speech Copyright 2021 - Pass with PASS, LLC 56 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 7: Neurology Cranial Nerves CN I: Olfactory: Smell CN II: Optic: Vision CN III: Oculomotor: eye movement, pupillary constriction CN IV: Trochlear: down and inward eye movement CN V: Trigeminal: jaw movement CN VI: Abducens: lateral eye movement CN VII: Facial: facial movement CN VIII: Vestibulocochlear: hearing and equilibrium CN IX: Glossopharyngeal: swallow, phonation CN X: Vagus: parasympathetic nervous system CN XI: Accessory: shoulder shrug CN XII: Hypoglossal: tongue movement “On Occasion Our Trusty Truck Acts Funny Very Good Vehicle Any How” Copyright 2021 - Pass with PASS, LLC 57 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 8 Endocrine System Copyright 2021 - Pass with PASS, LLC 58 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 8: Endocrine System Endocrinology ENDOCRINE GLANDS EXOCRINE GLANDS Ductless Release chemical products through ducts Have localized effects Secrete hormones directly into circulation Widespread effects Act on distant tissues HORMONES Just read the names to determine their effect/role “Growth hormone releasing hormone (GHRH)” Releases growth hormone “Growth hormone inhibiting hormone (GHIH)” Inhibits growth hormone release TERMS Anabolism: Build up, uses energy Catabolism: Breakdown, no energy required Copyright 2021 - Pass with PASS, LLC 59 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 8: Endocrine System Endocrine Anatomy Hypothalamus: Located deep within the cerebrum of the brain. Hypothalamic cells – nerve cells or neurons, receive messages from ANS and detect internal conditions. Gland cells produce and release hormones. Pituitary Gland: “Master Gland”. Size of a pea, broken into “anterior” and “posterior” glands. Anterior responds to hypothalamic hormones. Posterior responds to nerve impulses from hypothalamus. Has direct impact on endocrine glands throughout body. Prolactin (PRL) ANTERIOR PITUITARY GLAND Adrenocorticotropic hormone (ACTH) Adrenal cortexes Female mammary glands POSTERIOR PITUITARY GLAND Antidiuretic hormone (ADH) Retention of water Oxytocin Uterine contraction Thyroid stimulating hormone Lactation (TSH) Thyroid Diabetes Insipidus Follicle stimulating hormone Large volumes of urine (FSH) Gonads or sex organs Inadequate ADH secretion Luteinizing hormone (LH) Gonads Copyright 2021 - Pass with PASS, LLC 60 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 8: Endocrine System Endocrine Anatomy Thyroid: Two lobes, butterfly shaped, located in neck anterior and inferior to larynx. Produces three hormones: Thyroxine (T4): stimulates cell metabolism Triiodothyronine (T3): stimulates cell metabolism Calcitonin: lowers blood calcium levels Parathyroid: Four small glands located on posterior lateral surfaces of thyroid. Secretes parathyroid hormone (PTH): increases blood calcium levels PTH is antagonist of calcitonin; balance of PTH and calcitonin determines level of blood calcium Thymus: In mediastinum, just behind the sternum. During childhood, it secretes thymosin → maturation of “T” lymphocytes responsible for cell-mediated immunity. The “T” of “T” lymphocytes (or “T” cells) stands for “thymus”. Disappears after childhood – cannot be seen on chest x-ray Pancreas: Located in LUQ, retroperitoneal behind stomach. Has both endocrine and exocrine tissues. Endocrine tissue known as “Islets of Langherns” Alpha: Glucagon → raises blood sugar Beta: Insulin → lowers blood sugar breakdown of glycogen Delta: Somatostatin Exocrine tissues secrete digestive enzymes. Gluconeogenesis → New glucose from Glycogenolysis → Glucagon stimulates non-sugar sources Copyright 2021 - Pass with PASS, LLC 61 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 8: Endocrine System Endocrine Anatomy Pineal Gland: Located in roof of thalamus in brain. Releases hormone melatonin in response to changes in light. Melatonin may affect mood. Adrenal Gland: Subdivided into “Adrenal Cortex” and “Adrenal Medulla” ADRENAL CORTEX Outermost layer Steroids Glucocorticoids → increase BGL Mineralocorticoids → salt/fluid balance Produce estrogen and progesterone POSTERIOR PITUITARY GLAND Middle layer Catecholamines Adrenal Medulla Nerve cells and gland cells Secretes epinephrine (adrenalin) Norepinephrine Androgenic hormones → same effect as secreted by gonads MALE GONADS Tests produce sperm cells FEMALE GONADS Ovaries produce eggs Sexual maturation → puberty and subsequent reproduction Ovaries (female gonads) Paired organs about size of almond Located in pelvis on either side of uterus Copyright 2021 - Pass with PASS, LLC 62 Sexual maturation → puberty and subsequent reproduction Testes (male gonads) Located outside abdominal cavity in scrotum Testosterone → secondary male sexual characteristics and sperm development Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 9 Reproductive Systems Copyright 2021 - Pass with PASS, LLC 63 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 9: Reproductive System Female Reproductive System Ovaries Small, oval-shaped glands on each side of the uterus; produce eggs, estrogen, and progesterone Fallopian Tubes Uterine ducts for the ovaries; location where the ovum is fertilized Uterus Organ size and shape of a pear; accepts and nourishes the fertilized egg Vagina Birth canal; female organ of copulation External Genital Organs (vulva) Outer parts of the female genitalia; protects internal organs from infectious disease Mammary Glands Organs of milk production – located in the breasts; under the influence of hormones, gland secrete milk during nursing Menstruation Normal, periodic discharge of blood, mucus and cellular debris from the uterine mucosa. Occurs approximately every 28 days at regular intervals from puberty to menopause, lasts approximately 4 – 6 days. Onset of menses: between ages 12 – 13 Menstruation ends permanently on average at 47 years of age, normal age for menopause can range from 35 – 60 years Copyright 2021 - Pass with PASS, LLC 64 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 9: Reproductive System Phases of Menstruation Follicular Phase • Begins of first day of the menstrual cycles, lasts for 10 – 17 days. • Release of 15 – 20 oocytes • Follicle Stimulating Hormone (FSH) → ovaries → recruits several follicles which begin racing to the release their egg at ovulation. • The fastest, healthiest follicle and egg will “win” the race and release an egg (ovum) at the time of ovulation. • The “losers” of the race will be reabsorbed and have lost their chance to fully mature or ever be released. Ovulatory Phase • Occurs mid-cycle; between day 10 – 17 of the Follicular Phase • Increased estrogen from Follicular Phase triggers the release of Luteinizing Hormone (LH). • LH causes the “winner” follicle to expand and burst, releasing its mature egg. • Egg is captured in the fallopian tube, where it may or may not be fertilized. Luteal Phase • Lasts approximately 14 days; empty follicle is transformed into a yellow-grandular structure called the corpus luteum. • If pregnancy occurs, the fertilized egg travels through the fallopian tube and implants in the uterus. • Chorionic gonadotropin is released → prevents corpus luteum from degenerating. • Estrogen and progesterone levels do not decrease, and the menstrual period does not occur. This Photo by Unknown Author is licensed under CC BY Corpus Luteum This Photo by Unknown Author is licensed under CC BY-SA-NC Copyright 2021 - Pass with PASS, LLC 65 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 9: Reproductive System Male Reproductive System Urethra Duct that carries urine from the bladder to the exterior of the body – approximately 20 cm long and ends at the tip of the penis. Testes Primary male reproductive organs. Produce hormones responsible for sexual maturation and sperm cells. Epididymis and Vas Deferens Sperm cells pass from the testis into the epididymis, a small sac where they are stored. Sperm are then sent from the epididymis in the vas deferens. Prostate Gland Surrounds the male urinary bladder neck and the first part of the urethra runs through it. An enlargement of the prostate can impinge upon the urethra and restrict urination. Penis Male organ of copulation; sponge-like tissues fill with blood to cause an erection. Foreskin is often removed after birth (“circumcision”). This Photo by Unknown Author is licensed under CC BY Copyright 2021 - Pass with PASS, LLC 66 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 10 Gastroenterology Copyright 2021 - Pass with PASS, LLC 67 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 10: Gastroenterology Gastroenterology Anatomy This Photo by Unknown Author is licensed under CC BY-SA Copyright 2021 - Pass with PASS, LLC 68 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 10: Gastroenterology Gastroenterology Anatomy Esophagus • 10 inches in length • Straight, but collapsible tube • Passes food from mouth to stomach Liver • Located in right upper quadrant • Largest internal organ of the body • Weighs ~ 3 pounds in adult • Enclosed in fibrous capsule • Storage of glucose, protein synthesis and filters blood waste Kidneys • Smooth, bean-shaped organs • Enclosed in a tough, fibrous capsule • Lie on each side of the vertebral column • Upper border near T12 • Help maintain homeostasis, form urine and excrete, assist with blood pressure regulation (see RAAS under Cardiology Anatomy) Spleen • Located in left upper quadrant • Very vascular, helps fight infection • Holds a reserve amount of blood that releases during shock Pancreas • Makes insulin (beta cells), glucagon (alpha cells) and somatostatin (delta cells). Stomach • Pouch-like organ shaped like a “J” • Capacity ~ 1 liter • Mixes food with gastric juice – begins digestion • Moves food to small intestine Copyright 2021 - Pass with PASS, LLC 69 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 10: Gastroenterology Gastroenterology Anatomy Appendix • Sits at the junction of the small and large intestine • Approximately 4 inches long • Can rupture and cause appendicitis/peritonitis Large Intestine Has little to no digestive function Secretes mucus from goblet cells – protects intestinal wall from abrasion Small Intestine • Longest part of the digestive tract • Major site of food digestion and nutrient absorption • Contains three portions • Duodenum • Jejunum • Ileum Gallbladder • Pear-shaped organ • Epithelial lining and strong wall muscles • Stores bile (produced by liver) • Connected to the cystic duct which connects to the common hepatic duct • Then, to common bile duct which leads to duodenum Copyright 2021 - Pass with PASS, LLC 70 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. 11 Anatomical Differences Adult/Child Copyright 2021 - Pass with PASS, LLC 71 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are copyrighted. Chapter 11: Anatomical Differences Adult/Child Anatomical Differences Airway • Larynx is higher (C3/C4) in children • Trachea is bifurcated at a higher level in children • Cricoid ring is narrowest part of airway in children / adults = vocal cords • Jaw and tongue are proportionately larger • Epiglottis is omega-shaped, extends into airway at a 45-degree angle in children • Pad under the shoulders of small children for airway management • Avoid hyperflexion or extension of the neck in children • Gentle intubation to avoid soft-tissue injury • Infants may breathe through nose during first month of life Respiratory System • Tidal volume is proportionately smaller • Metabolic oxygen requirements are double that of the adult’s • Smaller oxygen reserves • Muscles are main support for chest wall, become tired easily during respiratory distress • Increased and inadequate respiratory rate and effort • Nasal flaring, retractions, seesaw breathing, grunting • No distal air movement • Cyanosis or low oxygen saturation despite supplementary oxygen Cardiovascular System • Less able than adults to increase cardiac output • Children can vasoconstrict longer than adults, allowing them to compensate blood pressure longer • Loss of small volumes of fluid and blood can cause shock • May be in shock despite normal blood pressure • Bradycardia often a response in hypoxia Skin & Body Surface Area • Skin is thinner and more elastic than in adults • Less subcutaneous fat; increases likelihood of hypothermia, hyperthermia and dehydration • Newborns have limited capacity to shiver or sweat to maintain temperature Copyright 2021 - Pass with PASS, LLC 72 Prepared exclusively for Robert Hug Transaction: PWP4834 No one other than the individual above should access or use this study guide. Contents are NREMT Test Prep copyrighted. If you’re an EMT, AEMT, or Paramedic student and are enrolling in class, preparing for your course final or the National Registry Exam – consider checking out our study guides and NREMT review lectures at www.passwithpass.com! Thank you for your support and best of luck! www.passwithpass.com Copyright 2021 - Pass with PASS, LLC 73