Planes of the Body
Coronal (front and back)
Transverse (top and bottom)
Sagittal (left and right)
Midsagittal (midline split L/R)
Directional - Front and Back
Anterior (ventral)
Posterior (dorsal)
Directional - Top and Bottom
Superior (head)
Inferior (feet)
Directional - Closest and Farthest
Proximal (closest to point of attachment)
Distal (farthest from the point of attachment)
Directional - Middle and Side
Medial (closest to the midline)
Lateral (farthest from the midline)
Directional - In and Out
Superficial (closest to the surface)
Deep (farthest from the surface)
Movement
Flexion (bending of joint)
Extension (straightening of joint)
Adduction (motion toward midline)
Abduction (motion away from midline)
Quadrants
RUQ
LUQ
RLQ
LLQ
On incline, feet higher than head
Trendelenburg’s Position
Head and torso supine, lower limbs raised
Shock or modified Trendelenburg
Sitting up with knees drawn in
Fowler’s Position
Lying face down
Prone position
Lying face up
Supine position
Skeletal support structures
Ligament (connects bone to bone)
Tendon (connect muscle to bone)
Cartilage (cushion between bones)
Cranium Bones (5)
occiput (posterior) temporals (lateral) parietal (top) frontal (front) foramen magnum is hole in occiput for spinal cord
Facial Bones (14)
maxillae (fixed jaw)
zygomas (cheek)
mandible (moveable jaw)
nasal
Eye Socket
framed by frontal bone, temporal bones, nasal bones, zygomatic bones, and maxilla
Bones of Spinal Column (33)
Cervical vertebrae (7) Thoracic vertebrae (12) Lumbar vertebrae (5) Sacral vertebrae (5) Coccygeal vertebrae (4)
Thoracic Cavity
Formed by 12 thoracic vertebrae and 12 pairs of ribs, sternum (manubrium, body and xiphoid process).
Inferior boundry is diaphragm which separates thorax from abdomen.
Shoulder Girdle
clavicle
scapula - acromion is bony process that joins with clavicle
humerus
Glenohumeral (shoulder - joins humerus and scapula
Acromioclavicular (joins lateral clavicle to scapula)
Sternoclavicular (joins medial clavicle to sternum
Bones of Arm and Hand
humerus ulna (larger proximal) radius (larger distal) wrist (8 carpal bones) metacarpals (5) phalanges (5 - digits or fingers)
Pelvic Bones (2)
Pelvic bone is fusion of:
ilium - ischium - pubis
Joined together posteriorly by the sacrum, anteriorly at the pubic symphysis (has cartilage to allow slight movement).
Leg Bones
Femoral head (attaches at acetabulum) Greater trochanter (lateral) and lesser trochanter (medial). Patella (kneecap) anterior to knee joint Tibia (shin bone) larger and anterior Fibula on lateral side of leg.
Ankle and Foot Bones
Ankle consists of 7 Tarsal bones (talus is part of leg joint, calcaneus is heel). Talus to cuboid to navicular
Foot consists of 5 Metatarsals and Phlanges (toes)
3 phalanges in each toe except big toe which has 2.
Pelvis
Sacrum
Pelvic bones (2)
ilium - ischium - pubis
Acetabulum is socket on pelvis where lower leg connects.
Muscles under voluntary control
skeletal muscle
Muscles found within blood vessels and intestines
smooth muscle
Muscles found within the heart
cardiac muscle
Upper Airway Structures (7)
nose mouth tongue jaw oral cavity larynx pharynx
Protects the opening of the trachea
epiglottis
Warm, filter and humidify air
nasopharynx
Anterior part of larynx
thryroid cartilage or Adam’s Apple
contains vocal cords
Immediately below thyroid cartilage
Cricoid cartilage
Location for using Sellick maneuver (press on the cricoid cartilage to compress the esophagus behind it so as to prevent gastric reflux from occurring.
Depression in the midline of the neck, just inferior to the thyroid cartilage
cricothyroid membrane
landmark for needle airway
Approximate length of trachea
5 inches
Division of trachea
carina
700 million grape like sacs
alveoli
Lower airway
trachea carina main bronchi (2 - R/L) bronchioles to right (3 lobes) and left (2 lobes) alveoli
Has characteristics of skeletal and smooth muscles
diaphragm
Process of gas exchange
respiration
Movement of air between lung and environment
ventilation
Process to move O2 and CO2 across capillaries
diffusion
Gas content of exhaled air
16% O2
3 - 5% CO2
Center for control of breathing
brain stem
sensors determine level of CO2 in spinal fluid
Function of medulla oblongata
Portion of the hindbrain that controls autonomic functions such as breathing, digestion, heart and blood vessel function, swallowing and sneezing.
What are Hering-Breuer reflexes?
In chest wall, detects lung expansion or deflation and directs pneumotaxic and apneustic centers.
Active in increased emotional or physical stress.
Dorsal and Ventral respiratory groups
Part of Medulla
Dorsal causes forced inspiration and is part of normal rhythmic breathing
Ventral causes forced expiration or inspiration with speech or stressful situations
Pneumotaxic and Apneustic centers
Part of Pons
Inhibit and excite (respectively) the Dorsal Respiratory Group of Medulla under stress.
Lung capacity of adult male
6 liters
Normal tidal volume
0.5 liters
Inspiratory reserve volume
deepest breath you can take, about 3 L
Expiratory reserve volume
maximum amount of air that you exhale, about 1.2 L
Residual volume
Volume of air that does not flow in ventilation 1.2 L
Normal rate of breathing in adult
12 - 20 breaths / minute
Signs that a patient is not breathing normally
less than 12 or more than 20 breaths / minute
labored breathing
pale or cyanotic skin
cool, damp skin (clammy)
tripod position (leaning forward on outstreched arms
Systemic Circulation
carries oxygen rich blood from the left ventricle, through the body to the right atrium.
high pressure system
Pulmonary Circulation
carries oxygen poor blood from right ventricle through the lungs and back to the left atrium.
low pressure system
Parts of left heart
mitral valve aortic valve coronary arteries and veins left ventricle left atrium
Parts of the right heart
tricuspid valve
pulmonary valve
right ventricle
right atrium
Bands of fibrous tissue attached to heart valves
chordae tendineae
Normal heart rate
50 - 60 beats per minute resting
up to 180 with vigorous exercise
Stroke volume
70 - 80 mL
Cardiac output equation
amount of blood pumped in 1 minute
CO = HR x SV
Central pulses (6 primary)
carotid artery
femoral artery
radial artery (wrist at base of thumb)
brachial artery (medial arm midway elbow-shoulder)
posterior tibial artery (posterior and medial ankle)
dorsalis pedis artery (top of foot)
also superficial temporal and external maxillary
Function of Spleen
Filtering worn out blood cells, foreign substances, bacteria.
Assist in immune response.
Hemoglobin is recylced.
450 mL blood on board
Blood Composition
Water 92% of plasma
Proteins 7% of plasma
Oxygen almost all bound to hemoglobin
What is perfusion
circulation of the blood in an organ.
Function of blood
Fight infection - WBC
Transport oxygen - RBC
Transport carbon dioxide - Plasma
Control pH - Chemicals in plasma
Transport wastes and nutrients - Plasma/Water
Clotting - Platelets and clotting factors
Nervous System effects on Cardiovascular System
Sympathetic:
Alpha-1 Constrict blood vessels
Beta-1 Increase heart rate and force of contraction
Beta-2 Dilate bronchioles in lung
Parasympathetic:
Decrease heart rate and force of contraction
Cerebrum
gray matter
3/4 of brain mass
frontal, parietal, temporal and occipital lobes
Primary motor center / opposite sides
Cerebellum
underneath cerebrum
coordination of activities
Brain Stem
primative brain controls cardiac, respiratory, basic functions conciousness reticular activating system midbrain, pons, medulla oblonggata
Blood Supply to Brain
Blood in from carotid arteries
Drains into internal and external jugular veins
Cerebrospinal fluid colorless surrounds brain and spinal cord.
Spinal Reflexes
Sensory stimuli traveling to brain through spinal cord have direct connections to motor nerves coming from brain to muscle. Muscle can respond without signal making it all the way to brain.
Knee tap is test of reflex loop.
Somatic Nervous System
i) Spinal Nerves: They are peripheral nerves that carry sensory information into the spinal cord and motor commands.
ii) Cranial Nerves: They are the nerve fibers which carry information into and out of the brain stem. They include smell, vision, eye, eye muscles, mouth, taste, ear, neck, shoulders and tongue.
iii) Association Nerves: These nerves integrate sensory input and motor output numbering thousands.
Autonomic Nervous System
Sympathetic - fight or flight
Parasympathetic - generally slows body.
Motor nerves
Cell body for motor nerves lies in spinal cord.
Skin (Integumentary System) Anatomy
Superficial epidermis has germinal layer that produces new cells that move to stratum corneal layer
Deeper dermis has sweat glands, sebaceous glands, hair follicles, blood vessels and nerve endings
Subcutaneous tissue is composed largely of fat - insulation and energy storage.
Mucous Membranes
Mouth, nose, anus, vagina not covered by skin but by mucous membranes. GI tract is completely mucous membranes.
Skin Physiology
Skin is single largest organ in body.
protects body from invasion by infectious organisms
Regulation of body temperature
Information about the environment - sensations
Abdomen
2nd largest body cavity
Diaphragm separates abdomen from thorax
Inferior is pelvis which is separated by an imaginary plane that extends from pubic symphysis through sacrum’
RUQ - Liver, gall bladder, portion of colon
Liver fills entire AP space under 8th to 12th ribs.
LUQ - Stomach, spleen, portion of colon
Spleen lateral and posterior, mostly under 9th to 11th ribs; stomach may sag into LLQ when full.
RLQ - Large intestine (cecum and ascending colon), appendix.
LLQ - Large intestine (descending and sigmoid).
Small intestine occupies central parts around umbilicus in all four quadrants.
Pancreas and Kidneys behind posterior abdominal wall in RUQ and LUQ (retroperitoneal).
Urinary bladder just behind pubic symphysis in middle of abdomen (RLQ LLQ)
Roof of mouth formed by __________
Hard palate - bony plate lying anteriorly
Soft palate - fold of muscle and mucous membrane extending posteriorly
Salivary glands
2 under tongue and 2 in cheek.
Produce 1.5 L saliva daily - 98% water.
Saliva composed of mucus, salts, organic compounds and certain digestive enzymes
Extends vertically from back of mouth to esophagus and trachea.
Oropharynx
Collapsible tube extends from end of pharynx to stomach.
Esophagus - about 10” long
Just anterior to spinal column
Hollow organ in LUQ
Stomach, protected by lower left ribs.
Produces approximately 1.5 L of gastric juice daily, churning and secretions turn food into chyme.
Takes 1-3 hours to discharge small meal into duodenum.
Flat solid organ that lies below and behind liver
Pancreas
Deep in abdomen and not easily damaged.
Exocrine secretes 2 L of enzyme containing juice daily into duodenum along pancreatic ducts.
Endocrine is islets of Langerhans that produce insulin to regulate glucose in body.
Solid organ in RUQ immediately beneath diaphragm
Liver
extends into LUQ.
Processes toxic products of digestion, produces blood clotting factors and produces plasma.
Between 0.5 and 1 L of bile made daily to assist in fat digestion pass through bile ducts to duodenum.
Gallbladder is out pouching of bile ducts which store bile until needed (60 - 90 mL). Green color turns feces brown.
Main storage of sugar and starch for immediate use for body energy.
All blood circulation from digestive system passes through portal vein before returning to heart (25% of Cardiac Ouput passes through liver - 1.5 L / min).
Bile ducts
Major hollow organ of the abdomen
Small intestine
Duodenum (12 inches long), jejunum and ileum (together 20 feet long).
Walls secrete mucous and enzymes to aid digestion
Organ encircling the outer margin of the abdomen
Large intestine - 5 feet long
Cecum, Colon, Rectum
Removes final 5 - 10% of digested food and water to form stool which is stored in rectum and passed through anus.
Tubular organ in RLQ
Appendix is tube 3 - 4 inches long that opens into cecum.
Can easily become blocked and infected. Major cause for severe abdominal distress.
Normally, without food or fluid ingestion, between 8 and 10 L / day of fluid secreted into GI tract
About 7% of body weight is delivered as fluid daily.
Diarrhea and vommitting for 2-3 days will severely deplete body fluid.
Complex message and control system to integrate bodily functions
Endocrine System uses hormones released into circulatory system to control body.
Hormones have specific effects on organs, tissues or processes.
Epinephrine and Norepinephrine released by adrenal gland.
Insulin from pancreas cause glucose to enter cells.
System to control fluid balance, filter waste and control pH
Urinary System
Kidneys (solid organ) located posterior muscle wall in retroperitoneal space.
20% of cardiac output (1.2 L/day) passes through kidney.
Aorta to kidney to inferior vena cava.
Filtered fluid flows to renal pelvis then to ureter and to bladder by peristalsis.
Urinary bladder immediatel behind pubic symphysis in pelvic cavity.
Urethra leads out, healthy adult forms 1.5 to 2 L / day.
Male Reproductive System
Prostate gland and seminal vesicles lie inside the pelvic cavity, others outside.
Testicles produce immature sperm and male hormones.
Epididymis stores and matures sperm.
Vas deferens carries semen to urethra then to penis.
Female Reproduction System
Ovaries produce female sex hormones (directly to cirulation) and ovum (mature egg cell) (through fallopian tubes to uterus).
Vagina is muscular distensible tube that connects uterus to vulva.
Normal gestation 40 weeks.
Vagina also channels menstrual flow
System that depends on oxygen to use fuel
Aerobic metabolism
Cells use oxygen to utilize ATP 15 times more efficiently than without oxygen. Waste products are CO2 and water.
Without O2, brain cells begin to die within 4 to 6 minutes.
System that does not depend on oxygen to use fuel
Anaerobic metabolism
When oxygen is not present, cells can utilize energy less efficiently. Waste products include lactic acid.
Lactic acid is converted back into useful energy once oxygen is available.
Normal Physiological pH
7.35 - 7.45
V/Q Ratio
How much gas is being moved effectively to the alveoli (Ventilation) and how much blood is gaining access to the alveoli (Perfusion).
Condition where organs and tissues are not receiving an adequate flow of blood and oxygen.
Shock:
Hypovolemic - Loss of blood or other fluid
Cardiogenic - Loss of heart function
Distributive - Excessive vasodilation (septic most common)
Gas content of inhaled air.
20.6% oxygen
0.03% carbon dioxide
78% nitrogen
The medial surface of the lower extremity of tibia is prolonged downward to form a pyramidal process.
medial malleolus
The lower extremity of the fibula is of a pyramidal form and somewhat flattened from side to side.
lateral malleolus or external malleolus,
Spinal nerve roots
C3-5 Phrenic nerve (diaphragm)
C5-6 Arm flexion
T2-7 Chest and intercostal muscles
L2-4 Knee extension