Anatomy and Physiology for the EMT

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Anatomy and Physiology for the EMT

• Travis R. Welch, NREMT, PA-S
• EMS Director, Zionsville Fire Department

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Learning Objectives

• Identify the following terms medial, lateral
  proximal, distal, superior, inferior, anterior,
  posterior, midline, right, left, bilateral,
  mid-clavicular, mid-axillary
• Describe the anatomy and function of the
  following major body systems respiratory,
  circulatory, musculoskeletal, nervous, and
  endocrine.

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Introduction

• As a firefighter/EMT you will be faced with
  patients that complain of a wide variety of
  illnesses and injuries.
• To adequately asses and treat the sick or injured
  patient, the firefighter/EMT must have a basic
  knowledge of where the structures of the body are
  (anatomy) and how they work (physiology).

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First things first

• We have to be able to speak the language

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Anatomical Terms

• Normal anatomical position
• The position that a patient is in when
  determining terms.
• Person standing, facing forward
• Palms facing forward
• Looks something like this

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Anatomical Planes

• No, Brett, Owen-not a new version for you to have
  to deal with at work
• Midline
• Imaginary line drawn vertically through the
  middle of the body (Nose to umbilicus (belly
  button)) that divides the body into right and
  left
• Mid-axillary
• Imaginary line drawn vertically from the middle
  of the armpit to the ankle dividing the body into
  anterior and posterior (front and back).

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Anatomical Planes-Descriptive Terms

• Torso
• Trunk
• Medial
• Toward midline
• Lateral
• Away from midline
• Proximal
• Toward center of the body
• Distal
• Away from center of body

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Anatomical Planes-Descriptive Terms

• Superior
• Is either your supervisor---or means something
  higher (closer to the head)
• Inferior
• Lower, away from head
• Anterior
• Front
• Posterior
• Back

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Anatomical Planes-Descriptive Terms

• Right and Left
• Your patients right and left!
• Mid-clavicular
• Line that runs down the middle of the clavicle
  (the nipple of the breast usually is
  mid-clavicular)
• Bilateral
• Both sides
• Dorsal
• Back side, or top (dorsal fin of fish)
• Ventral
• Opposite of Dorsal, front side

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Dorsal
Having a bad day
Ventral
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Anatomical Planes-Descriptive Terms

• Plantar
• NO, not one who plantsbut rather the bottom of
  the foot
• Palmar
• Gee, Mr. ObviousI never made the connection
• Supine
• Lying down on back
• Prone
• Lying down on front
• Fowlers
• Seated, head up- 45-60 degrees

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Anatomical Planes-Descriptive Terms

• Trendelenburg
• Supine, feet elevated, head down
• Shock position
• Modified Trendelenburg, supine with legs elevated
  12-16
• Lateral recumbent
• recovery position, laying on side

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Take 5 minutes, then we will take a look at

• Body Systems

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Musculoskeletal System

• Function
• Gives body shape
• Protects vital organs
• Provides for body movement
• Components
• Bones, joints, connective tissues and muscles

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Bones

• Skull-houses and protects the brain
• Face
• Orbit
• Nasal bone
• Maxilla
• Mandible
• Zygomatic bones (cheeks)
• Spinal Column (33 vertebrae)
• Cervical (neck) 7 vertebrae
• Thoracic (upper back) 12 vertebrae
• Lumbar (lower back) 5 vertebrae
• Sacral (back wall of pelvis) 5 vertebrae
• Coccyx (tail bone) 4 vertebrae

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Bones

• Thorax
• Ribs
• 12 pairs
• Attached posterior to the thoracic vertebrae
• Pairs 1-10 attached anterior to the sternum
• Pairs 11 and 12 are floating
• Sternum (breast bone)
• Manubrium (superior portion of sternum)
• Body (middle part)
• Xiphoid process (inferior portion of sternum)

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Bones

• Pelvis
• Iliac crest (wings of pelvis)
• Pubis (anterior portion of pelvis)
• Ischium (inferior portion of pelvis)
• Lower extremities
• Greater trochanter (ball) and acetabulum (socket
  of hip bone) make up hip joint
• Femur (thigh)
• Patella (kneecap)
• Tibia (shin, lower leg)
• Fibula (lower leg)

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Bones

• Medial and lateral malleolus are surface
  landmarks of ankle joint
• Tarsals and metarsals
• Calacneus
• Phalanges
• Upper extremities
• Clavicle (collar bone)
• Scapula (shoulder blade)
• Acromion (tip of shoulder)
• Humerus (superior portion of upper extremity)
• Olecranon (elbow)

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Bones

• Radius (lateral bone of the forearm)
• Ulna (medial bone of the forearm)
• Carpals (wrist)
• Metacarpals (hand)
• Phalanges

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Joints

• Where bones connect to other bones
• Ball and socket
• Hinge
• Fixed

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Now its your turn!
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Connective Tissue

• Ligaments
• Hold joints together
• Tendons
• Attach muscle to bone

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Muscle Types

• Voluntary (skeletal)
• May also attach muscles to bones
• Form major muscle mass in the body
• Under control of the nervous system and the
  brain can be contracted and relaxed by the will
  of the patient
• Responsible for movement

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Muscle Types

• Involuntary (smooth)
• Found in the walls of the tubular structures of
  the gastrointestinal tract and the urinary system
  as well as blood vessels and bronchi
• Control the flow of blood through these
  structures
• Carry out automatic muscular functions of the
  body
• Patients have no direct control over these
  muscles
• Respond to stimuli such as stretching, heat and
  cold

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Types of muscle

• Cardiac
• Found only in the heart
• Involuntary muscle
• Has its own supply of blood through the coronary
  artery system
• Can tolerate interruption of blood supply for
  only very short time periods
• Automaticity-has the ability to contract on its
  own

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Respiratory System

• Nose and mouth
• Pharynx
• Oropharynx
• Nasopharynx
• Epiglottis-leaf shaped structure that prevents
  food and liquid from entering trachea during
  swallowing
• Trachea (windpipe)
• Cricoid cartilage-firm cartilage ring forming the
  lower portion of the larynx

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Respiratory System

• Larynx (voice box)
• Bronchi-two major branches of the trachea to the
  lungs which subdivide into smaller passages
  ending in the alveoli
• Lungs

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Respiratory System

• Diaphragm
• Inhalation (active)
• Diaphragm and intercostal muscles contract
  increasing size of the thoracic cavity
• Diaphragm moves slightly downward, ribs move
  upward/outward
• Air flows into lungs
• Exhalation
• Diaphragm and intercostal muscles relax
  decreasing the size of the thoracic cavity
• Diaphragm moves upward, ribs move downward/inward
• Air flows out of the lungs

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Respiratory Physiology

• Alveolar/capillary exchange
• Oxygen right air enters the alveoli during each
  inspiration
• Oxygen poor blood in the capillaries pass into
  the alveoli
• Oxygen enters the capillaries as carbon dioxide
  enters the alveoli
• Capillary cellular exchange
• Cells give up carbon dioxide to the capillaries
• Capillaries give up oxygen to the cells

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Infant and Child considerations

• Mouth and nose are smaller and more easily
  obstructed
• Pharynx- tongues take up proportionally more
  space than adults
• Trachea
• Narrower, more easily blocked
• Softer and more flexible
• Diaphgram-chest wall is softer, depend more on
  diaphragm for breathing

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Circulatory (Cardiovascular)

• Heart
• Structure/function
• Atrium
• Right-receives blood from the veins of the body
  and heart, pumps oxygen poor blood into right
  ventricle
• Left-receives blood from the pulmonary veins
  (lungs), pumps oxygen right blood to left
  ventricle
• Ventricle
• Right-pumps blood to lungs
• Left-pumps blood to body
• Valves-prevent backflow of blood

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Cardiac Conduction System

• Heart is more than a muscle
• Specialized contractile and conductive tissue in
  the heart
• Electrical impulses
• Automaticity

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Arteries

• Carry blood away from the heart to rest of the
  body
• Major arteries
• Coronary arteries-supply the heart with blood
• Aorta-major artery supplies other vessels with
  blood, originates from the heart lying in front
  of the spine in the thoracic and abdominal
  cavities and divides at the level of the navel
  into the iliac arteries

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Arteries

• Pulmonary-originates at right ventricle and
  carries oxygen poor blood to the lungs
• Carotid-major artery of the neck, supplies head
  with blood, pulsations can be palpated on either
  side of the neck
• Femoral-major artery of the thigh, supplies groin
  and lower extremities with blood, pulsations can
  be palpated in groin area
• Radial-major artery of the lower hand, pulsations
  can be palpated at the wrist thumb side

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Arteries

• Brachial-an artery of upper arm, pulsations on
  inside of the arm between elbow and shoulder,
  used with determining blood pressure
• Posterior tibial-pulsations can be palpated on
  the posterior surface of the medial malleoulus
• Dorsalis pedis-an artery in the foot, pulsations
  can be palpated on the anterior surface of the
  foot
• Arterioles are the smallest branch of an artery
  leading to capillaries

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Capillaries

• Tiny blood vessels that connect arterioles to
  venules
• Found in all parts of the body
• Allows for the exchange of nutrients and waste at
  the cellular level
• Venules are the smallest branch of the veins
  leading to the capillaries

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Veins

• Carry blood back to the heart
• Major veins
• Pulmonary vein-carries oxygen rich blood from
  the lungs to the left atrium
• Venae cavae
• Superior
• Inferior
• Carries oxygen poor blood back to right atrium

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Blood composition

• Red blood cells
• Give blood their color
• Carry oxygen to organs
• Carry carbon dioxide away from organs
• White blood cells-part of the bodys defense
  against infections
• Plasma-fluid that carries blood cells and
  nutrients
• Platelets-essential for the formation of blood
  clots

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Physiology

• Pulse
• L ventricle contracts, sending a wave of blood
  through arteries
• Can be palpated anywhere an artery passes near
  the skin surface and over a bone
• Peripheral pulses
• Radial
• Brachial
• Posterior tibial
• Dorsailis pedis
• Central
• Carotid
• Femoral

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Blood Pressure

• Systolic-the pressure exerted against the walls
  of the artery when the L ventricle contracts
• Diastolic-pressure exerted against the walls of
  the artery when L ventricle is at rest

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Inadequate circulation/shock

• Hypoperfusion resulting in profound depression of
  vital processes of the boy
• Characterized by these signs and symptoms
• Pale, cyanotic (blue colored), cool, clammy skin
• Rapid, weak pulse
• Rapid, shallow breathing
• Restlessness, anxiety or mental dullness
• Nausea and vomiting

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Shock

• Reduction in total blood volume
• Subnormal temperature

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Perfusion

• Defined circulation of blood through an organ
• Perfusion is the delivery of oxygen and other
  nutrients to the cells of all organ systems and
  the removal of waste products
• Hypoperfusion is the inadequate circulation of
  blood through an organ

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Nervous system

• Controls the voluntary and involuntary activity
  of the body
• Components
• Central nervous system
• Brain-located within cranium
• Spinal cord-located in spine from brain to lumbar
  vertebrae
• Peripheral nervous system
• Sensory nerves carry info from body to brain and
  spinal cord
• Motor nerves carry info from the brain and spinal
  cord to the body

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Endocrine System

• Secretes chemicals (hormones), responsible for
  regulating body activities such as reproductive
  changes and regulation of metabolism
• Organs include the hypothalamus in the brain,
  pituitary gland, thyroid and parathyroid glands,
  adrenal glands, and parts of the pancreas

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Gastrointestinal System

• Responsible for the digestion of food
• Chemicals aiding in digestion produced by liver,
  gallbladder and parts of pancreas

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Genitourinary system

• Organs include reproductive organs and those
  organs responsible for the production and
  secretion of urine
• Located close together in abdomen and pelvis
  because of shared functions

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Skin

• Integumentary system
• Protects body from environment, bacteria, and
  other organisms
• Helps regulate body temperature
• Senses heat, cold, touch, pressure, and
  pain-transmits this information to brain and
  spinal cord

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Layers of the Skin

• Epidermis-outermost layer of skin
• Dermis-deeper layer of skin containing sweat and
  sebaceous glands, hair follicles, blood vessels,
  and nerve endings
• Subcutaneous layer

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Any questions???