All lectures Flashcards
Upper airway: parts
Nose, mouth, pharynx, larynx
Upper airway: function
Conducts air to lower airway, protects lower airway
Lower airway: parts
Trachea, bronchi, bronchioles and aveoli
Lower airway: function
Gasses travel through these structures to and from the blood. Connects to upper airway
Capacity of lungs
5-6L
Rate of gas exchange depends on…
Respiration frequency, Diffusion (passive), Perfusion (heart rate)
Thoracic wall: Parts
Thoracic vertebrae, ribs, costal cartilages, sternum and associated muslces
Thoracic wall: Function
Protect the lungs
Thoracic wall: dorsal, between & ventral
Dorsal: vertebrae, between: ribs, ventral: sternum
Dorsal & Ventral
Dorsal is back, Ventral is front
Respiratory rate
12-18 at rest, 40-60 during exercise
Visceral: inside
Parietal: outside
Child’s airway differences
More anterior and higher
Like a funnel (the cricoid ring is the narrowest point)
Larger tongue
Adult’s airway differences
Less anterior than child
Cylindrical (vocal chords are narrowest points)
Respiratory system functions
Gas exchange, regulation of blood PH, voice production, olfaction, protection
cardiology
study of the heart
How to diagnose acute coronary syndrome or heart attack?
- History
- ECG
- Blood test (troponine)
what does the heart function as?
a pump
What is important in history of patient for acute coronary syndrome?
- Chest pain
- Radiation of the pain
- Sweating, nauseous, vomiting
- Risk factors (smoking, blood pressure, cholesterol, diabetes, obesity, family history)
- Previous stable angina pectoris
Autorhythmic
Heart beats at its own rhythm without need of stimuli from nervous system
How to treat heart attack?
Dotter treatment (PCI)
Bypass operation
Secondary prevention: medication & healthy lifestyle
What do contractile cardiomyocytes have?
A stable resting potential, waiting to receive a signal from the subendocardial conducting network (or from each other)
3 causes for heart attack:
- Stable angina (plaque in coronary artery but problems only with exercising)
- Unstable angine (plaque an rupture which can cause artery to close)
- Acute myocardial infarction (sudden plaque ruptures, blood clot, part of heart muslc edies)
Most common pattern of systemic blood flow:
Blood leaves heart through arteries, pass through apillaries, return to heart via veins
What is atrial fibrilation?
Irregular palpataions & feeling dizzy
Portal system (pattern of blood flow)
BLood flows through two capillary beds in a row before returning to heart (e.g. kidneys or intestine-liver, where substance is picked up & given off)
How to diagnose atrial fibrilation?
ECG (very irregular) + signals anywhere in atria & av node cannot take all signals
Anastomoses of heart
Routes in which blood bypasses capillaries
Treatment atrial fibrilation?
Main risk = stroke
Anticoagulations (blood thinners) or medication
Cardoversion (restore rhythm)
Ablation (treat spots which give sign)
Symptoms aortic dissection
Acute stabbing pain between shoulder blades & chest + see in patients with high bp
How to treat type A aortic dissection?
- Ascending aorta: immediate surgery
How to treat type B aortic dissection?
Descending aorta = mediation to lower BP * rest
Diagnose aortic dissection?
- mostly men (60-70 years old)
- vital signs
- CT scan (contrast fluid)
Symptoms cardiac tamponade?
- E.g. stabbed with knife, heart can’t beat
Diagnose cardiac tamponade?
- Hypotension (lower BP)
Jugular venous distension (veins in neck can’t go back) - Muffled heart sounds
- Tachycardia, shock
- Respiratory distress
- Cardiac ultrasound
- X-ray of chest
-ECG (signals lower) - CT-scan
Treatment cardiac tamponade?
pericardiocentesis (needle)
Surgery (hole to remove blood)
symptoms heart failure?
shortness of breath
gained weight
increasing edema in legs (pulmonary edema = blood in lungs)
causes heart failure?
heart attack, hypertension, valve abnormalities, medication (chemotherapy), anemia, infection of the heart
diagnose heart failure?
synptoms
higher bp
higher respiration rate
blood test
x-ray of chest
treatment heart failure?
oxygen
CPAP (continuous positive airway pressure)
medication (vasodilation - nitroglycerin, increase urine production - diuretics)
common features of shock
tachychardia (increased heart rate)
hypotension (low blood pressure)
altered mental status (confusion)
oliguria (decreased urine production)
lactic acdisosi
laboratory evidence for inadequate tissue oxygenation:
serum lactate > 4 mmol/L
multiorgan dysfunction
treatment of shock
varies per shock. treat the cause.
- improve tissue perfusion and reduce tissue demand by maximizing cardiac output & increasing oxygenation
important to remember in shock?
a ‘‘normal’’ blood pressure does not exclude the diagnosis of shock, and hypotension may occur in the absence of shock
causes of hypovolemic HEMORRHAGIC shock
external trauma or internal bleeding –> rapid reduction in blood volume
treatment hypovolemic HEMMORHAGIC shock
volume resuscitation (isotonic fluid), blood transfusion, hemorrhage control (not too much thin blood though!)
diagnosis hypovolemic HEMMORHAGIC shock
clinical (hemoglobin will be normal until compensatory fluid shifting or fluid resuscitation occurs)
causes of hypovolemic NON-HEMORRHAGIC shock
children, diarrhea, burn patients, metabollic problems –> volume intake is insufficient for volume losses
treatment hypovolemic NON-HEMORRHAGIC shock
oxygen & ventilation, isotonic fluid crystalloid (volume resusciation)
diagnosis of hypovolemic NON-HEMORRHAGIC shock
hemoglobin ar eelevated, creatinine is elevated, sodium is elevated due to free water loss
causes cardiogenic shock
acute myocardial infarction due to ischemia, or myocardial dysfunction, valvular disease, brady/tachyarrhythmias –> reduced cardiac output resulting in decreasing oxygen delivery to the tissues with signs end-organ hypoperfusion
diagnosis cardiogenic shock
clinical
ecg
chest x-ray
laboratory (elevated troponins)
treatment cardiogenic shock
ensure adequate oxygenation and ventilation (identify underlying cause)
causes obstructive shock
cardiac tamponade, tension pneumothorax, pulmonary embolism, aortic dissection –> cardiac obstruction impedes cardiac filling
diagnosis obstructive shock
clinical: chest pain, shortness of breath, hypotension, tachycardia, tachypnea, icnreased JVD, chest trauma, signs of deep vein trombosis
treatment obstructive shock
determined by cause, goal is to relieve obstruction to flow
causes distributive shock
sepsis, anaphylaxis, neurogenic shock, rewarming in severe hypothermia –> impaired tissue oxygenation due to peripheral vasodilation with a low systemic vascular resistance with a normal or reducd cardiac output
treatment to all shocks:
ventilation & oxygenation
symptoms 1st degree
redenss, swelling, pain, no blisters or wounds
higher capillary refilll
higher sensation
heals in 7 days
symptoms 2nd degree burn, superficial
very painful, pale pink, blistered, moist, higher capillary refill, higher sensation, heals in 14 days
symptoms 2nd degree burn, deep
blotchy red, painful, less capillary refill, less sensation
symptoms 3rd degree burn
coloured white or black, waxy or leathery, flangds & follicels destroyed, lower capillary refill, lower sensation
symptoms 4th degree burn
fascia, muscle and bone visible and damaged, systemic toxic reactions & sepsis
Treatment burns
- Prevention of worsening (cooling tepid water, remove clothing, cover with plastic wrap/foil)
- Pain management: painkillers & covering’
- Infection prevention (antibiotic profylaxis in specific cases)
Non-surgical treatment for burns
Dressings like aquacell
Vaseline, flammazine
Don’t puncture blister
Remove entire blister if already ruptured
Treatment of intoxication
- Identify intoxication
- Route of exposure (how much, when, why?)
- Remove toxin/decontamination
- Antidote
- Definitive treatment
symptoms sympathomenic intoxication
dilated pupils
high heart rate
high breathing rate
high respiratory rate
sweating
hyper alert
symptoms anticholinergic
same as sympathomenic but no sweaty & red skin
inhibition of parasympathetic system
bowel & bladder lose their tone (no bowel sounds)
heart runs alone
blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone
symptoms sedative-hypnotic
inhibtion of GABA receptors
slows you down in everything (lower heart rate, lower respiratory rate)
inhibition of CNS
hypothermia, less bowel sounds
symptoms opioid syndrome
slow to unresponsive, hypotension, hypothermia, less bowel sounds, don’t respond to light, inhibition of CNS
multipolar neurons
one axon and multiple dendirtes (most common type in brain and spinal cord)
bipolar neurons
one axon and one dendrite, sensory neurons of hearing, smell and vision
unipolar neurons
one process leading away from the soma; one branch bringing signals from sources such as skin and joints, the other branch leading to the spinal chord
The 3 classes of neurons
Sensory (afferent) neurons: detect stimul & transmit information to CNS
Interneurons: perform integrative functions of nervous system > processing, storing, retrieving information, making decisions
Motor (efferent) neurons: carry outgoing signals from CNS to cells and organs
Afferent vs efferent
Afferent: toward CNS
Efferent: away from CNS
3 functions of the nervous system
- sensory: respond to stimuli within and around the body and generate signals that carry info abuot stimuli
- Integrative: ability to preceive and process information, store and retrieve it, and make decisions
- Motor: issue outgoing signals to muscle and gland cells to produce response
white matter:
bundles of nerve fibers called tracts tha ttravael up and down the spinal cord, between brain regions & brain and spinal cord
many fibers in brain are myelinated. What does myelinated mean?
Myelin gives the white matter a glistening, pearly white color
Gray matter
Neurosomas, dendrites & synapses. They have a little myalin.
Gray part vs white part?
Gray part is information-processing of CNS, while white matter is more like a telephone cable
what is the brainstem?
'’information highway’’ between cerebrum & lower body. Nuclei in brainstem form the reticular formation; network of nerve fibers in medulla, pons & midbrain which regulate sleep, consciousness, cardiovascular, respoiratory control & pani modulation
Mdulla olongata:
passageway where nerves extend to and from the brain to the spinal cord and other organs (motor signals that travel through pyramids)
Pons
contain nuclei concerned with sleep, hearing, equilibrium, taste, eye movement, etc
Thalamus
Role in memory, emotion, motor control & sensation. ‘‘Gateway to cerebral cortex’’
Hypothalamus:
instinctive & automatic functions including water balance, blood pressure, metabolism, etc
Pituitary gland:
endocrine master gland
PNS?
Motor system & autonomic nervous system
Approach neurological patient
History
Neurological exam
Localization in nervous system
