Anatomy 7 Flashcards
Which group gives guidelines for Basic Life Support (BLS) in the UK? Website?
Resuscitation Council UK
What is Basic Life Support? (BLS)
Maintaining airway patency and supporting breathing and circulation without the use of equipment other than a protective device.
What is the main sign which indicates treatment for cardiac arrest in current BLS guidelines?
What do you no longer look for to assess whether a cardiac arrest has taken place?
The main sign which indicates treatment for cardiac arrest is the absence of normal breathing sounds.
You no longer check for a carotid pulse as this can be time consuming and unreliable.
If you find a collapsed person, what is the overall BLS sequence you should follow?
Make sure you, the victim and bystanders are safe
Check for a response
If responsive, don’t move them, try to find out what is wrong.
If unresponsive shout for help
Open airway
If breathing normally, put into the recovery position
If not breathing normally, call 999
Start CPR: begin with compressions
30 chest compressions, 2 breaths
When obtaining help in BLS, what should you ask for?
Ask for an automated external defibrillator, if one is likely to be available.
Describe the chest compressions you should give in CPR
Compress vertically, in the centre of the sternum. Compress to a depth of 5-6cm, at a rate of 100-120 per min (Staying Alive).
How long should a rescue breath take? Why?
A rescue breath should take about 1 sec, no more so that the pauses in chest compression is minimised.
During CPR, when should you stop to check the victim, or discontinue CPR?
Do not stop to check the victim or discontinue CPR unless the victim starts to show signs of regaining consciousness, such as coughing, opening his eyes, speaking or moving AND then starts to breathe normally.
What should you do with a responsive patient? (3)
- Leave them in the position in which you find them provided they are in no danger
- Try to find out what is wrong with them
- Reassess them regularly
How do you open an airway
Turn the victim onto their back
Place a hand on the victims forehead and gently tilt his head back
With your fingertips under the point of the victim’s chin, lift the chin to open the airway.
How do you check for breathing?
Keep the airway open
Look for chest movement
Listen at the victims mouth for breath sounds
Feel for air on your cheek
How long do you check for breathing?
What do you do if you are unsure of breathing is normal?
What do first aiders sometimes mistake for normal breathing?
Check for no more than 10 seconds
If there is any doubt as to whether there is normal breathing, act as if breathing is not normal
In the first few minutes after cardiac arrest, a paitent may be barely breathing, or taking infrequent, noisy gasps. This is often termed agonal breathing and must not be confused with normal breathing
What do you do with a patient who is unconscious, but is breathing normally?
Turn them into the recovery position
Call 999 from a mobile. If there is no signal, send a bystander to find a phone. Only leave the victim if there is no other option.
Continue to assess that the breathing is normal. If there is any doubt as to whether the breathing is normal, commence CPR.
What is the first thing you do if you have a patient who is unconscious and not breathing normally?
Call 999/ask someone to call for an ambulance
Only leave the patient if there is no other option for summoning an ambulance
Ask a bystander to find an AED if this seems likely to be available
Then you should start CPR.
How do you do a chest compression?
Kneel by the side of the victim
Place the heel of one hand in the centre of the victims chest (lower half of the sternum)
Place the heel of your other hand on top of the first hand, and interlock fingers. Ensure that there is no pressure on the ribs or abdomen.
Press down vertically and with your arms straight. Aim to press 5-6cm
After each compression release all pressure on the chest without losing contact with the patient
Compression and release should take the same amount of time
How do you do a rescue breath?
Open the airway using head tilt and lift
Pinch the victims nose using the index finger and thumb of the hand on their forehead
Allow the mouth to open while maintaining chin lift
Take a normal breath and seal your lips to their mouth
Blow steadily into their mouth while watching the chest rise, take about 1 sec
Take your mouth away and watch for the air leaving the chest
Do one more breath, then return to the compressions straight away. 30 compressions:2breaths
What do you do if the first rescue breath does not make the chest rise and fall?
Check the victims mouth, and remove obstruction
Recheck that there is adequate head tilt and chin lift
Do not attempt more than two breaths each time before returning to chest compressions.
If there are two BLS trained first aiders there, how often do you change roles and why?
Swap compressions/breaths every one to two minutes to avoid fatigue
Do this as quickly as possible, trying to keep compressions uninterrupted.
If you cannot face giving rescue breaths, what can you do?
Give compression only CPR. Continue for as long as you would with normal CPR
Continue resuscitation until…
- Qualified help arrives and takes over
- The victim starts to regain consciousness AND starts breathing normally
- You become exhausted
How do you put someone in the recovery position?
- Remove glasses and check pockets for anything bulky
- Kneel beside the victim and make sure that both legs are straight
- Place the arm nearest to you out at right angles to the body, elbow bent with the hand palm-up
- Bring the far arm across the chest and hold the back of the hand against the victims cheek next to you
- With your other hand, grasp the far leg above the knee and pull it up, keeping the foot on the ground
- Keeping his hand pressed against his cheek, pull on the far leg to roll the victim towards you on to his side
- Adjust the upper leg so that both the hip and knee are bent to 90 degrees
- Tilt the head back to make sure the airway remains open
- If necessary, adjust the hand under the cheek to keep the head tilted and facing downwards to allow liquid material to drain from the mouth
- Check breathing regularly
- If they have to be kept in the recovery position for more than 30mins, turn them onto the other side
What is the main modification for CPR on a child?
How does the sequence of CPR slightly alter?
Main modification: Do chest compressions to one third of the depth of the chest. Use 2 fingers for an infant under 1, and use one or both hands for older children
Do 5 breaths before you start compressions
If you are on your own, do 1 min CPR before going for help
What modification to CPR is useful for victims of drowning?
Do 1 min of CPR before going to get help
What are the functions of the blood? (5)
- Transportation of dissolved gases, nutrients, hormones and metabolic waste
- Regulation of pH and ion composition of interstitial fluids
- Restriction of fluid loss at injury sites by clotting
- Defense agaist toxins and pathogens
- Stabilisation of body temperature
What does plasma consist of?
- 92% water
- Dissolved proteins which are different in composition to those of interstitial fluid
- Dissolved ions
What are the 5 types of white blood cell? (Leucocyte) There is a mnemonic to help.
- Neutrophil
- Lymphocyte
- Monocyte
- Eosinophil
- Basophil
(never let monkeys eat bananas)
What is the structure of a red blood cell? What is its function?
Red blood cells are disc shaped with a dimple in the centre. Their function is to carry oxygen around the body.
What is the structure of a monocyte? What is its function?
Monocytes are spherical and are about twice the size of a RBC. When flattened in a blood smear they look even larger, so they are easy to identify. The nucleus is large and tends to be oval or kidney shaped.
Monocytes use the blood stream for transportation, remianing in circulation for only 24 hours before they enter peripheral tissues to become a tissue macrophage. Macrophages are phagocytes which can attract other phagocytes and fibrocytes.
What is the structure of a lymphocyte in the blood? What is its function?
Lymphocytes are distinguished by having a deeply staining nucleus that may be eccentric in location, and a relatively small amount of cytoplasm without stained granules. They are slightly larger than RBCs.
The blood contains 3 types of lymphocyte: B cells, Tcells and Natural Killer cells.
B cells make antibodies that bind to pathogens to enable their destruction
T cells co-ordinate the immune response and are important in the defense against intracellular bacteria.
Natural killer cells: Natural killer cells are able to kill cells of the body that are displaying a signal to kill them, as they have been infected by a virus or have become cancerous.
What is the structure of a neutrophil in the blood? What is its function?
Neutrophils have a multi-lobed nucleus that may appear like multiple nuclei. They are sometimes called polymorphonuclear leukocytes. The cytoplasm may look transparent because of fine granules that are dificult to stain and so appear ‘neutral’.
Neutrophils defend against bacterial or fungal infection and are usually first responders to microbial infection; their activity and death in large numbers forms pus. These cells are not able to renew their lysosomes (used in digesting microbes) and die after having phagocytosed a few pathogens.
What is the structure of a basophil? What is its function?
Basophils are characterized by their large blue granules.The nucleus is bi- or tri-lobed, but it is hard to see because of the number of coarse granules that hide it.
Basophils are chiefly responsible for allergic and antigen response by releasing the chemical histamine causing vasodilation. They also release heparin, which prevents blood clotting. They are relatively rare, accounting for only 1% of WBCs.
What is the structure of an eosinophil? What is its function?
In general, their nucleus is bi-lobed. The cytoplasm is full of granules that assume a characteristic pink-orange color with eosin stain.
Eosinophils primarily deal with parasitic infections. Eosinophils are also the predominant inflammatory cells in allergic reactions. The most important causes of eosinophilia include allergies such as asthma, hay fever, and hives; and also parasitic infections.
What is a white blood cell differential?
This is a blood test which indicates the percentage of each type of white blood cell that is present. It is normally run as part of the complete blood count (CBC).
What is a white blood cell differential used for? (6)
The white blood cell differential assesses
- the ability of the body to respond to and eliminate infection.
- the severity of allergic and drug reactions
- the response to parasitic and other types of infection.
- the reaction to viral infections
- response to chemotherapy
- It can also identify various stages of leukemia.
When might the neutrophil count increase (3) or decrease (4)?
Increased neutrophil levels:
- bacterial infection
- inflammatory disease.
- Severe elevations in neutrophils may be caused by a bone marrow disorder, such as chronic myelogenous leukemia.
Decreased neutrophil levels:
- severe infection
- responses to various medications, particularly chemotherapy.
- liver disease
- enlarged spleen
When might the eosinophil count increase (5) or decrease (1)?
Eosinophils can increase in response to:
- allergic disorders
- inflammation of the skin
- parasitic infections
- some infections
- bone marrow disorders
Decreased levels of eosinophils can occur as a result of infection.
Where is the spleen located?
the spleen lies against the diaphragm, in the area of rib 9 to rib 10 in the left upper quadrant of the abdomen.
What are the two ligaments that connect to the spleen? What else do they connect to? What are these ligaments part of?
The spleen is connected:
- to the greater curvature of the stomach by the gastrosplenic ligament, which contains the short gastric and gastro-omental vessels.
- to the eft kidney by the splenorenal ligament which contains the splenic vessels.
Both these ligaments are parts of the greater omentum.
What are the two surfaces of the spleen, what are they in contact with?
What are the borders of the spleen?
What structures does the spleen come into contact with?
Posteriorly, there is a diaphragmatic surface, which lies in contact with the diaphragm;
Anteriorly, there is a visceral surface toward the stomach;
There is an inferior border, resting on the splenic flexure of the colon;
There is a superior border, which lies in contact with the diaphragm;
medially and inferiorly, the spleen is in contact with the upper anterior part of left kidney.
Where is the hilum of the spleen?
What structures enter at the hilum?
The hilum is on its anterior or gastric surface and posterior to it is a depression in which is lodged the tail of the pancreas.
It is the point of attachment for the gastrosplenic ligament, and the point of insertion for the splenic artery and splenic vein.
What is the arterial supply of the spleen? Where does this artery originate?
The splenic artery, the largest branch of the celiac trunk, takes a tortuous course to the left along the superior border of the pancreas. It travels in the splenorenal ligament and divides into numerous branches, which enter the hilum of the spleen.
As the splenic artery passes along the superior border of the pancreas, it gives off numerous small branches to supply the neck, body, and tail of the pancreas.
What is the venous drainage of the spleen? Where does it drain to?
The splenic vein forms from numerous smaller vessels leaving the hilum of the spleen. It passes to the right, passing through the splenorenal ligament with the splenic artery and the tail of pancreas. Continuing to the right, the large, straight splenic vein is in contact with the body of the pancreas. Posterior to the neck of the pancreas, the splenic vein joins the superior mesenteric vein to form the portal vein.
What is the lymphatic drainage of the spleen?
structures supplied by the the celiac trunk (i.e., structures that are part of the abdominal foregut) drain to pre-aortic nodes near the origin of the celiac trunk.
lymph from these celiac nodes enters the cisterna chyli.
What is this structure? Complete the labels.
The Spleen
What are the surfaces of the liver?
Surfaces of the liver include:
- a diaphragmatic surface in the anterior, superior, and posterior directions. This is smooth and domed, lies against the inferior surface of the diaphragm. Associated with it are the subphrenic and hepatorenal recesses.
- a visceral surface in the inferior direction. The visceral surface of the liver is covered with visceral peritoneum except in the fossa for the gallbladder and at the porta hepatis.
What are the names of the lobes of the liver?
What are the right and left lobes separated by?
Right, Left, Quadrate and Caudate.
The liver is divided into right and left lobes by fossae for the gallbladder and the inferior vena cava, and the falciform ligament appears to separate the two on the anterior surface.
Describe the lobes of the liver.
The right lobe of liver is the largest lobe, whereas the left lobe of liver is smaller.
The quadrate and caudate lobes are described as arising from the right lobe of liver, but functionally are distinct.
The quadrate lobe is visible on the anterior part of the visceral surface of the liver and is bounded on the left by the fissure for ligamentum teres and on the right by the fossa for the gallbladder. Functionally it is related to the left lobe of the liver.
The caudate lobe is visible on the posterior part of the visceral surface of the liver. It is bounded on the left by the fissure for the ligamentum venosum and on the right by the groove for the inferior vena cava. Functionally, it is separate from the right and the left lobes of the liver.
Where is the porta hepatis/hilum? What structures enter and leave the liver here?
hepatic portal vein (entering)
hepatic artery proper (entering)
common hepatic duct (leaving)
The hepatic duct lies in front and to the right, the hepatic artery to the left, and the portal vein behind and between the duct and artery.
It also transmits nerves and lymphatics.
What are the relations of the liver when viewed in medial saggital section?
Anterior/superior - diaphragm
Inferior to the left lobe - stomach, connected by the lesser omentum
Posterior - omental bursa
What are the anatomical relations of the liver when considered from an anterior view?
Anterior/superior - diaphragm
Inferior to the lateral part of the right lobe - colon
Inferior to the left lobe and the medial part of the right lobe - stomach, attached by the lesser omentum
