Thorax Flashcards
Segmental innervation
Innervates the piece of skin at that level, all the way to the back. T1 is responsible for sensation on your medial forearm - last nerve root that will move along UE. T2 can sometimes do medial arm.
The umbilicus has which nerve root?
T10
If someone has a transection at T4 then
You can move your head, neck, and all UE. Will also have sensation from T4 and up, and can breathe on your own because the diaphragm was already innervated. But you will be a community ambulator, can’t walk or sit up straight or have sensation below T4
External intercostals run
downward and forward (more lateral)
Internal intercostals run
downward and backward (more medial)
All the intercostal muscles will
bring the ribs closer together. They are muscles of ventilation - process of getting air in and out of the lungs
Innermost intercostals run
straight up and down
Transversus thoracis
Comes from the body of the sternum and inserts onto ribs 3,4,5,6
Will pull the ribs down so we use it for forceful exhaling.
Inconsistant muscle
Diaphragm
Main muscle of respiration.
Separates thoracic cavity from abdominal cavity. Lies completely over your liver, spleen, pancreas, stomach, and lines the under surface of the rib cage and goes all the way to the posterior abdominal wall. Untapped muscle for stability, should be incorporated
Pelvic floor muscles have
Poor recruitment patterns, poor firing patterns during pain (delayed), called an adaptive change - someone’s in pain the muscle doesn’t fire appropriately. If it doesn’t go away after pain is gone then we have a maladaptive pattern
What works best to treat chronic lower back pain?
Pain education, myopyschosocial behavior counseling, and aerobic exercise
What works best to treat hypermobility problems?
Stabilization exercises
Lungs are where we
Exchange our gases
In the front they run down to…
In the back they run down to…
Rib 8
Rib 10
Lungs have two layers of tissue between them and the chest wall called
Parietal pleura which covers the entire thoracic cavity.
Visceral pleura which is a thin lining around the lungs only.
Mediastinum
Area between the lungs.
4 areas: superior, anterior, middle, posterior
Hypothetical line at T4 to separate superior mediastinum on top from the other three ones below
Superior mediastinum structures
Thymus gland Superior vena cava Brachiocephalic veins and arteries Internal jugular veins Common carotid arteries Subclavian veins and arteries Trachea and esophagus Phrenic nerves and vagus nerves
Patients who have serious cervical spine trauma like whiplash from an MVA can have structural damage to the
Sympathetic chain ganglion - In your thoracic spine (lateral to spinal cord between T1-T3).
Can only be associated with superior mediastinum.
Going to present with clinical symptoms like nausea, vomiting, increased sweating. Research that a single upper thoracic spine thrust manipulation can send a mechanical input to the system that will change the neurophysiological output
Anterior mediastinum structures
Space between the front of the lungs and the sternum, no big structures
Middle mediastinum structures
Pericardium and the heart
Posterior mediastinum structures
2 vagus nerves, 2 phrenic nerves, esophagus, trachea
The superior vena cava is formed by
Both brachiocephalic veins
Each brachiocephalic vein is formed from the
Internal jugular vein and the subclavian vein
Great veins are…. to the great arteries
anterior
Trachea begins at the
cricoid cartilage
Trachea runs down and splits at the
carina to form the right and left main stem bronchus, which will give us the right and left lungs
How many lobes do the right and left lungs have?
Right has 3 lobes: upper middle and lower
Left has 2 lobes: upper and lower, and another piece called the lingula
3 primary coronary arteries
Left anterior descending
Right anterior descending
Circumflex
They will supply the heart and myocardium with blood rich in oxygen
6-way bypass surgery
Have signs like being out of breath after only 3 stairs, squeezing tightness etc. Coronary artery bypass graft x6, 6 vessels were blocked so they bypass those vessels and take new grafts from the veins in your legs and they reroute your blood supply. Need to restore oxygenated blood to the heart. Discharge from hospital is 2 days. These people are in their 40s and 50s.
Blood enters the heart via 3 ways
Superior vena cava - which will dump blood from the UE and the head.
Inferior vena cava - which will dump blood from the LE, hepatic circulation.
Cardiac circulation itself - blood will flow through the coronary sinus.
Blood flow through the heart
Blood will enter the right atrium after going through the thespian valve. Blood in the right atrium travels to the right ventricle through the tricuspid valve. This valve called the atrioventricular valve will have papillary muscles and chordae tendinae. These structures on the valve will prevent the valve from being blown open backwards and prevent backflow of blood. From the right ventricle blood passes thru the pulmonic semilunar valve and enters the pulmonary artery. This is the only artery that will carry deoxygenated blood to the lungs to become oxygenated. Blood will then enter the pulmonary vein (which is the only vein that carries oxygenated blood) and it will then enter the left atrium. Oxygenated blood passes from left atrium to left ventricle through the bicuspid / mitral valve, another AV valve. Once in the left ventricle blood will pass through the aortic semilunar valve to the entire circulation – cardiac output 5L per minute
In diastole
The atria are contracting and the AV valves are open, semilunar valves are closed
In systole
The ventricles are contracting and the AV valves are closed preventing backflow of blood while the semilunar valves are open
Automaticity
Heart will beat by itself
Intercalated discs
In cardiac muscle. Will break up the cardiac muscle into clumps which will allow parts of the cardiac muscle to depolarize all at once in sections
SA node
Located in the right atrium
Controls the cardiac cycle
Heart’s implanted pacemaker which will set the beat between 60-100bpm (endocrine system)
When the SA node depolarizes
The atria contract first, and the impulse will travel to the AV node
When the AV node depolarizes
The ventricles will begin to contract
The AV node is located at the
Top of the interventricular septum. As the impulse travels down the walls of the ventricles and up the sides the purkinjie fibers will begin to contract to finish depolarization of the heart
Aortic valve auscultation point
To the right of the sternum in the 2nd intercostal space
Pulmonary valve auscultation point
To the left of the sternum in the 2nd intercostal space more laterally
Bicuspid valve auscultation point
To the left of the sternum much more laterally in the 5th intercostal space
Tricuspid valve auscultation point
To the left of the sternum in the 5th intercostal space medially right off the sternum
EKG
Only as good as the second you take it, not going to predict any pathology
