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ESSENTIALS OF A&P FOR EMERGENCY CARE CHAPTER 13 The Cardiovascular System: Transport and Supply Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Multimedia Asset Directory Slide 27 Slide 35 Slide 36 Slide 37 Slide 52 Slide 71 Slide 127 Slide 128 Slide 129 Slide 130 Slide 143 Slide 155 Chambers of the Heart Video Cardiac Cycle of the Heart Animation Blood Flow through the Atria Animation Atrial Contraction Animation Electrocardiology Video Blood Clotting Animation Head and Neck Animation Abdomen and Trunk Animation Arm Animation Leg Animation Heart Failure Animation Aneurysm Animation Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Multimedia Asset Directory Slide 160 Slide 161 Slide 162 Slide 163 Slide 164 Slide 165 Slide 169 Slide 171 Slide 179 Heart Attacks Video Dysrhythmia Animation Angina Video Coronary Artery Disease Video Shock Animation Shock Animation 2 Sickle Cell Anemia Video Leukemia Video Cardiovascular Technology Video Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Introduction • The cardiovascular system transports nutrients and oxygen to the cells in your body while carbon dioxide and waste products of cells’ metabolism are removed. • The pump that circulates the transport medium (blood) is the heart. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Learning Objectives • Identify structures and functions of the cardiovascular system. • Trace the blood flow through the vessels and chambers of the heart. • Explain the coronary circulation of the heart. • Describe the contraction of the heart and the conduction system. • Differentiate between arteries, veins, and capillaries. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Learning Objectives • List the major components of blood and their functions. • Discuss the importance of blood typing. • Explain the process of blood clotting. • Explain regulation of blood pressure. • Describe various cardiovascular diseases. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Pronunciation Guide Click on the megaphone icon before each item to hear the pronunciation. agglutinate (ah GLUE tin ate) albumin (al BYOO men) anemia (ah NEE mee ah) aneurysm (AN yoo riz em) arterioles (are TEE ree ohlz) arteriosclerosis (are TEE ree oh skleh ROH sis) atherosclerosis (ATH er oh sklesh ROH sis) atrioventricular node (AY tree oh venhn TRIK yoo lahr) Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Pronunciation Guide Click on the megaphone icon before each item to hear the pronunciation. atrium; atria (AY tree um; AY tree uh) autorhythmicity (AW toe rith MIH sih tee) basophils (BAY soh filz) bundle of His (HISS) cor pulmonale (KOR pull moh NAH lee) diastole (dye ASS tole lee) embolus (EM boh lus) endocardium (EHN doh KAR dee um) eosinpohils (EE oh SIN oh filz) Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Pronunciation Guide Click on the megaphone icon before each item to hear the pronunciation. erythrocytes (eh RITH roh sights) hemophilia (HEE moh FILL ee ah) hemostasis (HEE moh STAY sis) inotropism (EYE no TROPE iz em) ischemia (iss KEE mee ah) polycythemia (PALL ee sigh THEE mee ah) prothrombin (pro THROM bin) systole (SIS toh lee) thrombocytes (THROM boh sights) Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Pronunciation Guide Click on the megaphone icon before each item to hear the pronunciation. tunica externa (TOO nik ah ex TERN ah) tunica interna (TOO nik ah in TERN ah) venules (VEHN yulz) Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. System Overview • The major components include the heart, blood, and a network of blood vessels. • Circulation is the movement of blood to and from the heart. Circulation can be split into two systems, pulmonary circulation, from heart to lungs and back, and systemic circulation, from heart to body tissues and back. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. System Overview • Arteries carry blood away from the heart, branch into smaller vessels called arterioles, which become capillaries. Capillaries become venules, that enlarge and become veins. • Veins differ from arteries because they carry blood toward the heart, have valves, and have thinner walls. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-1 Overview of the cardiovascular system. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Applied Science: Color-Coded Blood • Blood is depicted as being red or blue depending on the area where it is located. When the blood contains high amounts of oxygen it causes a chemical change within the red blood cells. This occurs in most arteries. As a result of that change, the arterial blood turns a bright red color. As the oxygen is being delivered to the tissue the blood begins to turn dark red, mostly in the veins. You can see the blue vein in your hand or arm. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. General Structure and Function of the Heart • The heart is the size of your fist, located slightly left of the center of your chest. • The base of the heart is proximal to your head while the apex of the heart is distal. • While the heart is one single organ, it is easier to understand if you think of it as two pumps working together. • The right side collects blood from the body and sends it to the lungs, the left side collects blood from the lungs and sends it to the rest of the body. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Heart Wall • The heart is surrounded by a tough membrane, the fibrous pericardium. – Inside the fibrous pericardium is the serous pericardium. The parietal layer of the serous pericardium lines the fibrous pericardium. The visceral layer is fused to the heart surface, and there is a potential cavity between the layers called the pericardial cavity. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Heart Wall • The outer layer of the heart wall is the epicardium. – Same layer as visceral pericardium • The middle layer of the heart wall, the myocardium, is made of cardiac muscle. • The heart is lined by epithelium, called the endocardium. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Internal Anatomy • The heart has four chambers. – The small upper chambers are the atria. – The large lower chambers are the ventricles. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Internal Anatomy • The heart has four chambers. – The chambers of the right side of the heart are separated from the chambers of the left side of the heart, so there is no mixing of blood from one side to the other. The wall that separates the two atria is called the interatrial septum. The wall between the ventricles is called the interventricular septum. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Internal Anatomy • The atrial walls are thinner than the ventricular walls. • Higher pressures are generated in the ventricles to move blood. • The walls of the left ventricle are thicker than the walls of the right ventricle because the right ventricle only pumps blood to the lungs while the left ventricle must pump blood throughout the entire body. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Internal Anatomy • Two veins bring the blood to the right atrium. – Superior vena cava – blood from the head, neck, chest, and upper extremities – Inferior vena cava – blood from the trunk, organs, abdomen, pelvic region, and lower extremities. • Pulmonary veins bring blood back to the left atrium. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Internal Anatomy • The pulmonary trunk carries blood from the right ventricle to the lungs. • The aorta carries blood from the left ventricle to the body. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Internal Anatomy • To keep blood flowing in the correct direction through the heart, there are two sets of valves. • Atrioventricular (AV) valves – between each atrium and the ventricle on the same side – On the right side is the tricuspid valve because the valve is formed with three cusps, or folds. – The valve on the left is the bicuspid, or mitral valve. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Internal Anatomy • Semilunar valves – between the ventricles and the large arteries that carry blood away from the heart – The pulmonary semilunar valve is on the right. – The aortic semilunar valve is on the left. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Flow Through the Heart • The right atrium – a collecting chamber where blood is returned to the heart via large veins after its trip through the body. • Once the blood is collected, it drains to the right ventricle and is pumped to the lungs. • Blood returning from the lungs flows into the left atrium and then into the left ventricle. • It is then pumped to the body. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-2 The anatomy of the heart. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view a video on the topic of the Chambers of the Heart. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. The Cardiac Cycle • The movements of the heart, called the cardiac cycle, can be divided into two phases called systole and diastole. – Systole is contraction of a chamber; the chamber is pumping blood out of the chamber. – Diastole is relaxation; the chamber is filling with blood. – Both atria and ventricles undergo systole and diastole, but usually when discussing heart movement, we refer to ventricular activity. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. How Valves Work • The movements of the heart, called the cardiac cycle, can be divided into two phases called systole and diastole. – When the right ventricle is full of blood, the ventricle contracts. Because the tricuspid valve is a one-way valve, as the right ventricular pressure increases, the valve shuts so blood doesn’t squirt back into the right atrium. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. How Valves Work • The movements of the heart, called the cardiac cycle, can be divided into two phases called systole and diastole. – As the pressure increases, the blood has to go somewhere. Now the only way for the blood to travel is through the pulmonary semilunar valve to the pulmonary trunk, which divides into the left and right pulmonary arteries. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. How Valves Work • The same thing happens on the left side of the heart. When the left ventricle is full, the ventricle contracts (squeezes). • The ventricular pressure increases, forcing the mitral valve shut and ejecting the blood out of the left ventricle through the aortic semilunar valve to the ascending aorta, sending it on its way throughout the body. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-3 The functioning of heart valves and blood flow. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-3 (continued) The functioning of heart valves and blood flow. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Cardiac Cycle Points to Remember • Both atria fill at the same time. • Both ventricles fill at the same time. • Both ventricles eject blood at the same time when the heart contracts. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the Cardiac Cycle of the Heart. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on Blood Flow through the Atria. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on Atrial Contraction. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Coronary Arteries • A portion of the newly oxygen enriched blood leaving the heart is diverted from the aorta by the right and left coronary arteries. • These arteries continuously divide into smaller branches forming a web of interconnections, known as anastomoses, in order to consistently supply the heart muscle with a rich supply of blood. • Regular aerobic exercise increases the density of these blood vessels and the number of anastomoses also increases. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Coronary Arteries • The right coronary artery provides blood for the right ventricle, the posterior portion of the interventricular septum, and inferior parts of the heart. • The left coronary artery provides blood to the left lateral and anterior walls of the left ventricle, and portions of the right ventricle and interventricular septum. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-4 Coronary circulation. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-4 (continued) Coronary circulation. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. The Electrical Pathway • The cardiac muscle is autorhythmic, meaning it can contract without nerve impulses or hormones. • Uncontrolled individual contractions would not be efficient, so there are specialized cardiac cells that create and distribute an electrical current that causes a controlled and directed contraction of the heart. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. The Electrical Pathway • Nodal cells, or pacemaker cells, are specialized cells that create an electrical impulse at a regular interval. – Nodal cells are divided into two groups, the sinoatrial node and atrioventricular node. The sinoatrial (SA) node is located in the wall of the right atrium, near the entrance of the superior vena cava; generates an electrical impulse at approximately 70-80 impulses per minute. The atrioventricular (AV) node is located in the inferior wall of the right atrium; the cells in the AV node generate an electrical impulse at a rate of 40-60 beats per minute. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. The Electrical Pathway • Nodal cells, or pacemaker cells, are specialized cells that create an electrical impulse at a regular interval. – The SA node sends its impulse to the AV node before the AV node can send a signal. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. The Electrical Pathway • Once an electric impulse is generated at the SA node, the impulse is transmitted to the AV node. – A slight signal delay allows for the atria to fill with blood before contraction occurs. • Once this charge reaches the AV node, it continues its journey through the AV bundle (bundle of His). Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. The Electrical Pathway • The AV bundle (in the interventricular septum) divides into the right and left bundle branches – spread across the inner surfaces of both ventricles. • Finally Purkinje fibers carry the impulse to the ventricles. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-11 Conduction system of the heart. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: EKGs • Because contraction is an electrical event, the charge can actually be detected on the surface of the body by using an electrocardiograph (ECG or EKG). • The normal EKG has three distinct waves representing specific heart actions. • The P wave is the first wave representative of the impulse generated by the SA node and depolarization of the atria before they contract. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: EKGs • The QRS complex represents the depolarization of the ventricles that occurs right before the ventricles contract. Due to the greater muscle action of the ventricles in relation to the atria, this wave is greater in size than the P wave. • The final wave is the T wave, which represents repolarization of the ventricles where they rest before the next contraction. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: EKGs • Repolarization of the atria occurs during the QRS complex but is overshadowed by the ventricular activity. • There are set ranges for height, depth, and length of each of the waves and changes or additions to these parameters are called cardiac arrhythmias. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-12 Typical EKG tracing. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view a video on Electrocardiology. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Emergency Cardiac Care • Emergency Cardiac Care (ECC) is a comprehensive system designed to deal with sudden, often life-threatening cardiovascular events. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Emergency Cardiac Care • ECC specifically includes: – Recognition of early warning signs of heart attack and stroke – Use of immediate basic life support (BLS) and cardiopulmonary resuscitation (CPR) – Use of advanced cardiac life support (ACLS) as soon as possible – Transfer of the stabilized patient to a specialty cardiac care center. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Coronary Artery Disease • Atherosclerosis refers to the thickening and hardening of medium size and large arteries. • Arteriosclerosis occurs when soft deposits of intra-arterial fat and fibrin cause thickening of the arterial wall. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Coronary Artery Disease • Atherosclerosis risk factors include: – Age – Gender – Tobacco use – Diabetes – Obesity – Hypertension (HTN) – Many others Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Coronary Artery Disease • Acute Coronary Syndrome (ACS) is a spectrum of diseases caused by underlying atherosclerotic coronary artery disease. – Examples include acute myocardial infarction (AMI) and unstable angina. – Syndrome is the result of coronary artery occlusion. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Coronary Artery Disease • Signs and symptoms of ACS • Assessment • Diagnostic tests – 12-lead electrocardiogram (ECG) – Blood tests Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Coronary Artery Disease • Treatment is time sensitive – Medications – Cardiac catheterization – Percutaneous transluminal coronary angioplasty (PCTA) – Coronary artery bypass graft (CABG) Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Defibrillation • Defibrillation is used to treat lifethreatening dysrhythmias such as ventricular fibrillation (V-Fib) and ventricular tachycardia (V-Tach). Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-9 Ventricular fibrillation is a lethal dysrhythmia where the cells throughout the heart fire in an uncoordinated fashion, resulting in loss of the heart’s pumping action. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Defibrillation • How it works: – A sufficient amount of electrical energy is applied to the hart to cause complete depolarization. – The goal is for the heart’s own pacemaker to start up again in an organized rhythm. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Defibrillation • Some patients may have permanently implanted devices referred to as implanted automatic cardioverter-defibrillators (IACDs) Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood • Blood is a fluid form of connective tissue. • The amount of blood in the body depends on size and sex. Normally you have 4-6 liters of blood; about 7-9% of your total body weight. • Blood has three functions: – Transportation – Regulation – Protection Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Transportation • Blood transports oxygen from the lungs, nutrients from the digestive system and fat cells, and hormones from endocrine glands to approximately 75 trillion cells in the body. • On the return trip blood carries carbon dioxide and other waste products to the kidneys, lungs, and other organs for removal. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Regulation • Blood helps to regulate a variety of levels in the body to help maintain homeostasis by ensuring that pH (levels of acidity or alkalinity) and electrolyte values are within normal parameters for proper cell functioning. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Regulation • Blood helps to regulate body temperature by absorbing heat generated by skeletal muscles, spreading it throughout the rest of the body or releasing heat through the skin. • Blood can take in or give up more fluid to help regulate fluid balance of the body. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Protection • Blood helps to protect us from invasion and infection by pathogens and toxins. • Specialized white blood cells and special proteins called antibodies function to prevent infection. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Composition • The major components of blood are plasma and formed elements. • Plasma: – Plasma is the yellowish, straw-colored liquid that comprises about 55% of the blood’s volume. – Plasma is 90% water. The other 10% contains nutrients, salts, oxygen, hormones and other regulatory substances. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Composition • Plasma: – Plasma proteins are an important group of dissolved substances that include albumin, which aids in keeping the correct amount of water in the blood. Fibrinogen is a substance needed for blood clotting, and globulins for protection from infection. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the topic of blood clotting. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Composition • Formed elements – Red Blood Cells (RBCs) or erythrocytes – White Blood Cells (WBCs) or leukocytes Basophils Eosinophils Lymphocytes Monocytes Neutrophils – Thrombocytes or platelets Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-16 Composition of blood. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Erythrocytes • Red blood cells are created by the red bone marrow through a process called hemopoiesis because they lack a nucleus to reproduce themselves. • RBCs are similar to a doughnut in shape. • Red blood cells perform two crucial functions: – With the aid of an iron-containing red pigment called hemoglobin, RBCs transport oxygen. – On a lesser scale, RBCs help to transport carbon dioxide from the cells to the lungs for removal. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Leukocytes • Leukocytes are our guardians from invasion and infection. • There are several different types of white blood cells, divided into two main types. – Polymorphonuclear granulocytes originate from red bone marrow. – Mononuclear agranulocytes originate from bone marrow, but mature in lymphoid and myeloid tissue. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-17 Functions of white blood cells. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Polymorphonuclear Granulocytes • Three types of polymorphonuclear granulocytes: – Neutrophils Most aggressive WBCs in cases where bacteria attempt to destroy tissue Use phagocytosis to destroy bacteria As an infection occurs, the body produces a higher than normal number of neutrophils – Eosinophils Utilized to combat parasitic invasions and allergies Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Polymorphonuclear Granulocytes • Three types of polymorphonuclear granulocytes: – Basophils Involved with allergic reactions and inflammation Secrete the chemical heparin, which helps to keep blood from clotting Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Mononuclear Agranulocytes • The two types of mononuclear agranulocytes: – Monocytes Found in higher than normal amounts when a chronic infection occurs. Monocytes destroy invaders through phagocytosis. Even though it takes longer for monocytes to arrive on the scene of the infection than neutrophils, their numbers are greater and they destroy more bacteria. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Mononuclear Agranulocytes • The two types of mononuclear agranulocytes: – Lymphocytes Protect us from infection by using a process that produces antibodies that inhibit or directly attack invaders. Some lymphocytes directly attack invaders. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Thrombocytes • Thrombocytes are also known as platelets. • They are the smallest formed elements and are responsible for the blood’s ability to clot. • Platelets stick together and plug a hole in a blood vessel and can release a substance called serotonin, which causes smooth muscle constriction and decreased blood flow. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Types and Transfusions • A person needing a blood transfusion cannot randomly select a blood donor because of antigens, cell surface markers. • Foreign antigens which were not originally found in the body are “non-self” antigens. • “Self-antigens” exist on the cell membrane of every cell in our body. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Types and Transfusions • Antibodies will react with the antigens that caused them to form, and the antigens stick together in little clumps, called agglutination. • This chain of events called the antigenantibody reaction is the basis of your immune response. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Type A • While there are over 50 different antigen types, the main focus is on A, B, and Rh antigens. • Type A blood is very common. Approximately 41% of the American population has this type of blood. • “A” represents a specific type of “self” antigen found on the cell membrane of the red blood cell. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Type A • Since this person was born with type A blood, no antibodies were created to fight it, so there are no anti-A antibodies, but there are anti-B antibodies. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Type B • Type B RBCs possess type B antigens. • The plasma contains anti-A antibodies. • If a person with type B blood was given type A blood, the anti-A antibodies would attack the donated red blood cells and destroy them because they see the cells as foreign material. The antibodies cause agglutination, resulting in serious harm and even death. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Type AB Blood • Type AB blood contains both A and B self antigens. • Type AB blood has neither A nor B antibodies in the plasma. • Because there are no A or B antibodies, people with type AB blood are called universal recipients because they can accept any type of blood type transfusion. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Type O Blood • Type O RBCs contain no A or B antigens, but its plasma contains both A and B antibodies. • Type O blood can be given to anyone and the person with type O blood is labeled a universal donor. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-18 Blood types and results of donor recipient combinations. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-18 (continued) Blood types and results of donor recipient combinations. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Rh Factor • Special blood antigens were first found in the blood of Rhesus monkeys, and were labeled Rh factor. • Rh factor is found in 85% of the white and 88% of the African American population of the United States. • If an individual has this antigen they are said to be Rh positive, if not they are Rh negative. • As a result, people are either A, B, AB, or O negative or positive. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Rh Factor • If the father is Rh positive and the mother is Rh negative, and the baby inherits the father’s Rh factor, the mother will develop anti-Rh antibodies. This baby will be okay, but any future babies may be attacked by the anti-Rh antibodies if that baby has the Rh positive trait in its blood. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Aspirin • Acetylsalicylic acid, aspirin, is used to treat many types of cardiovascular disorders because it inhibits platelet aggregation. • Aspirin reduces further occlusion in patients with AMI, unstable angina, ischemic stroke or transient ischemic attacks (TIAs) Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Blood Transfusion Reactions • Blood transfusion reactions can develop quite rapidly and are sometimes fatal. • A common type of blood transfusion reaction is the hemolytic reaction, in which red blood cell antibodies cause red blood cells to lyse in the circulatory system. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Blood Transfusion Reactions • Shock and renal failure can occur as a result of a hemolytic reaction. • Signs and symptoms • Treatment Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Clotting • The CV system is a closed and pressurized system. • If a break or leak in the system couldn’t be stopped, you would lose a large amount of blood. • Several substances in your blood plug leaks. • Hemostasis, or the prevention of blood loss, is accomplished through a chain of events. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Clotting • When the inner wall of a vessel is damaged, an underlying collagen fiber becomes exposed. • Platelets that are floating in the blood begin to attach to that rough, damaged site. • The attached platelets release several chemicals that draw more platelets, creating a platelet plug. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Clotting • The platelets secrete serotonin which causes blood vessels to spasm, decreasing blood flow to that area. • Within 15 seconds, blood clotting (coagulation) begins. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Clotting • With the help of calcium ions and 11 different plasma proteins, a chain reaction starts. • One of the clotting proteins, prothrombin, produced by the liver with the help of Vitamin K, is converted to thrombin. • Thrombin transforms fibrinogen, dissolved in the blood, into an insoluble, hair-like form called fibrin. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Clotting • Fibrin forms a net-like patch at the site of the injury, snagging more blood cells and platelets. Within 3–6 minutes a clot is created. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Clotting • Once the clot is formed, it begins to retract and pulls the edges of the damaged tissue together allowing the edges to regenerate the necessary epithelial cells to make a permanent repair over time. Eventually the clot is dissolved when it is no longer needed. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-20 The clotting process. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: Clotting Gone Bad • The clotting reaction must be stopped or clotting would continue unchecked. A rough surface on a smooth blood vessel allows platelets to begin “sticking”, forming a clot called a thrombus. A thrombus in a coronary artery can partially or totally block blood flow to a portion of the heart, causing a heart attack. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: Clotting Gone Bad • The area of myocardium affected will determine the severity of the attack. Part of the thrombus can break off and travel (called an embolus) until it gets stopped by a small vessel, partially or completely blocking the vessel and affecting blood flow. A cerebral embolus would cause a stroke, a pulmonary embolus would affect oxygenation. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: Clotting Gone Bad • Slow blood flow can cause unwanted clot formation, such as in bedridden people or those sitting for long periods on a plane, car, or bus. Women who smoke and use oral contraceptives, as well as people on certain types of chemotherapy, are at increased risk of clot formation. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: Clotting Gone Bad • Aspirin, heparin, or coumadin can be taken to decrease the risk of clot formation. Some drugs, like streptokinase are “clot busters,” dissolving clots which have already formed. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Vessels – Vascular System • Blood leaves the heart through the aorta which branches into large vessels called arteries. • Arteries divide into smaller and smaller vessels, the smallest of which are called arterioles. • Arterioles feed into capillaries that form capillary beds in your body’s tissues, allowing oxygen and nutrients to enter cells and removing carbon dioxide and waste products. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Fibrinolytic Therapy: The Era of Reperfusion • Fibrinolytic (thrombolytic) agents are drugs that dissolve arterial and venous blood clots and restore blood flow to oxygen-deprived tissues. • Life-threatening clots are caused by: – Thrombi – Emboli Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: ACS and Fibrinolytic Therapy • Acute coronary syndrome (ACS) results from the formation of a clot in one of the coronary arteries. • The blockage causes myocardial cell death. • Fibrinolytic therapy may restore blood flow to the affected heart muscle is started within time. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Acute Ischemic Stroke and Fibrinolytic Therapy • An acute ischemic stroke is the presence of a blood clot in the brain circulation that interrupts blood flow to a part of the brain. • Fibrinolytic therapy may dissolve the clot and restore blood flow if initiated in time. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Deep Venous Thrombosis and Fibrinolytic Therapy • A deep venous thrombosis (DVT) is the formation of a clot within one of the larger veins of the lower extremity. • Patient is at risk for the clot breaking loose and traveling to the lungs. • Fibrinolytic therapy may dissolve the clot and restore circulation. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Peripheral Arterial Occlusion and Fibrinolytic Therapy • A peripheral arterial occlusion occurs when a clot forms in a peripheral artery halting blood flow. • Thrombolytic agents may restore blood flow to the affected area. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Vessels–Vascular System • Blood continues the journey from capillaries to small vessels called venules. • Venules combine into veins, which eventually empty back into the heart. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Walls of Blood Vessels • Walls are composed of three layers, often referred to as coats or tunics. – Tunica interna – innermost layer. It is composed of a loose layer of tissue made up of squamous epithelial cells. – Tunica media – middle layer. This layer is thicker and is composed mainly of smooth muscle, elastic tissue, and collagen. By contracting or relaxing those muscles, this layer actually controls the diameter of the vessels to meet certain blood flow needs of the body at a given time. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Walls of Blood Vessels • Walls are composed of three layers, often referred to as coats or tunics. – Tunica externa – outermost layer Due to its composition of mostly fibrous tissue, its job is to provide vessel support and protection. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Walls of Blood Vessels • The structure of the blood vessels varies depending on their job. – Arteries possess much thicker walls than veins because arteries are closer to the heart and have to deal with higher pressures. Larger arteries contain complete sheets of elastic tissue, elastic laminae, in their middle walls to help deal with this increased pressure. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Walls of Blood Vessels • The structure of the blood vessels varies depending on their job. – The lumen in veins are larger than in arteries, and also contain valves that prevent backward flow of blood. The relaxation and contraction of muscles in your body that surround veins help to “milk” the blood toward the heart. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Walls of Blood Vessels • Capillaries – Composed of only the tunica interna. – With a diameter of only 0.008 millimeters (slightly larger than the diameter of single red blood cell), this wall is only one cell layer thick, so oxygen and nutrients can easily move into the tissues and carbon dioxide and wastes can move into the blood. – Dozens of capillaries form a web, or network, of vessels called a capillary bed. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Walls of Blood Vessels • Capillary beds – Composed of two types of blood vessels Vascular shunt – main road connecting the arteriole to the venule True capillaries – make the actual exchanges with body cells. True capillaries can be considered the on-ramps and off-ramps to and from the vascular shunt. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Walls of Blood Vessels • Precapillary sphincters – Composed of smooth muscle, allow blood to flow through or stop blood flow when they contract. Blood flows through, it travels through the true capillaries and to cells of the tissue. If the blood is stopped then the blood travels through the vascular shunt. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-23 Blood vessels and the capillary connection. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-24 Capillary beds and sphincters. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: Taking a Blood Pressure • Measuring BP is an important diagnostic test, performed with a stethoscope and sphygmomanometer. The balloon-like cuff is inflated and squeezes the brachial artery shut. As the cuff is deflated, the stethoscope, placed over the brachial artery, allows the listener to hear the first sound (systole) of blood flow returning to the artery. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: Taking a Blood Pressure • The last sound (diastole) indicates there is no longer any pressure required for blood to flow through the artery. • Pressure is measured using a column filled with mercury, a round pressure gauge, or a digital readout. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-25 Blood pressure measurement. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Table 13-1 Blood Pressure Classifications. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the topic of the Head and Neck. The animation may take a moment before playing. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the topic of the Abdomen and Trunk. The animation may take a moment before playing. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the topic of the Arm. The animation may take a moment before playing. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the topic of the Leg. The animation may take a moment before playing. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Regulation of Blood Pressure • Blood pressure (BP), like many of your body’s characteristics is controlled to maintain homeostasis. As BP rises, homeostatic actions will bring it down back to normal, if BP falls, homeostatic actions will bring it back up to set point. • Blood pressure can be homeostatically controlled by blood vessel diameter (peripheral resistance), the amount of blood pumped by the heart (cardiac output), and changes in fluid volume. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Regulation of Blood Pressure • Cardiac output is a function of heart rate and the amount of blood pumped with each contraction (stroke volume). • Remember a simple formula: Cardiac output (CO)= Heart Rate (HR) × Stroke Volume (SV) CO = HR × SV Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Regulation of Blood Pressure • Stroke volume is influenced mainly by blood volume or blood return (preload). • For example, increased fluid volume, increased heart rate, and increased peripheral resistance (PVR) would lead to increased blood pressure. • Another important formula: Blood Pressure = CO × PVR Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Regulation of Blood Pressure • Heart rate and stroke volume (cardiac output) are regulated by the autonomic nervous system. – The autonomic nervous system has direct connections to the SA and AV nodes, as well as to the myocardium (sympathetic only). – The sympathetic division can release neurotransmitters that increase heart rate and the force of the contraction (inotropism). Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Regulation of Blood Pressure • Heart rate and stroke volume (cardiac output) are regulated by the autonomic nervous system. – The parasympathetic division, through the vagus nerves, releases a neurotransmitter that can decrease heart rate. – Ions (electrolytes), hormones, body temperature, age, gender, and a history of exercise can all affect heart rate. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Regulation of Blood Pressure • Peripheral resistance is controlled by the sympathetic nervous system. – When blood pressure drops, sympathetic signals to blood vessels cause vasoconstriction (decreased diameter), increasing peripheral resistance and increasing BP. – If BP increases, blood vessels vasodilate (increased diameter) as needed to lower blood pressure. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Regulation of Blood Pressure • Fluid volume is controlled by hormones. – All these hormones affect the kidney, causing either increased or decreased urination. – Decreased urination increases fluid volume, increasing BP. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Shock • Shock (hypoperfusion) is a state of inadequate tissue perfusion and is often the end product of disease or acute injury. • Body tissues are deprived of oxygen. • Several types – Cardiogenic – Hypovolemic – Neurogenic – Anaphylactic – Septic Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Cardiovascular Disorders: Cor Pulmonale • Cor pulmonale is a condition in which the right side of the heart can’t move blood as efficiently as it should, as a result of heart muscles working harder than they normally do. • The muscles on the right side become too large and can no longer pump efficiently. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Cardiovascular Disorders: Cor Pulmonale • Polycythemia (thick blood due to elevated RBC levels) or constricted pulmonary vessels can cause the heart to work harder. • Eighty-five percent of patients with chronic obstructive pulmonary disease develop cor pulmonale. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Left-Side Heart Failure • A potentially life-threatening condition. • The healthy right pump pushes blood through the vasculature of the lungs on its way to the left-side pump. • If the left side can’t keep up with the blood being delivered to it, the blood backs up into the lungs, increasing the pressure in those blood vessels. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Left-Side Heart Failure • Once that pressure reaches a certain point, fluid leaks out of the vessels and into the lung tissue. • Pulmonary edema is the term for fluid that forms in the lungs and causes difficulty breathing. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the topic of Heart Failure. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-26 Left-side and right-side heart failure. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Valve Problems • There are two types of valve problems: if the valve is too small (stenosis), restricting flow, or too large allowing backflow of blood (insufficiency). • Clots can form in the damaged valve and then can detach and flow through the blood vessels and lead to pulmonary embolus or stroke. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Valve Problems • Papillary muscles are attached to the undersides of the cusps of the valve, and damage to these areas allows backflow of blood into the atria when the ventricle contracts. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Vessel Problems • Arteriosclerosis, or hardening of the arteries, occurs to some extent to all of us as we age. • It results from thickening of the interna, causing the involved vessels to become less flexible, or even brittle, increasing the risk of rupture and the likelihood of high blood pressure. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Atherosclerosis • Atherosclerosis is a potentially lifethreatening condition in which fatty deposits, called plaques, build up on the inner lining of blood vessels. • Blood flow can then become greatly or completely blocked by this buildup. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Atherosclerosis • Plaque is composed of cholesterol. Any blood vessel can be susceptible to atherosclerosis, but coronary and cerebral arteries are particularly susceptible. • Heredity is one factor for atherosclerosis, and it is a common side effect of diabetes. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-27 Atherosclerosis. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Infarction • If blood flow is restricted in one or more coronary arteries, heart muscle may become oxygen-starved with the result of dying myocardial tissue. • This would be a myocardial infarction, or heart attack. • If there is a blockage of blood flow to the brain, a cerebral vascular accident (CVA) or stroke can occur. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Infarction • Reduced blood flow leads to tissue injury, called ischemia. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Aneurysm • An aneurysm is a localized weakened area of blood vessel wall that may have been caused by a congenital defect, disease, or injury. • There appears to be a familial tendency for abdominal aortic aneurysms. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Aneurysm • Often there are no symptoms, but when the aneurysm continues to expand it can rupture, causing hemorrhage. If the aneurysm is in a major artery, an individual can bleed out in a matter of minutes. • Surgery can remedy the situation if the aneurysm is detected before it ruptures. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the topic of Aneurysms. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: Heart Attacks • A true heart attack occurs when there is an insufficient supply of blood from the coronary artery to the tissues of the heart. This could result from plaque buildup in arteries decreasing flow or a piece of plaque that breaks off and occludes the artery. A clot that forms and blocks the artery can be another scenario. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: Heart Attacks • If the decreased blood flow is sufficient to kill heart tissue, the condition is called a myocardial infarction (MI). Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: Heart Attacks • Most MIs start out slowly, with little or no pain (silent MI) and may progress over hours, days, or even weeks. Symptoms may include chest pain, chest heaviness, pain in left shoulder, neck, jaw, or radiating down the left arm. Nausea, heartburn, weakness, clamminess, diaphoresis, shortness of breath, and dizziness can also be warning signs. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Clinical Application: Heart Attacks • Denial can delay treatment. The first hour is the most important. Call 911 and chew an aspirin immediately because research shows this increases survival rates. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view a video on the topic of Heart Attacks. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the topic of Dysrhythmia. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view a video on the topic of Angina. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view a video on the topic of Coronary Artery Disease. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the topic of Shock. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view an animation on the topic of Shock. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Problems • Secondary polycythemia is a condition in which chronic low levels of oxygen cause the body to produce more than normal amounts of erythrocytes to transport more efficiently the decreased oxygen available. Primary polycythemia does the same thing but can be caused by bone marrow cancer. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Problems • Anemia is a condition with less than normal RBCs, or an abnormal or deficient amount of hemoglobin. Common symptoms include pale skin, mucous membranes, and nail beds; fatigue and muscle weakness; shortness of breath; and/or chest pain. • Sickle cell anemia is an inherited condition in which red blood cells and hemoglobin molecules can’t form properly. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Problems • The resultant RBCs are crescent or sickleshaped and have a tendency to rupture. • As cells are destroyed, the body is stimulated to produce more and more RBCs resulting in immature cells due to the high production rate. • Ruptured cells clog up small vessels, plus thicker blood from the high number of RBCs leads to increased clotting and impaired ability to carry oxygen. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view a video on the topic of Sickle Cell Anemia. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Problems • Leukemia, usually due to bone marrow cancer, is a condition in which a higher-thannormal number of white blood cells are produced. The white blood cells produced are immature and therefore ineffective in protecting the body. • Leukocytosis is often caused by an infection and also results in a high WBC count. • Leukopenia is a low WBC count as a result of drugs or chronic infection. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view a video on the topic of Leukemia. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Blood Problems • The inability of blood to clot properly is called hemophilia, an inherited blood condition. • Thrombocytopenia is a condition in which there are fewer than normal circulating platelets. If the count is low enough even normal acts of moving can lead to bleeding. Causes include liver dysfunction, decreased levels of vitamin K, radiation exposure, or bone marrow cancer. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Aneurysm • An aneurysm is a bulging in the weakened wall of a blood vessel. • Aneurysms are at risk for ruptures. • Several types: – – – – – Atherosclerotic Dissecting Infectious Congenital Traumatic Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Aneurysm • Causes • Signs and symptoms • Treatment Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-30 Most abdominal aortic aneurysms occur below the level of the renal arteries and extend down to the bifurcation of the common iliac arteries. Rupture can cause rapid exsanguination that will be rapidly fatal without emergency surgical repair. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets: Dissecting Aneurysm • Usually caused by degenerative changes in the smooth muscle wall of the artery. • Predisposing factors include hypertension, genetics and advancing age. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. The Lymphatic System • The lymphatic system runs parallel to the CV system and has three major responsibilities: – Maintain fluid balance by returning interstitial fluid to the venous side of the CV system – Assist the CV system in distributing nutrients and hormones, and the removal of waste products from tissues – Help to prevent infection and disease by utilizing lymphocytes Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Figure 13-31 Relationship of the lymphatic system to the cardiovascular system. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Click here to view a video on the topic of Cardiovascular Technology. Back to Directory Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Snapshots from the Journey • The cardiovascular system is a closed, pressurized system, much like the engine cooling system of a car, responsible for transportation of oxygen, hormones, and nutrients to the tissues of the body and for removing the by-products of metabolism by the cells. The cardiovascular system also helps maintain proper fluid balance of the body, assists in the control of body temperature, and is a major player in the body’s defense from infection. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Snapshots from the Journey • The heart is an organ that is actually two pumps working together to move blood. The heart’s right pump moves blood collected from the body to the lungs, where oxygen is loaded and carbon dioxide is removed to be exhaled by the lungs, while the heart’s left pump takes the freshly oxygenated blood and pushes it through the body so tissue cells can be kept healthy. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Snapshots from the Journey • Arteries carry blood from the heart. Veins bring blood to the heart. • Capillaries are blood vessels with walls the thickness of only one cell, which readily allows the transfer of oxygen and nutrients to the tissues in the body. This thinness of capillary walls also allows for waste products of the cells’ metabolism to be picked up by the blood for removal. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Snapshots from the Journey • The major components of blood are plasma, erythrocytes (red blood cells, the main transporter of oxygen), leukocytes (white blood cells, protectors from infection), and platelets (aid in the clotting of blood). • Blood pressure is controlled by cardiac output, peripheral resistance, and changes in fluid volume. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Case Study A 55-year-old male presents to the emergency department complaining of vague chest pains for the past several days. A quick patient history reveals the following: a twopack-a-day smoker since the age of 15; height of 67 inches; weight 240; lives alone and doesn’t prepare meals, preferring cookies, snack food, and diet cola; sedentary lifestyle; uses oxygen to relieve shortness of breath, and complains of occasional chest pain. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. Case Study Questions • Given these facts, what disease process do you think this individual may be experiencing? • What suggestions would you give the patient and his doctor? Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets You are called to a suicidal patient. An 18 year-old male ingested a whole bottle of his mother’s Cardizem®. Cardizem® is an antihypertensive drug that works by relaxing vascular smooth muscle and decreasing heart rate. He is slow to respond, hypotensive and bradycardic. A suicide note is found in his bedroom. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets Questions • Why is the patient hypotensive? • Why is he slow to respond? • What is his prognosis? Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets Questions • Why is the patient hypotensive? The overdose of Cardizem® caused massive vasodilation and a slow heart rate. This caused cardiac output & blood pressure to drop. CO=HR × SV and B/P=CO × PVR • Why is he slow to respond? His blood pressure is so low that his brain is not being perfused. This is causing an altered mental status. • What is his prognosis? This is a life-threatening emergency. He requires immediate supportive measures and emergency transport. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets You are transporting a 20-year-old male, who is a multiple trauma patient involved in a severe motor vehicle collision (MVC). He has a rigid distended abdomen and is disoriented, hypotensive, tachycardic, and has pale, cool and clammy skin. You call ahead to communicate with the receiving trauma center your findings and ETA. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets Questions • Calling ahead allows the trauma staff to prepare for your critical patient. What specific blood type will they have ready to transfuse when you arrive? Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. From the Streets Questions • Calling ahead allows the trauma staff to prepare for your critical patient. What specific blood type will they have ready to transfuse when you arrive? Because he is not Type and Crossmatched (identifies antibodies) he will receive Type O negative blood. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 1. The valve between the right and atrium and the right ventricle is the a. sinoatrial b. bicuspid c. tricuspid d. semilunar Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 2. During ventricular systole, these valves are closed: a. Sinoatrial b. Atrioventricular c. Semilunar d. Retroventricular Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 3. When cardiac output increases, what happens to BP? a. It increases b. It decreases c. It goes up and then back down d. It doesn’t change Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 4. The _______ wave of the EKG occurs during depolarization of the ventricles. a. P b. QRS c. PDQ d. T Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 5. After the electrical impulse leaves the AV node it travels down the: a. Purkinje fibers b. Left bundle branch c. AV bundle d. SA node Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 6. During what part of the ECG are ventricles contracting? a. PR b. QRS c. T d. PT Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 7. If a heart attack damages the interventricular septum, what part of the conduction system will be damaged? a. SA node b. Purkinje fibers c. AV bundle branches d. All of the above Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 8. An infection would generally cause increased numbers of which formed element? a. Erythrocytes b. Leukocytes c. Thrombocytes d. Antibodies Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 1. List three main functions of blood. 2. Decreased blood flow to cardiac muscle that only injures the tissue creates a condition known as ________. 3. The structures composed of smooth muscle that direct the flow through capillary beds are called ______. 4. ______ is an important vitamin that is needed for the proper clotting of blood. 5. ______ is a term for the dividing wall between the ventricles. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 6. Damage to the AV node causes a ________ (increase or decrease) in heart rate. 7. A young man falls, putting his hand through window. He is bleeding profusely. To try to maintain his blood pressure, his heart rate will _________ (increase or decrease). 8. Many endurance athletes live and train at high elevation because high elevation causes an increase in __________. Which may give the athletes a competitive advantage. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 1. Explain the control of blood pressure. 2. Describe the flow of blood beginning at the right atrium and ending at the aorta. 3. Explain the antigens of the A, B, and O blood types. 4. Explain hemostasis. 5. List the types of formed elements and their functions. Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved. End of Chapter Review Questions 6. What is one reason that iron is an important nutrient to include in your diet? 7. Why is the direction of the wave of contraction in the heart so important? Essentials of A&P for Emergency Care Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe Copyright ©2011 by Pearson Education, Inc. All rights reserved.
