Bestguard Lifeguarding Program Unit 4: General Patient Assessment

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Unit 4: General Patient Assessment
Lesson 7 – Human Body Systems as Related to First Aid
BESTGuard lifeguards are expected to have a basic understanding of human body systems and how they relate to the first aid situations that they may encounter, including drowning. The following pages provide lifeguards with a solid foundation for understanding the basics of how the body works, and some of the terms commonly used by the EMS/ICS personnel that come after them.

Terms used in anatomy/first aid

Body cavities: a hollow place in the body that contains organs. There are 5 cavities to remember – SPACT for spinal, pelvic, abdominal, cranial, thoracic

  • Cranial – contains the brain (the skull is also called the cranium)

  • Spinal – contains the spinal cord

  • Thoracic – contains the heart and lungs

  • Abdominal – contains the digestive organs: stomach, liver, pancreas, kidneys, intestines, spleen (the diaphragm and pelvis border this cavity)

  • Pelvic – contains the rectum, bladder, and reproductive organs

The body cavities are referred to when performing a physical exam or when locating an injury or medical problem.
Quadrants: 4 sections of the abdomen that assist in location of injuries. They are divided by the navel both horizontally and vertically. The vertical line cuts through the navel and extends to the xiphoid process on the sternum. The horizontal line cuts through the navel and essentially rests on the iliac crest. –

  • Upper right

  • Upper left

  • Lower right

  • Lower left

The quadrants are each palpated during the physical exam for abnormalities.

Directional/motion terms used in anatomy: terms of locations/directions/motion (always from the reference point of the patient) –

  • Medial – toward the mid-line or center

  • Lateral – toward the outside or away from the mid-line

  • Anterior – toward the front, or in the front

  • Posterior – toward the back or in the back

  • Superior – above or on top

  • Inferior – below or on the bottom

  • Distal – farthest from the body or midline (i.e. distal phalanges)

  • Proximal – closest to the body or midline (i.e. proximal phalanges)

  • Supinate – upward rotation, hands or entire body (supine)

  • Pronate – downward rotation, hands or entire body (prone)

  • Flexion – contraction of muscles that make limbs shorten, as in the biceps or hamstrings

  • Extension – contraction of muscles that make limbs lengthen, as in the triceps or quadriceps

  • Dorsiflexion – curling up the foot (anterior tibialis muscle does this)

  • Plantarflexion – pointing the toes (gastrocnemius, soleus)

  • Adduction – adding to the body, such as bringing an extended arm back to your side

  • Abduction – moving away from the body, such as moving an arm from your side up into a horizontal position

  • Process – a protrusion on a bone, such as the spinous processes on the vertebrae, or the acromion process on the scapula

  • Tuberosity – another bump on a bone; one of the most notable is the ischial tuberosity – because you literally sit on the pair of them whenever seated.

  • Tendon – connective tissue that connects muscle to bone

  • Ligament – connective tissue that connects bone to bone

Circulatory System

The circulatory system is involved in at least three functions vital to the human body: transportation, temperature regulation, and defense against diseases. It is failure of this system that results in heat stroke, heart attacks, strokes, and aneurysms.

The components of the circulatory system are:

  • Blood – composed of platelets and plasma, as well as red & white blood cells, the blood is like a mighty river that transports products on barges to different ports along the river. Plasma is the fluid portion of the blood, and platelets are mostly solid cell fragments (fragmented white blood cells). White blood cells are the body’s tiny army. They attack anything that is considered hostile to the body, like bacteria. They are far fewer in number than the red blood cells. Red blood cells are in charge of transportation. Their main function is the transportation of iron and oxygen/CO2. Red blood cells out-number white about 1000 to 1.

  • Arteries – are the high pressure blood vessels that carry blood away from the heart via the ventricles. Ventricles produce the high pressure that is measured in the systolic blood pressure. Arteries are the biggest “pipes” in the system. They divide into smaller arterioles, and end as microscopic capillaries. It is in the capillaries that all the business of the blood takes place: oxygen and carbon dioxide is exchanged in the tissues and the lungs. The tissues’ cells give off CO2 into the capillaries, while the capillaries supply fresh O2. In the lungs, blood releases CO2 into alveoli, and picks up fresh O2 that is delivered back to the cells.

The major arteries that lifeguards should be familiar with include: the carotid – the main arteries in the neck (used for pulse check during CPR); the brachial – in the upper arm and across the elbow joint (used for pulse check in an infant during CPR, and for auscultation blood pressure); the radial – in the lower arm, next to the radius bone on the thumb side of the wrist (used for pulse rate and for palpation blood pressure); the aorta is the biggest artery in the body, ascending out of the left ventricle. The aorta’s branches form all the other major arteries of the body, except for the pulmonary arteries; the pulmonary artery branches into the right and left pulmonary artery which supply oxygen poor blood to the lungs. The pulmonary artery comes directly out of the right ventricle. It is the only artery to carry O2 poor blood. This is usually the job of the veins. The coronary arteries are the very first branches of the aorta. They supply blood directly to the heart muscle (myocardium). These are the arteries that become obstructed in an acute myocardial infarction (heart attack). An abdominal aortic aneurysm is dilation in a branch of the aorta. Arterial bleeding is often life threatening, due to the high pressure, especially if it’s to one of the main arteries.

  • Veins – Veins carry oxygen-poor blood back to the heart, where they deliver it to the atria; the two chambers in the top of the heart. Veins are thinner walled than arteries, and have a series of one-way valves to prevent back-flow of blood.

They are of much lower pressure than arteries, thus don’t bleed nearly as freely. Veins start as capillaries, grow to venules, then larger veins. There are only a few veins that lifeguards need to know: the vena cava, the jugular veins, and the pulmonary veins. The vena cava is the largest vein in the body, and has both an inferior and superior component. The inferior vena cava is below the heart and brings blood back from the torso and lower body; the superior vena cava is above the heart and brings blood back from the upper body. Both deliver it to the right atrium. The jugular veins are also quite large and are adjacent to the common carotid arteries in the neck. The pulmonary veins bring oxygen-rich blood back from the lungs to the left atrium.

  • Heart – The heart has four chambers: two atria and two ventricles. The atria receive blood into the heart from veins, and the ventricles push blood out of the heart through arteries. The right side of the heart is the pulmonary circuit, bringing oxygen-poor blood to the lungs to receive oxygenation. The left side is the systemic circuit, bringing oxygen rich blood to all the tissues via the left ventricle and the aorta. Atria pump the received blood down into the ventricles as commanded by the sino-atrial node located at the top of the right atrium. The atrio-ventricular node then commands the ventricles to pump the blood out. These two nodes control the pulse, and are what malfunction during V-fib or V-tach. Atrial fibrillation can also occur, which is very much like the irregular twitching characteristic of V-fib. A-fib is generally not a life-threatening, no pulse situation, as in V-fib. It creates an inefficient arrhythmia that affects the blood flow, but does not usually stop the heart from beating altogether. Blood flow through the body and through the heart works in a continuous loop: blood coming from all the body’s cells enters the heart via the right atrium, is pumped down into the right ventricle, then pushed into the pulmonary artery and into the lungs. It unloads CO2 , picks up oxygen and brings it back to the heart via the pulmonary veins. The pulmonary vein delivers this blood to the left atrium, which pumps it down into the left ventricle, then out via the aorta to all the body’s cells; where it delivers the oxygen, picks up CO2 and starts the loop over again.

O2 poor blood arrives in vena cava

O2 poor blood to lungs via

It enters right atrium pulmonary artery

O2 rich blood returns to left atrium

Is pumped to right ventricle Is pumped to left ventricle

O2 rich blood exits heart via aorta

In addition to circulating blood, which is the transportation function, the circulatory system cools the body, and helps to maintain warmth by precise distribution of blood and constriction or dilation of vessels close to the skin. When cold, these vessels constrict , slowing the release of heat to the surrounding environment. When hot, they dilate to release heat and provide cooling. The system can also regulate where blood goes to protect the vital organs first, as during hypothermia or hemorrhagic shock. The temperature regulation function works in harmony with other systems, such as the pilomotor (arrector pili) muscles in the dermis, that make hairs stand up to create a layer of dead-air.

i love when music gives me chills and goosebumps

Arrector pili muscles

creating layer of dead air over

the skin
As mentioned earlier, the third function is to transport the army of white blood cells and anti-bodies that fight diseases. The blood transports everything else to the cells as well, drugs, nutrients, etc.

Respiratory System
This system works in tandem with the circulatory system to provide oxygen to the body’s cells and to release carbon dioxide from the cells. Breathing is accomplished through a change in chest cavity pressure: when inspiring (breathing in) the pressure is lowered in the lungs relative to the outside air so the air rushes in. When expiring (breathing out) the pressure in the lungs is greater than the outside air, and the air in the lungs is pushed out. Because it takes effort to expand the chest volume by the diaphragm and intercostal muscles, inspiration is the “active” part of breathing. Expiration is accomplished by merely relaxing the muscles of inspiration.
The components of the respiratory system are:

  • Lungs – Located inside the rib cage, and separated by the descending aorta and the vena cava, the lungs are the main component of the system, where O2 is exchanged with CO2.

  • Mouth – Air is inhaled and exhaled through the mouth and/or nose. OPAs are inserted into the mouth, and NPAs into the nose to the pharynx, to provide a clear passage of air and prevent the tongue from obstructing the airway.

  • Nose - Breathing is mostly through the nose, except during exertion when more oxygen is needed, and the mouth is used as well.

  • Pharynx – Is the back of the throat. The area that becomes obstructed by the tongue when the tongue falls back on an unconscious patient; or during anaphylaxis when the tongue is swelling into the pharynx.

  • Larynx – The voice box, located near the top of the trachea. Sounds and pitch are formed in the larynx, while words are formed by the tongue and lips.

  • Trachea – The wind-pipe. Air comes through the pharynx into the trachea where it branches off into the right and left bronchi. These two pipes supply the right and left lungs.

  • Epiglottis – The small flap over the opening to the trachea. It is a valve that prevents food or liquids from entering the trachea. Only air should be allowed in there! During a seizure, the epiglottis may be twitching along with other muscles in the body, allowing water to flood the lungs and disable alveoli.

  • Bronchioles – Smaller divisions of the bronchi that eventually end in the microscopic alveoli. COPD patients suffer from chronic inflammation, mucous production, and obstruction of these passages.

  • Alveoli – The microscopic sack-like structures that exchange oxygen and carbon dioxide.

Respiratory distress refers to difficulty breathing. Breathing rates that are outside the normal ranges for resting rate constitute respiratory distress: Respirations of less than 12 or more than 20 (adult), less than 15 or more than 30 (child), less than 25 or more than 50 (infant). Respiratory arrest means breathing has stopped.

Note: The esophagus is NOT a component of the

respiratory system. It is the tube directly behind the trachea

through which food is transported to the stomach.

Musculo-skeletal System
Bones, muscles, tendons, and ligaments, along with cartilage, and other specialized tissues comprise this system. Its functions are support and movement. Some of the major components are:

  • Bones – There about 206 bones in the body. Many have duplicates or numbers, so most of the bones can be identified by a lifeguard. A list of the major bones follows:

    • Bones of the skull/cranium – frontal: the forehead; parietal: the sides of the head above the temporal; temporal: the temples or sides of the head; occipital: the bone in the back of the head; zygomatic: the cheek bone; maxilla: upper lip (houses upper teeth); mandible: the jaw bone (houses lower teeth). The zygomatic and mandible are the two bones that are grasped by guards during the head/chin support position. The nasal bones are at the top of the nose and are quite thin & delicate. The vomer and lacrimal bones are also at the top of the nose: the vomer is in the center, and the lacrimal bones are just superior to the nasal bones. These bones are again quite thin and delicate. One other bone that is prominent on the skull is the mastoid process, just behind the ear (part of the temporal bone). There are other bones in the skull not in clear view: ethmoid, sphenoid, hammer (malleus), anvil (incus), stirrup (stapes).

Bones of the cranium

human skull bones

human cranium

    • Bones of the torso – The torso is formed by the ribs, clavicles, sternum, scapula, and vertebrae in the back. The ribs: are numbered, and have 12 pairs. The bottom two sets are called “floating” because they don’t articulate directly with the sternum. The sternum: the breastbone. It has 3 parts that guards should know – the manubrium, or upper part that articulates with the clavicles, the body – the main portion that is compressed during CPR, and the xiphoid process – the sharp tip at the bottom. There is one other bone in the front of the neck, just below the mandible, that is kind of isolated – the hyoid bone. It’s a slight structure, roughly horse-shoe shaped.

    • Bones of the pelvis – The pelvis has several bones, sometimes referred to collectively as the os coxae. The ilium, ischium, pubic bone, and sacrum are the four main bones. The coccyx: is the tiny tip of the sacrum, often referred to as the “tail bone.” The ilium: large wing like bones that hold up your pants and fold out and back. The ischium: smaller bones that have a hole in the middle. They are connected to the ilium and are the bones that we literally sit on. The pubic bone or pubis: a small bone directly in the center that separates the two ischium bones. The sacrum: a triangular shaped bone that is comprised of 5 fused vertebrae. The bottom of the sacrum is the coccyx, which consists of about 4 more tiny fused vertebrae.

    • Bones of the arms – The arms consist of many bones, most of which are in the wrists and hands. The humerus: the upper arm bone; the radius: the smaller forearm bone on the thumb side; the ulna: the other forearm bone on the little finger side (the elbow is part of the ulna). The wrist bones are called the carpals: there are 7 of them. The metacarpals: the bones of the hand (before the fingers).

Phalanges: the finger bones – have three sections: distal, middle, and proximal. Metacarpals and phalanges are numbered, whereas carpals have individual names.

    • Bones of the legs – The legs are similar to the arms in number of bones, and names. The femur – the upper leg bone, and one of the strongest bones in the body. The tibia – the shin bone. The fibula – a smaller support bone to the lateral side of the tibia. Instead of carpals, the ankles have the tarsals: again 7 bones all with individual names. Metatarsals: are the bones of the feet, and are numbered. Phalanges: are the same as in the hands. An additional bone is the calcaneous or heel bone. The big toe is called the talus, whereas the thumb is called the polis.

    • The vertebral column – The vertebral column consists of five sections totaling approximately 33 vertebrae. Vertebrae have three main processes: the lateral processes called the transverse, and the central process called the spinous process. It is the spinous process that protrudes directly backward, and thus can be felt just under the skin. The top section of the column is the cervical, of which there are 7 vertebrae. The top two are the atlas and axis. The remaining vertebrae have numbers, rather than names: the atlas is C-1, axis is C-2, etc. The cervical vertebrae are by far the most commonly injured, due their lack of protection from trauma, and smaller size.

The next section corresponds to the 12 pairs of ribs, thus there are 12 in the thoracic section. They are numbered T-1 to T-12.

The lower back is the lumbar section, of which there are 5. They are numbered L-1 to L-5 and are the strongest of the 33.

The sacrum has another 5, but fused together; the sacral vertebrae are numbered S-1 to S-5.

The coccyx makes up the last four, again fused; the coccygeal are not often referred to individually, since they are so small. They make up the point of the sacrum (the “tailbone”).


The Integumentary System

Integument is the anatomic name for the skin. The skin is the largest organ in the body. It has several functions: protection from disease and injury, temperature control, mineral storage and vitamin D production. The integumentary system includes the hair, nails, and skin. Oil glands provide waterproofing, softness, and elasticity to the skin. Sweat glands work in tandem with the arrector pili muscles in the dermis to assist in temperature control. To relieve excess heat, sweat glands release moisture through pores to produce cooling from evaporation.

Some of the major components of the integumentary system are:

  • Epidermis – The outer layer of the skin; mostly for protection from injury and disease.

  • Dermis – The second layer of the skin. The dermis contains the hair follicles, sweat glands, oil glands, blood vessels, and nerves.

  • Hypodermis – Inner layer (also called the subcutis or superficial fascia), containing the adipose (fat) layer. This layer allows the underlying muscles to move freely. At points where there are no underlying muscles, the skin attaches directly to the structure underneath.

The skin works in tandem with the circulatory system to provide body temperature regulation, through the constriction or dilation of blood vessels near the surface. Vessels are dilated when cooling is needed, making the skin appear flushed. Sweat glands release moisture onto the surface of the epidermis to assist in the cooling. Vessels are constricted when warmth is needed, making the skin appear pale. In addition to arrector pili muscles creating the “dead air” space to assist in warming, shivering reflexes are initiated to further generate heat. This system is also responsible for redistribution of blood in trauma situations where the body is trying to protect the vital organs (heart, lungs, and brain). When hypothermic, the temperature regulatory system becomes even more dramatic, by cessation of respirations, preservation of extremities via removal of blood flow, and establishment of a tiny circulatory loop that essentially includes only the heart muscle (myocardium) and brain. The temperature control system is overwhelmed when shivering ceases and the body begins to stiffen. Although the blood flow continues to be controlled by initiating the tiny loop just described, eventually all systems will fail due to hypoxia. This tiny loop can be effective for up to 1 hour before the heart and brain die.
Diagram of the integumentary system

Nervous System
The nervous system has several functions, all of which can be categorized into three divisions: coordination, orientation, and thought/intelligence. It is by far the most complex system in the body, and quite possibly the most complex system on earth. The nervous system has over 3 trillion cells that can run millions of different tasks at once. Although the nervous system for all mammals is amazing, the human version is far more complex, due to our extensive cerebral cortex – thus the ability to reason, dream, and seek answers to questions about how it all works.
Orientation – This spatial awareness/balance information is processed through organs of special sense and the information is transmitted via sensory neurons where it is processed in central coordinating areas of the brain; then sent out to organs which respond to the impulses sent from the brain (central coordinating). The ability to orient successfully to an ever changing environment is what keeps us safe.
Coordination – Refers to the ability of the nervous system to direct our bodies to move or react to a given stimulus in a coordinated fashion. Coordination works in tandem with orientation, since the sensory organs receive the initial stimulus, transmit it to the brain where it is processed, and a response is sent to the muscles (via efferent pathway) to cause a reaction.
Thought/intelligence – Refers to the ability to reason, calculate, imagine, create, predict, and exercise restraint. These qualities are unique to human brains, and are a function of our advanced cerebral cortex.

Diagram of neuron
Parts of the nervous system –

  • Central nervous system (CNS) – brain, spinal cord

  • Peripheral nervous system (PNS) – cranial nerves, spinal nerves: send impulses to the head and neck; or from spinal nerves to the rest of the body.

  • Autonomic nervous system – sympathetic, parasympathetic nerves connect to the midbrain and medulla via cranial nerves, and to spinal nerves.

  • Visceral afferent fibers – bring impulses from the PNS to the CNS, such as pain, nausea, hunger, and sexual impulses.

  • Neurons – consist of axons, dendrites, cell bodies, satellite cells, myelin sheaths, motor end plates, Schwann cells, Nissl bodies, neurofibrils, and a host of other structures. Neurons send impulses that travel along the axons and dendrites to a junction, called a synapse. The impulse jumps the synapse and continues on the journey following additional axons and dendrites.

  • Brain – consists of several bodies, all with specific functions. The terms forebrain, midbrain, and hindbrain originate from prenatal development; where the brain parts are lined up this way. As our brains develop, the sections fold on top of one another, until the terms really don’t describe the positions of the structures anymore. However, the structures are distinct, and have separate functions. A quick summary follows:

    • Forebrain (prosencephalon) – cerebral hemispheres

    • Midbrain (mesencephalon) – tiny section just above the pons

    • Hindbrain (rhombencephalon) – cerebellum, pons, medulla oblongata. The term brain stem refers to the pons and medulla.

Lateral view of brain, showing lobes

  • Cranial nerves – there are 12 cranial nerves; each with a particular job. The cranial nerves originate from the midbrain and brain stem. They are listed here merely to demonstrate the enormous complexity of the nervous system. Most of these functions are autonomic.

    • Olfactory I – smell

    • Optic II – vision (rods & cones connect)

    • Oculomotor III– pupil constriction/dilation, sensory of eyes

    • Trochlear IV – same as oculomotor, different eye muscles

    • Trigeminal V – chewing muscles, both sensory and motor

    • Abducens VI – another eye nerve, both sensory and motor

    • Facial VII – motor to facial muscles, sensory for taste and skin

    • Vestibulocochlear VIII- hearing and equilibrium

    • Glossopharyngeal IX – taste, sensory, swallowing, salivary secretion

    • Vagus X – sensory, taste, speech, respiration, digestion

    • Accessory XI– swallowing, speech, muscles of head/shoulder

    • Hypoglossal XII – muscles of the tongue

  • Spinal cord – the spinal cord is a bundle of nerves about 1 centimeter in diameter which ends at the base of the coccyx. At the level of about L3, the bundle breaks up, and points directly downward in a collection of fibers called the cauda equina (horse’s tail). Only one small fiber, the filum terminale, extends all the way to the tip of the coccyx. Individual nerves extend from the cord laterally through holes in the vertebrae called intervertebral foramen.

  • Meninges – the 3 linings of the brain and spinal cord (pia mater, dura mater, and arachnoid). Myelin sheaths are different; they are protective coverings over individual axons.

  • Cerebrospinal fluid – produced in the ventricles (spaces) in the brain, it bathes the brain and spinal cord, and is outside the meninges in an area called the subarachnoid space.

Spinal nerves diagram, explaining innervations at each level.

In a spinal injury, the nerves below the site are often affected.

Sensory nerves are afferent, and motor nerves are efferent. Another way to look at this is that afferent nerves travel from the PNS to the CNS (from peripheral to central) and that efferent travel from CNS to PNS (from central to peripheral). Sympathetic nerves are those that are involved in the “fight or flight responses” that are more animalistic in nature. They communicate with the spinal nerves from T1 to L3 in location. Parasympathetic nerves are involved in more of the “relax or rest responses,” and communicate with the midbrain, medulla, and sacral spinal nerves. Remember that the sympathetic and parasympathetic nerves are part of the autonomic (subconscious) nervous system.

The voluntary nervous system has conscious control of its nerves; thus it encompasses the central nervous system. It is more complex than that, of course; since these two systems overlap some.

Summary – The nervous system is so complex that even an overview is somewhat overwhelming. Although the information provided here is beyond the scope of what most first aiders will need, it is intended to provide lifeguards with a basic understanding of the way the nervous system is designed, and what the main structures are.
Injuries to the nervous system are manifested by burning pain, numbness, tingling, loss of function, paralysis, swelling, redness, head injury, deformity. Meningitis, particularly the bacterial version, is very serious and can be life-threatening. Another very serious nervous system condition is encephalitis; an inflammation of the brain.
Digestive System
The digestive system has four functions: ingestion – eating; digestion – processing or decomposing food; absorption – taking processed nutrients into the blood; egestion – elimination of wastes.
Ingestion: mouth & esophagus
Decomposition, digestion: stomach

Absorption: small intestine
Egestion: large intestine, rectum

Structures of the digestive system

  • Mouth – includes uvula, soft and hard palate. Digestion begins here.

  • Pharynx – includes nasopharynx, oropharynx, and laryngopharynx

  • Esophagus – tube going to the stomach

  • Stomach – first organ of digestion, does little absorption; mostly food decomposition.

  • Small intestine – second organ of digestion, includes the duodenum, jejunum, and ilium totaling about 21 feet. The duodenum is about 10 inches, the jejunum 8 ft and the ilium about 12 feet. This organ is in the absorption phase, and produces significant secretions through glands that facilitate absorption. The majority of digestion occurs here.

  • Large intestine – third organ of digestion, includes the cecum, colon (ascending, transverse, and descending), rectum, and anal canal. The large intestine is about 5 feet long. It has a folded, sack-like structure (the haustra) that distinguishes its appearance from the small intestine. The large intestine also produces secretions, but these are primarily mucus which aids in the formation of feces.

  • Vermiform appendix – a tiny worm-like tube that extends from the cecum of the large intestine.

  • Liver – produces enzymes that facilitate absorption. It also produces bile, which is involved in fat absorption and is stored in the gallbladder. It converts glucose to glycogen, makes vitamin A, and assists in blood clotting.

  • Gallbladder – stores bile and releases it into the duodenum when food is present.

  • Pancreas – a gland that produces the hormone insulin for the absorption of sugar. Although insulin production is an endocrine function, the pancreas also produces digestive enzymes that are emptied into the duodenum.

Structures of the digestive system are somewhat unprotected and are subject to blows and stab wounds, which can cause internal bleeding or serious infections.

The Genitourinary System

This is really 2 systems combined into one: the reproductive system and the urinary system. The urinary system is composed of the organs that eliminate wastes from the blood. The reproductive organs are very close in proximity to the urinary organs, and thus are susceptible to injury from the same incident.

Structures of the genitourinary system –

  • Kidneys – organs located behind the abdominal cavity that filter wastes from blood and form urine.

  • Ureter – the tubes that connect the kidneys to the urinary bladder.

  • Urinary bladder – the storage space for urine.

  • Urethra – the tube that connects the bladder to the exit point from the body (the external urethral orifice). The urethra exits above the vagina in females forming an external sphincter muscle. In males, the urethra exits from the glans of the penis. Urination (micturition) is the process of emptying the urinary bladder.

Kidney injuries can be very painful, and the kidneys are somewhat vulnerable to blows from behind. Blood in the urine may indicate a kidney stone, which is also accompanied by severe pain in the abdomen.drawing of male urinary and sexual system

Reproductive system:

Male anatomy -

  • Scrotum – the sacklike structure

that encloses the testis.

  • Testis – organs that produce sperm and

hormones, such as testosterone.

  • Epididymis – a small duct system at the top of the testis, contiguous to the vas deferens. It serves as a storage system for spermatozoa.

  • Vas deferens (ductus deferens) – the tube that connects the testis to the urethra in the penis. This is the tube that is cut in male sterilization surgery.

  • Seminal vesicles, prostate and bulbourethral glands – secrete fluids into the semen

  • Penis – external male reproductive organ, consisting of: the glans, prepuce (foreskin), the corpus cavernosum and corpus spongiosum (which make up the main body of the structure).

Injuries to the male genitalia are common, since the organs are unprotected and are outside of the body cavity. Priapism is a symptom of spinal cord injury that can occur in males. Hernias are another type of injury, where strain to the structure of the peritoneum causes extension beyond its normal location creating a “hernial sac” - that can protrude as far as the inferior portion of the scrotum (complete congenital inguinal hernia).

Female anatomy

  • Ovary – organs that produce ovum (eggs) and the hormone estrogen.

  • Fimbria – little finger-like projections at the ends of the uterine tubes.

  • Uterus – the organ where a fetus develops: consists of the fundus, body, and cervix (or neck). This organ develops a thick lining each month, which is sloughed off (menstruation) when impregnation does not occur.

  • Fornix – a small cavity at the top of the vagina just posterior to the cervix.

  • Vagina – “birth canal” through which the fetus must pass to exit the uterus.

  • Clitoris – the female counterpart to the glans penis, located at the top of the labia minor: consisting of a prepuce, body, glans, and crus.

  • Labia – two sets of folds that cover the vaginal vestibule. The labium minora are the inner folds, and the labium majora are the outer folds. The vaginal vestibule is the area surrounding the vaginal orifice separated by the labia minora.

  • Vulva (pudendum) – term for the female external genitalia.

  • Mons pubis – a fatty protrusion covering the pubic bone.

Female reproductive system, lateral view (internal organs)

Lesson 8: Patient Assessment Protocol
Introduction – As with other patient assessment models you may have learned in first aid courses, this model follows general steps, of which there are five:

  1. Do a scene size-up: what happened, how many victims, what kind of situation is this (medical vs. trauma), how dangerous is the scene, does the victim need to be moved, who is available to help, etc.?

  2. Do an initial assessment: check the patient for life-threatening conditions, including airway obstruction, respiratory arrest, cardiac arrest, severe bleeding, and obvious deformity.

  3. Do a physical exam: If the patient is injured badly, or has potential multiple injuries, check him from head to toe for injuries.

  4. Do a SAMPLE History: Look for signs of injuries or illness, ask if the patient is experiencing any Symptoms that you cannot see; ask if he has any Allergies that might be contributing to the condition; ask if he takes any Medications; ask if he has any pertinent Past medical history that might be contributing to his condition; ask when he Last ate or drank anything (including his medications); ask what happened right before he ended up in his current condition (Events leading up to the incident.)

  5. Do an ongoing assessment: Check Blood pressure, Level of consciousness, Skin color/temperature/wet or dry, Capillary refill, Pulse rate, Respiration rate. The highlighted letters spell BLSCPR.

What distinguishes the Emergency Medical Response model from more basic first aid is the level of detail in doing the assessments. Below is a set of acronyms that will help you to remember the details of each step.

Initial assessment

BSIBody Substance Isolation: putting on your gloves and other protection prior to contacting the patient.

MOI – Mechanism of Injury – how did the patient get injured? This is critical for determination of other injuries besides the chief complaint.

ABCD – Opening the patient’s airway, Checking for breathing, pulse/signs of circulation and bleeding for 10 seconds. Look for deformity.

LOC – Level Of Consciousness, relates directly to the next acronym AVPU.

AVPUAlert: the patient is conscious, and can talk to you normally; Verbal: the patient is conscious, cannot talk normally to you, however will respond to a verbal stimulus. For example, if you call the patient’s name, he will turn and look at you, but may not be able to articulate a verbal response. Painful: the patient will twitch if a painful stimulus is applied, such as a pinch just above the clavicle. Unresponsive: the patient is unconscious and will not respond to any stimulus.
Physical Exam -

DOTSDeformity: areas oddly shaped, hard and lumpy, or soft and depressed. Open wounds: areas that may be open to infection, where the skin is broken (either of these may be under clothing, and thus require exposure.) Tenderness: areas especially sensitive to palpation or movement. Swelling: areas greater than their normal size, due to collection of fluids/blood.
OPQRST – These refer to pain description. Onset: when did it start? Provocation: what provokes it? Quality: describe it – sharp, dull, ache, etc. Radiation/region: does it radiate down your arm/leg/neck, etc.? Severity: how would you rate it from 1-10? Time: how long does it last? Is it constant, does it come and go or change over time? If so, on what interval?
DCAP and BTLS are other acronyms commonly used by EMS, but we’re sticking with DOTS only, since they have some overlap with these.
SAMPLE History

SAMPLE - Look for Signs of injuries or illness, ask if the patient is experiencing any Symptoms that you cannot see; ask if he has any Allergies that might be contributing to the condition; ask if he takes any Medications; ask if he has any Pertinent Past medical history that might be contributing to his condition; ask when he Last ate or drank anything (including his medications); ask what happened right before he ended up in his current condition (Events leading up to the incident.)
Chief Complaint – What seems to be the patient’s main problem? Is it their leg, arm, stomach, etc.? We should focus first on the area that corresponds to the chief complaint, then look for other injuries or problems. Remember that just because the patient doesn’t complain about an injury, doesn’t mean that it isn’t there. The chief complaint may overshadow other injuries that could become very major later! When in doubt, do a complete physical exam along with your SAMPLE history.
Ongoing Assessment

BLSCPR - Check Blood pressure, Level of consciousness, Skin color/temperature/wet or dry, Capillary refill, Pulse rate, Respiration rate. These factors are checked every 5 minutes for unstable patients, and every 15 for stable patients. A stable patient is one who’s condition is alert and not worsening, but virtually staying the same. An unstable patient is one who’s condition is worsening or is already unconscious/unresponsive. Since it takes about five minutes to complete the six components of BLSCPR, you’re continually checking an unstable patient.

BBP: Bloodborne Pathogens - Remember that pathogens make people sick by the existence of four conditions: 1. A pathogen is present that can make you sick. 2. It is of sufficient quantity to get you infected. 3. You are susceptible to that particular pathogen. 4. It has an effective way of entering into your system. With BSI (body substance isolation), we’re looking at blocking #4 on this list. Don’t let it get in! We do this by wearing personal protective equipment (PPE) that creates an effective barrier to the pathogen. Although the Bloodborne pathogens are of great concern when dealing with bleeding patients, so are those transmitted by other means. We must use common sense to avoid contact with ANY potentially infectious substance. A quick BESTGuard rule of thumb: always put on your BSI gear before touching a patient on land, but do NOT stop to glove up before entering the water to rescue someone in the pool. Go get him first! Once he’s on deck, follow the protocols listed in this book for donning your gloves and other PPE. We strongly recommend that all lifeguards get vaccinated against Hepatitis B. As of this writing, there is still no vaccination for Hepatitis C, which is the most prominent chronic liver disease in the world. A well organized and properly functioning aquatic facility will combat all four of these conditions by requiring swim diapers and prohibition of anyone with open sores, active infections, etc. from swimming; by using UV, ozone, or another secondary oxidizer capable of killing the organisms that chlorine struggles to kill (crypto and giardia, for example); providing appropriate vaccinations for free to all guards on staff; requiring BSI and proper work practices be employed; and providing the PPE to do so.

Incident Command System – As we discussed earlier in unit 1, a key part of patient assessment is the seamless transition from first responder patient care to more advanced pre-hospital care that is provided by EMTs and Paramedics. Use your established patient assessment forms to guide you through the steps and record what you’ve found. Hand this off to the Paramedics or EMTs that come and take over for you. Be prepared to “package the patient” for transport when time and equipment allow you to do so. If you can save precious time by fully packaging a patient prior to when Paramedics arrive, he may have a greater chance of survival. For example, a possible spinal injury removed from the pool on a backboard, fully strapped in, with head immobilizer secured, and covered in a blanket - may be ready to go into the ambulance with attaching the backboard to the stretcher the only packaging required by the Paramedics.

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