MASTER TEACHING NOTES  Case Study Discussion  Teaching Tips Detailed Lesson Plan  Discussion Questions Chapter 7  Class Activities Anatomy and Physiology, and Medical Terminology  Media Links 360–420 minutes  Knowledge Application  Critical Thinking Discussion

Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes I. Introduction Case Study Discussion 5 A. During this lesson, students will read a brief overview of the human body.  What body systems might be affected by B. Case Study the woman’s injuries? 1. Present The Dispatch and Upon Arrival information from the chapter.  How will a thorough understanding of these 2. Discuss with students how they would proceed. systems help you assess and care for the patient? II. Anatomical Terms Teaching Tips 60 A. Anatomy refers to the structure of the body and the relationship of its parts to  Position a lightweight mannequin in supine, each other. prone, and lateral recumbent positions and B. Physiology refers to the function of the living body and its parts. ask students to identify each position. C. Anatomical position  Ask students to use the terms proximal, 1. Supine—Patient is lying face up on his back. distal, medial, and lateral to describe the 2. Prone—Patient is lying face down on his stomach. relationship of various body parts to each 3. Lateral recumbent position—Patient is lying on his left or other, such as the ankle, knee, wrist, right side. elbow, and shoulder. 4. Fowler position—Patient is lying on his back with his upper  Use a mannequin or skeleton to body elevated at 45° to 60° angle. demonstrate planes and lines. 5. Semi-Fowler position—Patient is lying on his back with his upper body elevated at an angle less than 45°. Class Activity 6. Trendelenburg position—Patient is lying on his back with Divide students into pairs. Give each pair a the legs elevated higher than the head and body on an inclined plane. length of masking or adhesive tape that the 7. Shock position—Patient is lying on his back with the feet students will tear into smaller pieces during and legs elevated approximately 12 inches. the exercise. During the exercise, two pairs of D. Anatomical planes and descriptions students at a time will come to the front of the 1. Sagittal plane class. The first pair will turn their backs so they 2. Frontal or coronal plane cannot see the second pair. One of the 3. Transverse or horizontal plane second pair will place a piece of tape 4. Midline somewhere on his partner. The class will

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 1 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 5. Midaxillary line describe to the first pair, using anatomical and 6. Transverse line directional terms, the location of the tape. For 7. Anterior and posterior example, “Two inches inferior to the right 8. Superior and inferior elbow, on the posterior aspect.” Without 9. Dorsal and ventral looking, one of the first pair will try to place a 10. Medial and lateral piece of tape in the location described by the 11. Proximal and distal class. This will assist students in accurately 12. Right and left using these terms when communicating with 13. Midclavicular and midaxillary other health care providers. 14. Plantar and palmer Discussion Questions  How are the terms anterior and posterior related to the terms ventral and dorsal?  How would you describe a transverse (horizontal) plane?  What are Fowler’s and semi-Fowler’s positions?

Knowledge Application  Point to several locations on your body. Have students describe the locations using anatomical terms.  Upon hearing “plain English” descriptions of patient positions, students will substitute the anatomically correct term.

Critical Thinking Discussion  What are the pros and cons of using anatomical terms of position and direction?  Why is it important for EMTs to understand this terminology?

Weblinks Go to www.bradybooks.com and click on the mykit link for Prehospital Emergency Care, 9th edition to access web resources on anatomy and physiology.

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 2 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes III. Body Systems—The Musculoskeletal System Class Activity 40 A. The musculoskeletal system consists of the bony framework held together by Play a game of “Mother May I” using the ligaments, muscles, tendons, and other connective tissues. motions allowed by joints (flexion, extension, B. The skeletal system abduction, and so on). 1. Functions a. Gives body shape Teaching Tip b. Protects vital organs Have students come up and point out the c. Allows for movement bones of different parts of the skeleton on a d. Stores minerals and produces blood cells model skeleton. 2. Components a. Skull houses and protects the brain. i. Cranium forms top, back, and sides of the skull plus Discussion Questions the forehead.  What are the functions of the ii. Face is the area between the brow and chin, which musculoskeletal system? includes the orbits, maxillae, zygomatic bones, and mandible.  What are examples of each of the three b. Spinal column, or vertebral column, is the principal support system of different types of muscle in the body? the body, which is made up of vertebrae separated by intervertebral disks. Animation i. Cervical spine—First seven vertebrae (neck) Go to www.bradybooks.com ii. Thoracic spine—Twelve thoracic vertebra inferior to and click on the mykit link for Prehospital the cervical spine (upper back) Emergency Care, 9th edition to access an iii. Lumbar spine—Five vertebrae inferior to thoracic animation labeling the bones of the skeletal spine that form the lower back (lower back) system. iv. Sacral spine—Five vertebrae inferior to lumbar spine that are fused together (back wall of pelvis) v. Coccyx—Last four vertebrae that are fused together (tailbone) c. Thorax, or chest, is composed of the sternum and thoracic spine. i. Sternum is a flat, narrow bone in the middle of the anterior chest. ii. Clavicle is attached to the superior portion of the sternum, known as the manubrium. iii. The ribs are attached to the body of the sternum. iv. The inferior portion of the sternum is the xiphoid process. d. Pelvis is a structure consisting of several bones, including the sacrum and the coccyx.

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 3 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes i. Iliac crest is a wing-like structure on either side of the pelvis. ii. Pubis is the anterior and inferior portion of the pelvis. iii. Ischium is the posterior and inferior portion of the pelvis. e. Lower extremities are the legs from the hip to the toes. f. Upper extremities are the shoulders, arms, forearms, wrists, and hands. g. Joints are places where bones connect to one another. i. Types of motion  Flexion  Extension  Abduction  Adduction  Circumduction  Pronation  Supination ii. Types of joints  Ball-and socket joint  Hinged joint  Pivot joint  Gliding joint  Saddle joint  Condyloid joint C. Bone injury 1. Fracture breaks continuity in structure. 2. May injure surrounding tissue 3. May result in blood loss D. Muscular system 1. Skeletal muscle, or voluntary muscle, is responsible for all deliberate movement. 2. Smooth muscle, or involuntary muscle, is made up of large fibers that carry out the automatic muscular functions of the body. 3. Cardiac muscle is a special type of involuntary muscle found only in the heart.

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 4 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes IV. Body Systems—The Respiratory System 40 A. Functions 1. Respiration, which is the process of moving oxygen and carbon dioxide across membranes Discussion Questions 2. Ventilation, which is the mechanical process by which air is move in and  How are respiration, ventilation, and out of the lungs oxygenation different from each other? 3. Oxygenation, which is the process through which oxygen molecules  What is the path of a molecule of oxygen move across a membrane from an area of high concentration to an area as it moves from the atmosphere to the of low concentration, and the removal of carbon dioxide level of the cell? 4. Maintenance of a normal acid-base balance  What are some differences between the B. Components respiratory systems of infants and children 1. Nose and mouth and those of adults? 2. Pharynx 3. Trachea and larynx 4. Epiglottis 5. Bronchi 6. Lungs 7. Diaphragm C. Anatomy in infants and children 1. Extra attention is required because mouth and nose are smaller than those of adults and can be more easily obstructed. 2. The tongue can block the pharynx more easily. Critical Thinking Discussion 3. The trachea is narrower and can be more easily obstructed. Why might a patient with a respiratory problem 4. Hyperextension can occlude the trachea. feel weak? 5. The cricoids cartilage is less developed and much less rigid. 6. Excessive movement of the diaphragm is a sign of respiratory distress. D. Mechanics of ventilation Discussion Question 1. Inhalation occurs when the intercostals muscles contract and the What are the muscles used in breathing? diaphragm moves downward, creating negative pressure in the chest. 2. Exhalation occurs when the intercostals muscles relax and the Teaching Tip diaphragm moves upward, creating a positive pressure in the chest. Demonstrate increased resistance to airflow 3. Diaphragm receives its stimulation from the phrenic nerve that exits the by having students breathe through coffee spinal cord at the cervical spine. stirrers or drinking straws to simulate reduced E. Physiology of respiration diameter of airways. 1. At the alveoli, oxygen enters the bloodstream while carbon dioxide and other wastes leave the bloodstream. 2. At the capillaries, oxygen moves from the blood into the cells while

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 5 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes carbon dioxide moves from the cells into the blood. F. Adequate and inadequate breathing 1. Characteristics of adequate breathing a. Adequate respiratory rate, which is the number of breaths a patient takes in one minute b. Adequate tidal volume, which is the amount of air the patient breathes in and out with one regular breath 2. Characteristics of inadequate breathing a. Rates that are too slow or too fast as compared with what is normal for the patient b. Irregular pattern of breathing c. Diminished or absent breath sounds d. Unequal chest expansion e. Pale or bluish mucous membranes or skin f. Use of accessory muscles Discussion Question g. Nasal flaring What are signs that breathing is inadequate? h. “Seesaw” breathing i. Heading bobbing j. Agonal respirations k. Grunting V. Body Systems—The Circulatory System Teaching Tip 10 A. Functions Write “right atrium” on the white board. Have 1. Provides a medium for perfusion of cells with oxygen and other nutrients students come up one at a time to write in the and removes carbon dioxide and other wastes next structure through which a drop of blood 2. Transports blood to cells and alveoli for gas exchange would pass to complete the circuit. 3. Serves as a reservoir to house blood 4. Serves as a medium for buffering the body’s acid-base balance 5. Provides a mechanism to deliver immune cells and other substances to fight infection 6. Contains substances that promote clotting B. Basic anatomy Discussion Questions 1. Heart pumps blood throughout the body.  Where is each of the heart valves located? a. Pericardium is a double-walled sac that encloses the heart, gives  What is the relationship between support, and prevents friction. hydrostatic pressure and edema? b. Atria are the upper chambers of the heart, which receive blood from the veins. c. Ventricles are the lower chambers of the heart, which pump blood to Animation

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 6 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes the arteries. Go to www.bradybooks.com d. Valves keep blood flowing in one direction. and click on the mykit link for Prehospital i. Tricuspid valve Emergency Care, 9th edition to access an ii. Pulmonary valve animation identifying the structures of the iii. Mitral valve, or bicuspid valve heart and the purpose of the cardiovascular iv. Aortic valve system. 2. Arteries carry blood away from the heart. a. Aorta is the major artery of the heart, which supplies blood to all other arteries. b. Coronary arteries supply the heart with blood. c. Carotid arteries supply the brain and head with blood. d. Femoral arteries supply the groin and legs with blood. e. Dorsalis pedis arteries extend into the feet. f. Posterior tibial arteries travel from the calf to the feet. g. Brachial arteries are the major arteries of the upper arm. h. Radial arteries are the major arteries of the arm distal to the elbow joint. i. Pulmonary arteries carry oxygen-depleted blood to the lungs. 3. Arterioles are the smallest kinds of arteries, which carry blood from the arteries to the capillaries. 4. Capillaries are tiny blood vessels that connect arterioles to venules and act as sites for the exchange of materials between the blood and the cells. 5. Venules are the smallest branches of veins. 6. Veins carry blood back to the heart. a. Vena cavae carry oxygen-depleted blood back to the right atrium. b. Pulmonary veins carry oxygen-rich blood from the lungs to the left atrium. C. Composition of the blood 1. Red blood cells carry oxygen to the body cells and carry carbon dioxide away from the cells. 2. White blood cells help defend the body against infection. 3. Platelets, along with other clotting factors, are necessary to stop Teaching Tip bleeding. Have students locate their carotid, dorsalis 4. Plasma is the liquid part of the blood, which carries blood cells and pedis, posterior tibial, brachial, and radial transports nutrients. pulses. D. Physiology of circulation

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 7 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 1. Pulse is a wave of blood propelled thorough the arteries. Discussion Question 2. Blood pressure is the force exerted by the blood on the interior walls What is perfusion? of the arteries. a. Systolic blood pressure is exerted against the walls of the arteries when the left ventricle contracts. Critical Thinking Discussion b. Diastolic blood pressure is exerted against the walls of the arteries  What are some things that could lead to when the left ventricle is at rest. hypoperfusion? c. Hydrostatic pressure is the force exerted on the inside of the vessel  What would happen in the body if the heart walls as a result of blood pressure and volume. rate became very slow? d. Perfusion is the delivery of oxygen, glucose, and other nutrients to  What would happen if the smooth muscle the cells, and the elimination of carbon dioxide and other waste in the blood vessels relaxed and the blood products. vessels throughout the body dilated? e. Hypoperfusion is the insufficient supply of oxygen and other nutrients to some of the body’s cells and the inadequate elimination of carbon dioxide and other waste products. E. Transport of gases in the blood Discussion Question 1. Oxygen is attached to hemoglobin and dissolved in plasma. How are carbon dioxide and oxygen carried in 2. Carbon dioxide is transported in the blood as bicarbonate, attached the blood? to hemoglobin, and dissolved in plasma. F. Cell metabolism 1. Aerobic metabolism is the release of energy from glucose in the presence of oxygen. 2. Anaerobic is the release of a small amount of energy from glucose in the absence of oxygen. VI. Body Systems—The Nervous System 25 A. Functions 1. Controls and maintains a conscious and aware state 2. Transmits sensory stimuli to the brain 3. Controls motor function and transmits motor impulses to muscles 4. Controls body functions through the autonomic nervous system B. Structural divisions of the nervous system 1. Central nervous system a. Brain is the control center of the nervous system. i. Cerebrum controls specific body functions and initiates and manages motions under conscious control. ii. Cerebellum coordinates muscles activity and maintains balance through impulses from the eyes and ears.

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 8 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes iii. Brain stem contains the mesencephalon, the pons, and the medulla oblongata and controls respiration, heart activity, and blood vessels. iv. Pons acts as a bridge to connect the other three parts of the brain. b. Spinal cord is an extension of the brain stem, which conducts nerve impulses. 2. Peripheral nervous system a. Afferent nerves carry sensory information from the body to the spinal cord and brain. b. Efferent nerves carry motor information from the brain and spinal cord to the body. C. Functional divisions of the nervous system 1. Voluntary nervous system influences the activity of skeletal muscles and movement. Discussion Questions 2. Autonomic nervous system influences the activities of smooth muscles  What are examples of voluntary and and glands. involuntary functions of the nervous a. Sympathetic nervous system system? b. Parasympathetic nervous system  What is the reticular activating system? D. Consciousness and unconsciousness 1. Cerebral hemispheres are the large right and left sides of the cerebrum. 2. Reticular activating system is a group of nerves that determine whether a patient remains aware of his surroundings. VII. Body Systems—The Endocrine System Discussion Question 25 A. Produces hormones that regulate the activities of certain organs What are some examples of endocrine B. Hormones are secreted by endocrine glands. glands? 1. Thyroid gland 2. Parathyroid gland Critical Thinking Discussion 3. Adrenal gland What is the relationship among the nervous, 4. Gonads circulatory, and respiratory systems? How 5. Islets of Langerhans does the endocrine system interact with these 6. Pituitary gland systems? C. Epinephrine and norepinephrine are the two primary hormones secreted by the sympathetic nervous system. Animation 1. Alpha1 effects cause the vessels to constrict. 2. Alpha effects are thought to regulate the release of alpha . Go to www.bradybooks.com 2 1 and click on the mykit link for Prehospital 3. Beta1 effects relate to heart rate, cardiac contraction, and the heart’s th electrical conduction system. Emergency Care, 9 edition to access an PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 9 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes

4. Beta2 effects cause smooth muscle to dilate. animation identifying the structure and function of the endocrine system.

Discussion Question

What are epinephrine’s alpha1, alpha2, beta1, and beta2 effects?

VIII. Body Systems—The Integumentary System (Skin) 20 A. Functions Critical Thinking Discussion 1. Protects the body from the environment How does loss of skin affect patients who are 2. Regulates body temperature burned? 3. Serves as a receptor for heat, cold, touch, pain, and pressure 4. Aids in the regulation of water and electrolytes B. Layers 1. Epidermis is the outermost layer of the skin. 2. Dermis is the second layer of the skin. 3. Subcutaneous layer is a layer of fatty tissue below the dermis. C. Accessory structures 1. Nails 2. Hair 3. Sweat glands 4. Oil glands IX. Body Systems—The Digestive System Discussion Question 20 A. Basic Anatomy What are the accessory organs of the 1. Alimentary tract digestive system? 2. Accessory organs B. Abdominal cavity 1. Stomach is a large, hollow organ in which the majority of digestion takes place. 2. Pancreas secretes pancreatic juices that aid in the digestion of fats, starches, and proteins. 3. Liver produces bile; stores sugars; produces components necessary for immune function, blood clotting, and plasma production; and renders toxic substances produced by digestion harmless. 4. Spleen helps in the filtration of blood and serves as a reservoir of

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 10 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes blood. 5. Gallbladder acts as a reservoir for bile, which aids in the digestion of fats. 6. Small intestine is the organ in which food is completely broken down into a form that can be used by the body. a. Duodenum b. Jejunum c. Ileum 7. Large intestine, also known as the colon, is the organ that absorbs water from wastes products that cannot be broken down by the small intestine and passes the remains to the rectum. C. Digestive process 1. Mechanical—Includes chewing, swallowing, peristalsis, and defecation 2. Chemical—Occurs when enzymes break down food in components that can be absorbed by the body X. Body Systems—The Urinary or Renal System Teaching Tip 15 A. Functions Ask students tor repeat the correct 1. Filters and excretes wastes from the blood pronunciation of anatomical structures. 2. Maintains balance of water and chemicals in the body 3. Helps maintain normal acid-base balance in the body B. Components 1. Kidneys filter waste from the bloodstream. 2. Ureters carry wastes from the kidneys to the bladder. 3. Urinary bladder stores urine prior to excretion. 4. Urethra carries urine from the bladder out of the body. XI. Body Systems—The Reproductive System Teaching Tip 15 A. Consists of organs that can function to accomplish human reproduction Ask students to explain back to you the B. Male physiology of each of the systems. 1. Sperm 2. Testes 3. Prostate gland 4. Penis C. Female 1. Ovaries 2. Fallopian tubes 3. Uterus PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 11 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes 4. Vagina 5. External genitals XII. Medical Terminology—Medical Words and Word Parts Class Activities 60 A. Refers to specialized language used in all fields of medicine  Have groups of students select medical B. Every medical word contains a combining form, which is a root, a combining terms from the glossary in the text or from vowel, and a hyphen. a medical dictionary and break them down C. Suffix is a word part added to the end of a combining form that modifies or for the class. gives specific meaning.  Have students divide into three groups. D. Prefix is a word part that comes before a combining form or forms, often One group will be assigned the list of indicating direction, time, or orientation. prefixes in the text, one will be assigned combining forms, and one will be assigned suffixes. The first group will call out a prefix, the second will add to it by calling out a combining form, and the third group will complete the term by calling out a suffix. Write each term on the board and discuss it. Be sure to indicate if the term is a legitimate medical term or just a fun term created by the exercise.

Teaching Tip Give examples of medical terms using the lists of prefixes, suffixes, and combining forms in the book.

Discussion Questions  What are the benefits of understanding medical terminology?  What are some medical terms you found interesting in your reading?

Knowledge Application Given a passage in the text, students should be able to determine the meaning of medical terms.

PREHOSPITAL EMERGENCY CARE, 9TH EDITION DETAILED LESSON PLAN 7 PAGE 12 Chapter 7 objectives can be found in an accompanying folder. These objectives, which form the basis of each chapter, were developed from the new Education Standards and Instructional Guidelines. Minutes Content Outline Master Teaching Notes Weblinks Go to www.bradybooks.com and click on the mykit link for Prehospital Emergency Care, 9th edition to access web resources on medical terminology. XI. Follow-Up Case Study Follow-Up Discussion 10 A. Answer student questions.  Why is assessment of the face and mouth B. Case Study Follow-Up important in this patient? 1. Review the case study from the beginning of the chapter.  What are some explanations for the 2. Remind students of some of the answers that were given to the patient’s increased pulse and blood discussion questions. pressure? 3. Ask students if they would respond the same way after discussing the chapter material. Follow up with questions to determine why students would or would not change their answers. Class Activity C. Follow-Up Assignments Alternatively, assign each question to a group 1. Review Chapter 7 Summary. of students and give them several minutes to 2. Complete Chapter 7 In Review questions. generate answers to present to the rest of the 3. Complete Chapter 7 Critical Thinking. class for discussion. D. Assessments 1. Handouts Teaching Tips 2. Chapter 7 quiz  Answers to In Review and Critical Thinking questions are in the appendix to the Instructor’s Wraparound Edition. Advise students to review the questions again as they study the chapter.  The Instructor’s Resource Package contains handouts that assess student learning and reinforce important information in each chapter. This can be found under mykit at www.bradybooks.com.

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