Body Fluids and Circulation
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Chapter 20 *Lecture Powerpoint the Circulatory System: Blood Vessels and Circulation
Chapter 20 *Lecture PowerPoint The Circulatory System: Blood Vessels and Circulation *See separate FlexArt PowerPoint slides for all figures and tables preinserted into PowerPoint without notes. Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Introduction • The route taken by the blood after it leaves the heart was a point of much confusion for many centuries – Chinese emperor Huang Ti (2697–2597 BC) believed that blood flowed in a complete circuit around the body and back to the heart – Roman physician Galen (129–c. 199) thought blood flowed back and forth like air; the liver created blood out of nutrients and organs consumed it – English physician William Harvey (1578–1657) did experimentation on circulation in snakes; birth of experimental physiology – After microscope was invented, blood and capillaries were discovered by van Leeuwenhoek and Malpighi 20-2 General Anatomy of the Blood Vessels • Expected Learning Outcomes – Describe the structure of a blood vessel. – Describe the different types of arteries, capillaries, and veins. – Trace the general route usually taken by the blood from the heart and back again. – Describe some variations on this route. 20-3 General Anatomy of the Blood Vessels Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Capillaries Artery: Tunica interna Tunica media Tunica externa Nerve Vein Figure 20.1a (a) 1 mm © The McGraw-Hill Companies, Inc./Dennis Strete, photographer • Arteries carry blood away from heart • Veins -
Comparative Cardiac Anatomy
5 Comparative Cardiac Anatomy ALEXANDER J. HILL, PhD AND PAUL A. IAIZZO, PhD CONTENTS HISTORICAL PERSPECTIVE OF ANATOMY AND ANIMAL RESEARCH IMPORTANCE OF ANATOMY AND ANIMAL RESEARCH LARGE MAMMALIANCOMPARATIVE CARDIAC ANATOMY REFERENCES 1. HISTORICAL PERSPECTIVE the dominion of man and, although worthy of respect, could be OF ANATOMY AND ANIMAL RESEARCH used to obtain information if it was for a "higher" purpose (2). Anatomy is one of the oldest branches of medicine, with his- Descartes described humans and other animals as complex torical records dating back at least as far as the 3rd century BC; machines, with the human soul distinguishing humans from animal research dates back equally as far. Aristotle (384-322 BC) all other animals. This beast-machine concept was important studied comparative animal anatomy and physiology, and for early animal researchers because, if animals had no souls, Erasistratus of Ceos (304-258 BC) studied live animal anatomy it was thought that they could not suffer pain. Furthermore, the and physiology (1). Galen of Pergamum (129-199 AD) is prob- reactions of animals were thought to be the response of auto- ably the most notable early anatomist who used animals in mata and not reactions of pain (2). research to attempt to understand the normal structure and The concept of functional biomedical studies can probably function of the body (2). He continuously stressed the cen- be attributed to another great scientist and anatomist, William trality of anatomy and made an attempt to dissect every day Harvey (1578-1657 AD). He is credited with one of the most because he felt it was critical to learning (3). -
Vii. Infection Prevention
VII. INFECTION PREVENTION Prevention of Hospital Acquired Infections What is Infection Prevention? Infection prevention is doing everything possible to prevent the spread of germs which lead to hospital acquired infection. What is a bloodborne pathogen? • Bloodborne pathogens are micro-organisms such as viruses or bacteria that are present in human blood that can cause disease in humans. These pathogens include, but are not limited to: – Hepatitis B (HBV) – Hepatitis C (HCV) – Human immuno-deficiency virus (HIV) – Malaria, syphilis, West Nile virus, Ebola OTHER POTENTIALLY INFECTIOUS MATERIAL (OPIM) • In addition to human blood, bloodborne pathogens can be found in other potentially infectious material such as: – Blood products (plasma/serum) – Saliva – Semen – Vaginal secretions – Skin tissue/cell cultures – Any body fluid that is contaminated with blood • Body fluids that are not usually considered infectious with bloodborne pathogens are: – Vomit – Tears – Sweat – Urine – Feces – Sputum /nasal secretions ALL BODY FLUIDS SHOULD BE REGARDED AS POTENTIALLY INFECTIOUS!!! TRANSMISSION IN THE WORKPLACE Bloodborne pathogens can be transmitted when blood or OPIM is introduced into the blood stream of a person • This can happen through: – Non intact skin (acne, scratches, cuts, bites, blisters, wounds) – Contact with mucus membranes found in the eyes, nose and mouth – Contaminated instruments such as needles and sharps METHODS TO PREVENT BLOODBORNE PATHOGEN EXPOSURE A. Standard Precautions – ALL body fluids should be considered as potentially infectious materials – Use stand precautions EVERY TIME you anticipate contact with blood, body fluids, secretions/excretions, broken skin and mucous membranes – Use appropriate personal protective equipment – Decontaminate spills METHODS TO PREVENT BLOODBORNE PATHOGEN EXPOSURE B. Personal Protective Equipment Include: gloves, gowns, laboratory coats, face shields or masks, eye protection, mouthpieces, resuscitation bags, pocket masks, or other ventilation devices. -
Guidelines on the Diagnosis and Management of Pericardial
European Heart Journal (2004) Ã, 1–28 ESC Guidelines Guidelines on the Diagnosis and Management of Pericardial Diseases Full Text The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology Task Force members, Bernhard Maisch, Chairperson* (Germany), Petar M. Seferovic (Serbia and Montenegro), Arsen D. Ristic (Serbia and Montenegro), Raimund Erbel (Germany), Reiner Rienmuller€ (Austria), Yehuda Adler (Israel), Witold Z. Tomkowski (Poland), Gaetano Thiene (Italy), Magdi H. Yacoub (UK) ESC Committee for Practice Guidelines (CPG), Silvia G. Priori (Chairperson) (Italy), Maria Angeles Alonso Garcia (Spain), Jean-Jacques Blanc (France), Andrzej Budaj (Poland), Martin Cowie (UK), Veronica Dean (France), Jaap Deckers (The Netherlands), Enrique Fernandez Burgos (Spain), John Lekakis (Greece), Bertil Lindahl (Sweden), Gianfranco Mazzotta (Italy), Joa~o Morais (Portugal), Ali Oto (Turkey), Otto A. Smiseth (Norway) Document Reviewers, Gianfranco Mazzotta, CPG Review Coordinator (Italy), Jean Acar (France), Eloisa Arbustini (Italy), Anton E. Becker (The Netherlands), Giacomo Chiaranda (Italy), Yonathan Hasin (Israel), Rolf Jenni (Switzerland), Werner Klein (Austria), Irene Lang (Austria), Thomas F. Luscher€ (Switzerland), Fausto J. Pinto (Portugal), Ralph Shabetai (USA), Maarten L. Simoons (The Netherlands), Jordi Soler Soler (Spain), David H. Spodick (USA) Table of contents Constrictive pericarditis . 9 Pericardial cysts . 13 Preamble . 2 Specific forms of pericarditis . 13 Introduction. 2 Viral pericarditis . 13 Aetiology and classification of pericardial disease. 2 Bacterial pericarditis . 14 Pericardial syndromes . ..................... 2 Tuberculous pericarditis . 14 Congenital defects of the pericardium . 2 Pericarditis in renal failure . 16 Acute pericarditis . 2 Autoreactive pericarditis and pericardial Chronic pericarditis . 6 involvement in systemic autoimmune Recurrent pericarditis . 6 diseases . 16 Pericardial effusion and cardiac tamponade . -
The ECG Made Very Easy Indeed: a Beginner’S Guide
Part 1 The ECG made very easy indeed: a beginner’s guide The ECG made very easy indeed 1 What is an ECG? 1 The heart is a pump driven by intrinsic electrical When do you need an ECG? 1 impulses which make the heart beat. An ECG is a paper recording of that electrical activity. The ECG records where How to record an ECG 2 electrical impulses start and how they flow through the How to interpret an ECG: the basics 2 heart. It does not measure how well the heart is pumping. The electrical activity of the heart starts in the ‘inter- The ECG waves and what they mean 2 nal pacemaker’, which is called the sinoatrial node. This Interpretation starts here! 4 is in the right atrium. The normal rhythm is called ‘sinus rhythm’ (properly it should be called sinoatrial rhythm, Rhythms you must be able to recognize 8 but it isn’t). The way electrical impulses flow through the Patterns you must be able to recognize 10 heart is called conduction. Abnormalities in the electrical activity of the heart can The normal ECG and its variants 13 result in abnormal conduction or rhythms where the heart ECG red flags 14 may go too quickly, too slowly, or beat irregularly. Changes to the normal flow of electricity through the heart can be shown on an ECG and may indicate damaged This guide has been written for those who are just starting heart muscle. Heart muscle can be damaged by many to use ECGs in their clinical practice. -
Blood Vessels: Part A
Chapter 19 The Cardiovascular System: Blood Vessels: Part A Blood Vessels • Delivery system of dynamic structures that begins and ends at heart – Arteries: carry blood away from heart; oxygenated except for pulmonary circulation and umbilical vessels of fetus – Capillaries: contact tissue cells; directly serve cellular needs – Veins: carry blood toward heart Structure of Blood Vessel Walls • Lumen – Central blood-containing space • Three wall layers in arteries and veins – Tunica intima, tunica media, and tunica externa • Capillaries – Endothelium with sparse basal lamina Tunics • Tunica intima – Endothelium lines lumen of all vessels • Continuous with endocardium • Slick surface reduces friction – Subendothelial layer in vessels larger than 1 mm; connective tissue basement membrane Tunics • Tunica media – Smooth muscle and sheets of elastin – Sympathetic vasomotor nerve fibers control vasoconstriction and vasodilation of vessels • Influence blood flow and blood pressure Tunics • Tunica externa (tunica adventitia) – Collagen fibers protect and reinforce; anchor to surrounding structures – Contains nerve fibers, lymphatic vessels – Vasa vasorum of larger vessels nourishes external layer Blood Vessels • Vessels vary in length, diameter, wall thickness, tissue makeup • See figure 19.2 for interaction with lymphatic vessels Arterial System: Elastic Arteries • Large thick-walled arteries with elastin in all three tunics • Aorta and its major branches • Large lumen offers low resistance • Inactive in vasoconstriction • Act as pressure reservoirs—expand -
Body Fluid Exposure Procedure
Employee Health Services 210 Lincoln Street Worcester, MA 01605 Body Fluid Exposure Procedure Step 1: Treat Exposure Site As soon as possible after exposure, use soap and water to wash areas exposed to potentially infectious fluids Flush exposed mucous membranes with water Flush exposed eyes with 500 ml of water or saline, at least 3-5 minutes Do not apply caustic agents, disinfectants or antibiotics in the wound Step 2: Gather Information and Document Employees need to complete a “First Report of Injury” form, state or clinical, as appropriate. Students need to complete an occurrence form. Using the UMMHC PEEP sheet as a guide, document o The circumstances of the occupational exposure o Evaluation of the employee . Evaluation of exposure site . Evaluation of Hepatitis B, C and HIV status Hepatitis B antibody (HBA) Hepatitis B antigen (HSA) Hepatitis C antibody (HCV) HIV antibody . Baseline lab. At the initial visit, we do not necessarily know the disease status of the source patient. Therefore, the baseline labs take into account only the decision to take or decline PEP. No Post-Exposure Prophylaxis (PEP) [2 gold top tubes] Alt HSA HBA HCV HIV Taking Post-Exposure Prophylaxis 2 gold top and 1 purple top tubes All of the above, PLUS AST Amylase Creatinine Glucose CBC/diff UCG as appropriate o Evaluation of the source patient . When the source of the exposure is known Source chart needs to be reviewed and source consented for HIV, Hepatitis B antigen and antibody, and Hepatitis C. J: Employee Health: Body Fluid Exposure Procedure-Revised 09/29/09 jc 1 On the University campus, notify Pat Pehl, the HIV counselor. -
Persistence of Ebola Virus in Various Body Fluids During Convalescence
Epidemiol. Infect. (2016), 144, 1652–1660. © Cambridge University Press 2016 doi:10.1017/S0950268816000054 Persistence of Ebola virus in various body fluids during convalescence: evidence and implications for disease transmission and control A. A. CHUGHTAI*, M. BARNES AND C. R. MACINTYRE School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia Received 19 November 2015; Final revision 22 December 2015; Accepted 6 January 2016; first published online 25 January 2016 SUMMARY The aim of this study was to review the current evidence regarding the persistence of Ebola virus (EBOV) in various body fluids during convalescence and discuss its implication on disease transmission and control. We conducted a systematic review and searched articles from Medline and EMBASE using key words. We included studies that examined the persistence of EBOV in various body fluids during the convalescent phase. Twelve studies examined the persistence of EBOV in body fluids, with around 800 specimens tested in total. Available evidence suggests that EBOV can persist in some body fluids after clinical recovery and clearance of virus from the blood. EBOV has been isolated from semen, aqueous humor, urine and breast milk 82, 63, 26 and 15 days after onset of illness, respectively. Viral RNA has been detectable in semen (day 272), aqueous humor (day 63), sweat (day 40), urine (day 30), vaginal secretions (day 33), conjunctival fluid (day 22), faeces (day 19) and breast milk (day 17). Given high case fatality and uncertainties around the transmission characteristics, patients should be considered potentially infectious for a period of time after immediate clinical recovery. -
1 SIZE, FORM, and LOCATION of the HEART FIGURE 20.2A 1. The
SIZE, FORM, AND LOCATION OF THE HEART FIGURE 20.2a 1. The heart is a cone-shaped structure that is approximately the size of a fist. 2. The apex (tip) of the heart points inferiorly, and the base of the heart is superior. Thus the cone is upside down. 3. The heart is part of the mediastinum, a partition of organs that divides the thoracic cavity into right and left halves. ANATOMY OF THE HEART Pericardium FIGURE 20.3 1. The heart is enclosed by a double-layered sac called the pericardium, or the pericardial sac. The pericardium has two main parts. A. The outer fibrous pericardium consists of connective tissue and is responsible for the strength of the pericardium. B. The inner serous pericardium is simple squamous epithelium that secretes serous fluid. It protects the heart against friction. The serous pericardium has two parts. 1) The visceral pericardium is in contact with the heart. 2) The parietal pericardium is in contact with the fibrous pericardium. 3) The pericardial cavity in-between the visceral and parietal pericardium is filled with pericardial fluid. 2. Pericarditis is inflammation of the pericardium that can cause substernal pain. It can be caused by infections or damage caused by radiation treatment for cancer. 3. Cardiac tamponade [tam-po-nAd′] is compression of the heart due to an accumulation of fluid in the pericardial space. Decreased venous input results in decreased output and death can result. Cardiac tamponade can be caused by pericarditis (build up of pericardial fluid) or wounds, such as stab or gunshot wounds (buildup of blood). -
Bio 104 Cardiovascular System
29 Bio 104 Cardiovascular System Lecture Outline: Cardiovascular System Hole’s HAP [Chapters 14, 15, 16] Blood: Introduction (Chapter 14) - - - - A. Characteristics of Blood 1. Blood Volume - - - 2. Blood Composition a. Blood Cells Red blood cells White blood cells Platelets b. Plasma 3. Origin of Blood Cells - - 30 Bio 104 Cardiovascular System B. Red Blood Cells 1. Characteristics - - - oxyhemoglobin - deoxyhemoglobin - 2. Red Blood Cell Counts 4.6 – 6.2 4.2. – 5.4 reflects blood’s ___________________________ 3. Red Blood Cell Production low blood oxygen ________________________ RBC production vitamin B12, folic acid, Fe are necessary Dietary Factors Affecting RBC Production 31 Bio 104 Cardiovascular System 4. Life Cycle of RBC lifespan worn out RBCs destroyed by Hb heme and globin 5. Anemia Def. = C. White Blood Cells 1. Functions & Types diapedesis positive chemotaxis granulocytes - - - agranulocytes - - 32 Bio 104 Cardiovascular System 2. White Blood Cell Counts 5, 000 - 10,000 leukopenia leukocytosis differential WBC count Granulocytes Agranulocytes Neutrophils (segs, PMNs, bands) Monocytes Eosinophils Lymphocytes Basophils D. Platelets - cell fragments -130,000 - 360,000 - helps control _______________ Plasma A. Characteristics 33 Bio 104 Cardiovascular System B. Plasma Proteins C. Gases and Nutrients Gases Nutrients - - - - - - D. Nonprotein Nitrogenous Substances Urea - Uric acid - Amino acids – Creatine – Creatinine – BUN – E. Plasma Electrolytes Absorbed from the _____________ or released as by-products -
Pericardial Effusion and Pericardiocentesis
Review http://dx.doi.org/10.4070/kcj.2012.42.11.725 Print ISSN 1738-5520 • On-line ISSN 1738-5555 Korean Circulation Journal Pericardial Effusion and Pericardiocentesis: Role of Echocardiography Hae-Ok Jung, MD Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea Pericardial effusion can develop from any pericardial disease, including pericarditis and several systemic disorders, such as malignancies, pulmonary tuberculosis, chronic renal failure, thyroid diseases, and autoimmune diseases. The causes of large pericardial effusion requiring invasive pericardiocentesis may vary according to the time, country, and hospital. Transthoracic echocardiography is the most important tool for diagnosis, grading, the pericardiocentesis procedure, and follow up of pericardial effusion. Cardiac tamponade is a kind of cardio- genic shock and medical emergency. Clinicians should understand the tamponade physiology, especially because it can develop without large pericardial effusion. In addition, clinicians should correlate the echocardiographic findings of tamponade, such as right ventricular collapse, right atrial collapse, and respiratory variation of mitral and tricuspid flow, with clinical signs of clinical tamponade, such as hypo- tension or pulsus paradoxus. Percutaneous pericardiocentesis has been the most useful procedure in many cases of large pericardial effu- sion, cardiac tamponade, or pericardial effusion of unknown etiology. The procedure should be performed with the guidance of echocardiog- raphy. (Korean Circ J 2012;42:725-734) KEY WORDS: Pericardial effusions; Echocardiography; Cardiac tamponade; Pericardiocentesis. Introduction ricardium. Pericardial fluid acts as a lubricant between the heart and the pericardium. Excess fluid or blood accumulation in this cavity is Normal pericardium is a double-walled sac that contains the heart called pericardial effusion.4)5) and the roots of the great vessels. -
Basic Rhythm Recognition
Electrocardiographic Interpretation Basic Rhythm Recognition William Brady, MD Department of Emergency Medicine Cardiac Rhythms Anatomy of a Rhythm Strip A Review of the Electrical System Intrinsic Pacemakers Cells These cells have property known as “Automaticity”— means they can spontaneously depolarize. Sinus Node Primary pacemaker Fires at a rate of 60-100 bpm AV Junction Fires at a rate of 40-60 bpm Ventricular (Purkinje Fibers) Less than 40 bpm What’s Normal P Wave Atrial Depolarization PR Interval (Normal 0.12-0.20) Beginning of the P to onset of QRS QRS Ventricular Depolarization QRS Interval (Normal <0.10) Period (or length of time) it takes for the ventricles to depolarize The Key to Success… …A systematic approach! Rate Rhythm P Waves PR Interval P and QRS Correlation QRS Rate Pacemaker A rather ill patient……… Very apparent inferolateral STEMI……with less apparent complete heart block RATE . Fast vs Slow . QRS Width Narrow QRS Wide QRS Narrow QRS Wide QRS Tachycardia Tachycardia Bradycardia Bradycardia Regular Irregular Regular Irregular Sinus Brady Idioventricular A-Fib / Flutter Bradycardia w/ BBB Sinus Tach A-Fib VT PVT Junctional 2 AVB / II PSVT A-Flutter SVT aberrant A-Fib 1 AVB 3 AVB A-Flutter MAT 2 AVB / I or II PAT PAT 3 AVB ST PAC / PVC Stability Hypotension / hypoperfusion Altered mental status Chest pain – Coronary ischemic Dyspnea – Pulmonary edema Sinus Rhythm Sinus Rhythm P Wave PR Interval QRS Rate Rhythm Pacemaker Comment . Before . Constant, . Rate 60-100 . Regular . SA Node Upright in each QRS regular . Interval =/< leads I, II, . Look . Interval .12- .10 & III alike .20 Conduction Image reference: Cardionetics/ http://www.cardionetics.com/docs/healthcr/ecg/arrhy/0100_bd.htm Sinus Pause A delay of activation within the atria for a period between 1.7 and 3 seconds A palpitation is likely to be felt by the patient as the sinus beat following the pause may be a heavy beat.