Xueren/EMS-Knowledge · Datasets at Hugging Face

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anatomy.json	knowledge	anatomy	how does the urinary system regulate arterial blood pressure?	urine formation renin-angiotensin system
anatomy.json	knowledge	anatomy	cns	central nervous system - responsible for thought, feeling, perception, and autonomic body functions
anatomy.json	knowledge	anatomy	pns	peripheral nervous system - responsible for transmitting information from brain to body and from body to brain
anatomy.json	knowledge	anatomy	occipital lobe of brain function	vision, and visual memory storage
anatomy.json	knowledge	anatomy	parietal lobe of brain function	storage of tactile memories, sense of touch and texture
anatomy.json	knowledge	anatomy	temporal lobe of brain function	hearing and smell language center storage of sound and odor memories
anatomy.json	knowledge	anatomy	frontal lobe - motor cortex function	voluntary muscle control storage of spatial memories
anatomy.json	knowledge	anatomy	frontal lobe - prefrontal cortex function	site of abstract intellectual functions judgement and prediction of consequences
anatomy.json	knowledge	anatomy	limbic system function	basic emotions basic reflexes
anatomy.json	knowledge	anatomy	thalamus (within the diencephalon) function	relay center for sensory and motor signals, allowing prioritization of important messages
anatomy.json	knowledge	anatomy	hypothalamus (within the diencephalon) function
anatomy.json	knowledge	anatomy	introduction	the human nervous system is broken up into the peripheral nervous system and the central nervous system. the brain, along with the spinal cord, is part of the central nervous system. there are two types of cells in the brain, nerve cells, and glial cells. nerve cells send and receive messages via nerve pathways and glial cells help provide the brain with nutrition and support.
anatomy.json	knowledge	anatomy	anatomy and physiology review	the skull protects the brain matter. the skull is made up of the cranium and the bones of the face. between the skull and the brain there are three layers of tissue. starting with the layer furthest from the brain they are the dura mater, the arachnoid mater, and the pia mater. the space between the dura mater and the arachnoid mater is called the subdural space and the space between the arachnoid mater and the pia mater is called the subarachnoid space. starting from the bottom of the brain, the spinal cord leads to the brainstem. the brainstem is made of the midbrain, pons, and medulla oblongata. the brainstem relays messages from the body to the brain and has an influence on breathing, blood pressure, and alertness. towards the back of the head is the cerebellum, a region controlling fine motor skills. above the cerebellum is the occipital lobe, which helps process visual information. the parietal lobes help receive information from all other regions of the brain, order it, and also develop memory. bordering the parietal lobes are the temporal lobes, which help recognize objects, faces, and language.
anatomy.json	knowledge	anatomy	recognition	though there are entire courses on the brain and brain anatomy, not all of that information is needed for ems professionals. when there is an issue with the brain, it generally presents as altered mental status (ams). sometimes the reason for the ams is obvious such as the patient was hit in the head with a baseball bat. sometimes it is more of a mystery to solve and working through a process can help identify the root cause of the altered mentation. frequently, the pneumonic aeiou-tips is used in the prehospital setting. a: alcoholism or acidosis e: environmental exposure, epilepsy, electrolytes, encephalopathy, endocrine disease i: infection o: oxygen deficiency, overdose u: underdose, uremia t: trauma i: insulin, intestinal p: psychogenic, poisons s: stroke, shock
anatomy.json	knowledge	anatomy	aeiou-tips pneumonic	a: alcoholism or acidosis e: environmental exposure, epilepsy, electrolytes, encephalopathy, endocrine disease i: infection o: oxygen deficiency, overdose u: underdose, uremia t: trauma i: insulin, intestinal p: psychogenic, poisons s: stroke, shock
anatomy.json	knowledge	anatomy	another pneumonic	oxygen: check oxygen saturation glucose: check blood sugar pump: check heart rhythm, rate, and 12 lead ecg s: structural such as stroke or trauma i: infection such as sepsis t: toxin such as drug overdose s: social or psych after all other causes have been thoroughly vetted
anatomy.json	knowledge	anatomy	treatment	treatment for ams starts with identifying the cause of the altered state of the patient. from that point on treatment can go from oxygen therapy to iv dextrose to rapid sequence intubation.
anatomy.json	knowledge	anatomy	scenario	you are called to a public park where there is a young man unconscious on the ground. he appears to be in his mid-twenties and there are two empty beer cans lying next to him. the scene is safe and controlled. what do you do first? after bsi and scene safety, a primary survey should be conducted. the patient is found to have a patent airway, be taking irregular breaths, and a slow, bounding radial pulse. the patient is responsive to pain. a: alcoholism or acidosis? there is some obvious alcohol use but two cans should not put a patient in this state. no obvious signs of acidosis e: environmental exposure, epilepsy, electrolytes, encephalopathy, endocrine disease? the patient is warm to the touch with no signs of hypo or hyperthermia. the patient has no bit tongue, no fistula, and no signs of hyperkalemia on the cardiac monitor as well. no obvious signs of encephalopathy or endocrine disease. i: infection? no infection site seen. o: oxygen deficiency, overdose? no track marks or drug paraphernalia found, oxygen saturation reads 99% room air. u: underdose, uremia? no pill bottles or prescriptions with patient, no signs of chf or other cause of uremia t: trauma? a full physical assessment reveals a closed skull fracture with indentation at the rear of the skull. this patient now has a suspected cause of the altered mentation. i: insulin, intestinal? capillary blood glucose is normal p: psychogenic, poisons? no sign of any toxin or foul play s: stroke, shock? the patient is inconclusive on the stroke scale but now has injury and mentation indication brain injury. due to the closed skull fracture, the patient should be transported to the largest trauma center available to transport to. obtain iv access. aggressive airway management should occur as the patient does not have the ability to protect their airway. once the patient is intubated, mild hyperventilation should take place to lower the etco2 to help lower icp and secondary brain injury from the pressure of an inflamed brain. focus on having a short scene time and rapid transport code 3 as definitive care for this patient is surgery or specialized care at a trauma center.
anatomy.json	knowledge	anatomy	final thoughts	use family and friends as a resource for patients who are exhibiting ams. they can be a wealth of knowledge for when the change in a patient occurred and/or the events going on when the patient's mentation changed. they can also answer questions like has this ever happened before? using these resources are key because once the patient is in the ambulance and you drive away you have no accurate reporter to provide additional information on the patient.
anatomy.json	knowledge	anatomy	introduction	the nervous system is one of the most complex systems in the body. it is responsible for our ability to interpret both internal needs and environmental stimuli. due to the complexity of the nervous system, it is subdivided to understand its various responsibilities better. the first two divisions are the central and peripheral nervous systems (commonly referred to as the cns and pns, respectively). the cns consists of the brain and spinal cord. the pns encompasses all nerves that branch from the cns to organs and muscles throughout the body. to better understand the pns, we further divide it into the autonomic and somatic nervous systems (ans and sns, respectively). some of our organs are "involuntary" or out of our conscious control. examples include our heart, kidneys, and digestive tract. these involuntary muscles and organs make up the ans. an easy way to remember this is that they are "automatic." other organs and muscles, however, are "voluntary" or largely within our control. these include the muscles in our legs or arms and make up the sns.
anatomy.json	knowledge	anatomy	ans overview	so…what is the ans? ans stands for the autonomic nervous system. the ans comprises the organs and muscles that are "automatic" or involuntarily controlled by our pns. what does the ans encompass? ans is responsible for involuntary functions like heart, digestive, and respiratory rates. it is broken down into two categories: the parasympathetic and sympathetic nervous systems. the parasympathetic nervous system is responsible for the relaxation or slowing of involuntary processes, such as slowing the heart rate when you sleep. the sympathetic nervous system is often called the "fight-or-flight" response and speeds up processes such as increasing the heart rate when you exercise or feel threatened.
anatomy.json	knowledge	anatomy	key terms	neuron - nerve cells that act as "messengers" by sending and receiving information throughout the body. axon - a long fiber that is an extension of the neuron. it is responsible for electrical impulses that leave the neuron. dendrites - branch-like structures that are part of the neuron. they receive information from other neurons. myelin sheath - a protective covering around the axon of each neuron. neurilemma - also known as schwann cells. these cells are responsible for the production of the myelin sheath. microglia - immune cells for the cns. they also help regulate inflammation. astrocytes - specialized glial cells that are the most abundant in the cns. schwann cells - main glial cells in the pns. neuroglia - provide support for neurons and can be found in the cns and pns.
anatomy.json	knowledge	anatomy	lessons and concepts	neurons are the foundational cells of the nervous system and are broken down based on their role and how they transmit information, i.e.: sensory or afferent neurons are found in the pns. they detect and relay information from both inside and outside the body to the cns. motor or efferent neurons are found in the cns. they send information from the cns to skeletal and smooth muscle cells. interneurons are found in the cns. they are the "go-between" for information relayed to and from sensory and motor neurons. they also play a role in coordination. nerves are found in the pns, and nerve tracts are found in the cns. sensory nerves enable us to sense the world through sight, taste, sound, touch, and smell. motor nerves relay signals from the cns to the muscles in the body to prompt movement. mixed nerves or interneurons send both sensory and motor signals.
anatomy.json	knowledge	anatomy	sympathetic and sympathetic divisions of the ans	the sympathetic division is responsible for the "fight-or-flight" response. increases heart and respiratory rate and prepares muscles for activation. decreases digestion. norepinephrine is the primary neurotransmitter of the sympathetic nervous system. it is both a hormone and a neurotransmitter and helps to elevate both blood pressure and heart rate. the parasympathetic division is responsible for the "rest & digest" response. promotes digestion. decreases heart rate and allows for a restful state. acetylcholine (ach) is the neurotransmitter found at all parasympathetic innervated organs.
anatomy.json	knowledge	anatomy	effects of the ans on organs/organ systems	eyes: sympathetic response causes dilation of pupils to help with vision. parasympathetic response cause tear production, improves close vision, and constricts pupils. skin: sympathetic response causes an increase in sweating and vasoconstriction of the blood vessels. cardiovascular system: medulla helps regulate arterial pressure through sympathetic and parasympathetic nerves. baroreceptors are part of a negative feedback system that helps regulate arterial pressure.
anatomy.json	knowledge	anatomy	autonomic dysfunction or dysautonomia	dysautonomia or autonomic neuropathy is common though the severity and onset can vary from person to person. men and women are equally affected, and symptoms may be present at birth or develop later in life. primary dysautonomia occurs when autonomic dysfunction is the main disease process. secondary dysautonomia occurs when autonomic dysfunction results from another disease process, such as diabetes. idiopathic dysautonomia occurs when there is no known disease process.
anatomy.json	knowledge	anatomy	treatment and management of dysautonomia	prioritize needs. patients experiencing dizziness or hypotension may be at greater risk for falling when standing and, therefore, may require additional resources to move/transport. initial actions: assess and manage airway, breathing, and circulation as needed. based on patient presentation, als may be necessary, so calling early is a high priority if als is not already available.
anatomy.json	knowledge	anatomy	the peripheral nervous system	to have an even better understanding of the pns, we can break it down even further. we know that some of our organs are "involuntary" or out of our conscious control. examples include our heart, kidneys, and digestive tract. these involuntary muscles and organs are innervated by the autonomic nervous system or ans. an easy way to remember this is that they are "automatic". other organs and muscles, however, are "voluntary" or within our control. these include the muscles in our legs and arms and make up the somatic nervous system or sns.
anatomy.json	knowledge	anatomy	the autonomic nervous system	the ans can again be divided into two more categories: the parasympathetic (pans) and sympathetic (sans) nervous systems.
anatomy.json	knowledge	anatomy	what is the ans?	ans stands for the autonomic nervous system. the ans makes up the organs and muscles that are "automatic" or involuntarily controlled by our pns
anatomy.json	knowledge	anatomy	what does the ans encompass?	the ans is responsible for involuntary functions, including heart rate, digestive function, and respiratory rate. it is broken down into two categories: the parasympathetic and sympathetic nervous systems
anatomy.json	knowledge	anatomy	the parasympathetic nervous system	the parasympathetic nervous system is responsible for the relaxation - or slowing - of these involuntary processes
anatomy.json	knowledge	anatomy	the sympathetic nervous system	the sympathetic nervous system is responsible for the "fight-or-flight" response, meaning it "speeds up" many involuntary processes
anatomy.json	knowledge	anatomy	neuroglial cells	there are four types of neuroglial cells: astrocytes, ependymal cells, microglial cells, and oligodendrocytes
anatomy.json	knowledge	anatomy	nerve impulses	nerve impulses are electrical signals that tell neurons to react to a stimulus. for example, you naturally withdraw from painful stimuli
anatomy.json	knowledge	anatomy	membrane potential	membrane potential is the difference between the electrical charge on the inside versus the outside of the cell
anatomy.json	knowledge	anatomy	depolarization	depolarization (first half of action potential) occurs when potassium leaves the cell, and sodium and calcium enter the cell.
anatomy.json	knowledge	anatomy	repolarization	repolarization (second half of action potential) occurs when sodium and calcium leave the cell and potassium enters the cell.
anatomy.json	knowledge	anatomy	impulse transmission	impulse transmission occurs in two different ways depending on how fast or slow the messages need to be sent and received
anatomy.json	knowledge	anatomy	distribution pattern of spinal nerves	sensory pathways. the posterior column pathway - also called the dorsal columns medial lemniscus pathway, is responsible for touch and pain sensations; it also allows for the conscious sensation of where the body is in space
anatomy.json	knowledge	anatomy	motor pathways	pyramidal system - travel through pyramids of the medulla, responsible for the voluntary control of muscles
anatomy.json	knowledge	anatomy	sympathetic division of the autonomic nervous system	"fight-or-flight" increases heart rate and respiratory rate and prepares muscles for activation
anatomy.json	knowledge	anatomy	parasympathetic division of the autonomic nervous system	"rest & digest" promotes digestion. decreases heart rate and allows for a restful state
anatomy.json	knowledge	anatomy	effects of the sympathetic and parasympathetic divisions of the ans	eyes. the sympathetic response causes dilation of pupils to help with vision. the parasympathetic response cause tear production, improves close vision, and constrict pupils
anatomy.json	knowledge	anatomy	autonomic dysfunction aka dysautonomia	damage to nerves of the ans may result in malfunction in the pans, sans, or both
anatomy.json	knowledge	anatomy	symptoms	bladder control and sensation issues. frequent urination or incontinence. difficulty regulating temperature, heart rate, and blood pressure
anatomy.json	knowledge	anatomy	treatment and management	prioritized needs: patients who are experiencing dizziness or hypotension may be at greater risk of falling when standing; therefore, you may need additional resources to help when moving the patient
anatomy.json	knowledge	anatomy	scenario	dispatch info: you are dispatched to the local high school for a 16-year-old female who had a syncopal episode.
anatomy.json	knowledge	anatomy	key takeaways	the initial presentation of the patient was stable, with no indications of acute distress. the patient's recent history during volleyball practice and the events surrounding her syncopal episode prompted ems involvement.
anatomy.json	knowledge	anatomy	tips and tricks	body functions that take place without any thought are "automatic" and therefore controlled by your autonomic nervous system
anatomy.json	knowledge	anatomy	the autonomic nervous system (ans)	to have an even better understanding of the pns, we can break it down even further. we know that some of our organs are "involuntary" or out of our conscious control. examples include our heart, kidneys, and digestive tract. these involuntary muscles and organs are innervated by the autonomic nervous system or ans. an easy way to remember this is that they are "automatic." other organs and muscles, however, are "voluntary" or within our control. these include the muscles in our legs and arms and make up the somatic nervous system or sns.
anatomy.json	knowledge	anatomy	the ans and its categories	the ans can again be divided into two more categories: the parasympathetic (pans) and sympathetic (sans) nervous systems.
anatomy.json	knowledge	anatomy	types of neuroglial cells	there are four types of neuroglial cells: astrocytes, ependymal cells, microglial cells, and oligodendrocytes microglia - immune cells for the cns. they target invaders and remove debris within the cns astrocytes - specialized glial cells that are the most abundant in the cns ependymal cells - secrete cerebrospinal fluid (csf) and encapsulate critical neural tissue oligodendrocytes - insulation of axons within cns
anatomy.json	knowledge	anatomy	neurons	neurons, the foundational cells of the nervous system, are broken down based on their role within the nervous system and how they transmit information. for example: sensory neurons, also known as afferent neurons, are found in the pns and respond to sensory information inside and outside the body. they are responsible for relaying that information to the cns think "arrive" at the cns motor neurons, also known as efferent neurons, are found in the cns and send information from the brain and spinal cord to skeletal and smooth muscle cells think "exit" from the cns interneurons are found in the cns, the "go-between" for information that is relayed to and from sensory and motor neurons, and play a role in coordination
anatomy.json	knowledge	anatomy	nerves	nerves are groupings of neurons that direct a signal to a target location sensory nerves are responsible for your ability to sense the world around you through sight, taste, sound, touch, and smell motor nerves send signals from the cns to the muscles in the body to prompt movement mixed nerves can send both sensory and motor signals. an example is the facial nerve. the facial nerve controls facial movement (motor) and taste (sensory)
anatomy.json	knowledge	anatomy	nerve tracts	nerve tracts are found in the cns, more specifically in the white matter of the brain, which is located deep to the grey matter and also makes up most of the brain tissue nerve tracts are classified into three categories based on what they connect commissural fibers connect the right and left hemispheres of the brain association fibers connect brain regions that are within the same hemisphere projection fibers connect the brain stem and spine to the cerebral cortex. these fibers are responsible for "projecting" motor and sensory signals between the cns and pns
anatomy.json	knowledge	anatomy	action potential	depolarization (first half of action potential) occurs when potassium leaves the cell, and sodium and calcium enter the cell. this action potential causes normal body functions to occur, such as a heartbeat repolarization (second half of action potential) occurs when sodium and calcium leave the cell and potassium enters the cell. this is also known as resting potential. this explains the pause between heartbeats
anatomy.json	knowledge	anatomy	effects of the sympathetic and parasympathetic divisions of the ans on various organs and systems of the body	eyes the sympathetic response causes dilation of pupils to help with vision the parasympathetic response cause tear production, improves close vision, and constrict pupils skin the sympathetic response causes an increase in sweating and vasoconstriction of the blood vessels
anatomy.json	knowledge	anatomy	cardiovascular system	the medulla helps regulate arterial pressure through sympathetic and parasympathetic nerves baroreceptors are part of a negative feedback system that helps regulate arterial pressure. there are two sites for arterial baroreceptors carotid sinus is located at the bifurcation of the external and internal carotids. small changes in mean arterial pressure (map) will activate these receptors to adjust back to normal by either increasing or decreasing map
anatomy.json	knowledge	anatomy	symptoms of dysautonomia	bladder control and sensation issues frequent urination or incontinence difficulty regulating temperature, heart rate, and blood pressure orthostatic hypotension syncope fatigue vertigo forgetfulness increase or lack of sweating chest pain shortness of breath migraines with possible noise and light sensitivity cardiac rhythm disturbances digestion issues nausea/vomiting hypoglycemia constipation sexual dysfunction erectile dysfunction increased vaginal dryness or pain during intercourse decrease in, or loss of, libido changes in vision blurriness
anatomy.json	knowledge	anatomy	ongoing treatment/treatment goals	iv/io access may be necessary for administering medications to help with blood pressure or heart rate continual cardiac monitoring (4 or 12-lead) etco2 and/or spo2 monitoring maintain/improve vital signs to within normal limits
anatomy.json	knowledge	anatomy	transport considerations	consider facilities with cardiac and stroke capabilities when patients present with acute cardiac disturbances or neurological deficits patients with difficult airways may require transport to the closest facility
anatomy.json	knowledge	anatomy	introduction	a&p of the upper and lower airway
anatomy.json	knowledge	anatomy	anatomy of the upper airway	the upper airway serves as a passageway for food, liquids, and air. it also heats, humidifies, and filters the air. the upper airway provides a path for coughing, swallowing, and speech.
anatomy.json	knowledge	anatomy	structures of the upper airway	pharynx: refers to the mouth, nasal cavity, and portion of the upper airway which all connect and lead to the esophagus and trachea. oropharynx: mouth and throat. nasopharynx: nasal cavity leading to throat. laryngopharynx: found beneath the hyoid bone, branching area where food and air pass to either the esophagus or the trachea. larynx: vocal cords or the structure marking the split between the upper and lower airway. allows for the passage of air into and out of the lungs. protects the lungs from aspiration and is involved in the production of speech. esophagus: muscular tube connecting the mouth and throat to the stomach allowing for passage of food and liquids.
anatomy.json	knowledge	anatomy	common airway terms	epiglottic vallecula: depression at the root of the tongue between tongue and epiglottis. traps food, liquids, and saliva to prevent the swallowing reflex. epiglottis: flap of elastic cartilage connected at the root of the tongue. responsible for opening and closing the entrance to the windpipe as a means to prevent aspiration. vocal cords (also known as larynx): the vocal cords are a key component in one's ability to speak, however, they are also crucial in protecting the lower airway from aspiration.
anatomy.json	knowledge	anatomy	movement of air	air passes from the upper airway and into the lower airway. it is then directed into one of two main airways, the right and left main bronchi. next, it will move into smaller passages called bronchioles, and finally into the terminal ends of the airway. the lower airway terminates in extremely small sacks where gas exchange occurs, called alveoli.
anatomy.json	knowledge	anatomy	gas exchange	gas exchange occurs by diffusion, which is molecules moving from high concentrations to low concentrations. for example, when blood reaches the pulmonary capillaries, it contains minimal amounts of oxygen and high amounts of carbon dioxide. the alveoli contain high amounts of oxygen and minimal amounts of carbon dioxide.
anatomy.json	knowledge	anatomy	lower airway structures	trachea: wind-pipe or a cartilaginous structure leading from the larynx down to the carina where it further splits into the lungs. carina: cartilaginous structure between the trachea and primary bronchi, produces a branching area separating the left and right lung. bronchus: larger airways composed primarily of cartilage leading from the trachea. these structures continue deeper into the lungs and branch into different pathways including the primary, secondary and tertiary bronchi. bronchioles: smaller, muscular structures found deep in the lungs between the bronchi and alveoli. alveoli: tiny air-sacs composed of single-layered tissue where gas exchange occurs between the lungs and the pulmonary capillaries.
anatomy.json	knowledge	anatomy	physiology	remember that the main goal of the respiratory system is gas exchange. a disruption in either the movement of air (ventilation) or gas exchange (respiration) will result in poor or inadequate perfusion. perfusion refers to an adequate volume of oxygen in the bloodstream and the ability of that oxygen to reach vital tissues.
anatomy.json	knowledge	anatomy	common physiology terms	ventilation: process of moving air in and out of the lungs. respiration: process of gas exchange across the alveoli. tidal volume: amount of airway moved in or out of the lungs in one breath, or with each respiratory cycle (inhalation or exhalation). respiratory rate: count of breaths taken per minute. perfusion: passage of blood and all of its contents through organs, tissues, and the vascular system. hypoxia: inadequate amounts of oxygen reaching tissues. hypoxemia: inadequate amounts of oxygen within the bloodstream, primarily referring to amounts within the arteries.
anatomy.json	knowledge	anatomy	introduction	anatomy and physiology overview of the cranial nerves. the human brain has 12 cranial nerves. there are three general types of cranial nerves, afferent nerves, efferent nerves, and mixed nerves. afferent nerves receive sensory input from the body and move it to the central nervous system (cns) and brain. efferent nerves pass impulses from the brain and cns to the motor system and control movement, specifically of the face.
anatomy.json	knowledge	anatomy	cranial nerves	i: olfactory nerve. (sensory) receives sensory input from the molecules in the nose and sends neural messaging back to the olfactory bulb. ii: optic nerve. (sensory) receives sensory input from eyes via nerves that meet at the optic chasm. input is sent back to the opposite side of the brain from the eye the sensory input comes from. iii: oculomotor nerve. (motor) controls motor function of eyes. also controls pupillary response as they respond to light. iv: trochlear nerve (motor) controls the oblique muscles. these muscles control outward, inward, and downward eye movements. v: trigeminal nerve (both) the largest cranial nerve. the trigeminal nerve is divided into 3 separate divisions, the maxillary (which sends sensory information from the middle of the head), the ophthalmic division (which sends sensory information from the scalp, forehead, and upper eyelids), and the mandibular division (which sends both sensory and motor information from the jaw, chin, lower lip, and tongue). vi: abducens nerve (motor) controls outwards eye motor movements. vii: facial nerve (both) transmits sensory input from the taste buds as well as controlling muscle function for tear production and saliva production. viii: vestibulocochlear nerve (sensory) consists of two divisions, the vestibular division, and the cochlear division. the vestibular division collects sensory input on balance and orientation. the cochlear branch receives sensory input from the inner ear regarding sound and pitch. ix: glossopharyngeal nerve (both) a sensory and motor nerve that carries nerve impulses for swallowing and the gag reflex. x: vagus nerve (both) the longest cranial nerve, divided into the left and right vagus nerves. a large focus of the parasympathetic response within the body involving the heart, lungs, and digestive system. xi: spinal accessory nerve (motor) a motor nerve that is associated with movement of the head, neck, and shoulders. xii: hypoglossal nerve (motor) a motor nerve that controls the movement of the tongue.
anatomy.json	knowledge	anatomy	prehospital assessment and treatment	in patients with suspected cranial nerve damage or head injury, a prehospital crania nerve assessment can be very useful for helping make a clinical impression of the injury and track changes in the patient's neurologic deficits. the cranial nerve assessment is less useful for massive head trauma or an obvious stroke with a large vessel occlusion. in those patients, it is not a hard assessment to determine that there is an injury to the brain. the cranial nerve assessment is really useful for in-between situations. a minor fall, a roll-out of bed, a patient that seems ok but just a little off. the cranial nerve assessment allows you to gather more information to help have a better guess at the severity of the injury to the patient. the pneumonic peee ffutss can be used for a complete cranial nerve assessment.
anatomy.json	knowledge	anatomy	cranial nerve assessment	pupils: use penlight to confirm pupillary response. eyes: test eye motion to all fields of direction. eyelids: have the patient close their eyes and try to keep them closed. using your fingers lightly, try to push the eyelids up so the eyes are open. they should not be able to open their eyes. ears: compare hearing in each ear and ask about ringing or other noises. facial sensation and mastication: hold the sides of the patient's mandibles and ask them to pretend like they are chewing. observe for equal strength. have the patient close their eyes and touch different parts of the face to test sensation. facial movement: have the patient smile and observe for symmetry. uvula: ask the patient to open their mouth and say 'ahhhhhh.' observe uvula to not have any traumatic damage and to be midline. tongue: ask the patient to stick out their tongue. the tongue should stick out normal. swallow: ask the patient to swallow and observe for any abnormalities. shrug: resting your hands on the patient's shoulders, have them shrug. their strength should be equal.
anatomy.json	knowledge	anatomy	scenario	you are dispatched to some sort of accident on the road. when you arrive, it looks like an electric scooter had hit a pothole at around 20 mph and the rider is sitting on the curb. there is a helmet sitting next to the rider with a solid dent in it. when making patient contact, the patient is a/o x4, gcs 15, but very slow to answer questions. the patient states they don't need to go to the hospital. you are not comfortable letting the patent sign a refusal also you ask if they will let you conduct a cranial nerve exam. the cranial exam conducted shows deficits within their shrug, eye movement, and eyelid strength. you decide to call online medical control to convince the patient to go to the hospital and they are successful. you conduct serial cranial nerve assessments throughout the transport and pick up on progressing neurological symptoms. this allows you to anticipate the need for advanced airway interventions before the patient crashes, even though the patient still has the same gcs score.
anatomy.json	knowledge	anatomy	final thoughts	the brain is the most important part of the body and also one that is so protected it can be hard to assess. due to this, conducting cranial nerve assessments can be an extremely valuable resource to assess brain injury, but also track changes in condition of patients with a brain injury. consistent assessments of the cranial nerves throughout time of patient care can help paramedics and emts anticipate changes in the patient condition before they occur.
anatomy.json	knowledge	anatomy	introduction	the nervous system is one of the most complex systems in the body. it is responsible for our ability to interpret both internal needs and environmental stimuli. due to the complexity of the nervous system, it is subdivided to understand its various responsibilities better. the first two divisions are the central and peripheral nervous systems (commonly referred to as the cns and pns, respectively). the cns consists of the brain and spinal cord. the pns encompasses all nerves that branch from the cns to organs and muscles throughout the body. to better understand the pns, we further divide it into the autonomic and somatic nervous systems (ans and sns, respectively). some of our organs are "involuntary" or out of our conscious control. examples include our heart, kidneys, and digestive tract. these involuntary muscles and organs make up the ans. an easy way to remember this is that they are "automatic." other organs and muscles, however, are "voluntary" or largely within our control. these include the muscles in our legs or arms and make up the sns.
anatomy.json	knowledge	anatomy	ans overview	so…what is the ans? ans stands for the autonomic nervous system. the ans comprises the organs and muscles that are "automatic" or involuntarily controlled by our pns. what does the ans encompass? ans is responsible for involuntary functions like heart, digestive, and respiratory rates. it is broken down into two categories: the parasympathetic and sympathetic nervous systems. the parasympathetic nervous system is responsible for the relaxation or slowing of involuntary processes, such as slowing the heart rate when you sleep. the sympathetic nervous system is often called the "fight-or-flight" response and speeds up processes such as increasing the heart rate when you exercise or feel threatened.
anatomy.json	knowledge	anatomy	key terms	neuron - nerve cells that act as "messengers" by sending and receiving information throughout the body. axon - a long fiber that is an extension of the neuron. it is responsible for electrical impulses that leave the neuron. dendrites - branch-like structures that are part of the neuron. they receive information from other neurons. myelin sheath - a protective covering around the axon of each neuron. neurilemma - also known as schwann cells. these cells are responsible for the production of the myelin sheath. microglia - immune cells for the cns. they also help regulate inflammation. astrocytes - specialized glial cells that are the most abundant in the cns. schwann cells - main glial cells in the pns. neuroglia - provide support for neurons and can be found in the cns and pns.
anatomy.json	knowledge	anatomy	lessons and concepts	neurons are the foundational cells of the nervous system and are broken down based on their role and how they transmit information, i.e.: sensory or afferent neurons are found in the pns. they detect and relay information from both inside and outside the body to the cns. motor or efferent neurons are found in the cns. they send information from the cns to skeletal and smooth muscle cells. interneurons are found in the cns. they are the "go-between" for information relayed to and from sensory and motor neurons. they also play a role in coordination.
anatomy.json	knowledge	anatomy	sympathetic and sympathetic divisions of the ans	the sympathetic division is responsible for the "fight-or-flight" response. increases heart and respiratory rate and prepares muscles for activation. decreases digestion. norepinephrine is the primary neurotransmitter of the sympathetic nervous system. it is both a hormone and a neurotransmitter and helps to elevate both blood pressure and heart rate. the parasympathetic division is responsible for the "rest & digest" response. promotes digestion. decreases heart rate and allows for a restful state. acetylcholine (ach) is the neurotransmitter found at all parasympathetic innervated organs.
anatomy.json	knowledge	anatomy	effects of the ans on organs/organ systems	eyes: sympathetic response causes dilation of pupils to help with vision. parasympathetic response cause tear production, improves close vision, and constricts pupils. skin: sympathetic response causes an increase in sweating and vasoconstriction of the blood vessels.
anatomy.json	knowledge	anatomy	autonomic dysfunction or dysautonomia	dysautonomia or autonomic neuropathy is common though the severity and onset can vary from person to person. men and women are equally affected, and symptoms may be present at birth or develop later in life. primary dysautonomia occurs when autonomic dysfunction is the main disease process. secondary dysautonomia occurs when autonomic dysfunction results from another disease process, such as diabetes.
anatomy.json	knowledge	anatomy	treatment and management of dysautonomia	prioritize needs. patients experiencing dizziness or hypotension may be at greater risk for falling when standing and, therefore, may require additional resources to move/transport. initial actions: assess and manage airway, breathing, and circulation as needed.
anatomy.json	knowledge	anatomy	scenario	dispatch info - you are dispatched to the local movie theater for a 28-year-old pregnant female who had a syncopal episode. scene info - when you arrive, her friends wave you into a theatre and tell you that after the movie, your patient passed out almost immediately upon standing up to exit.
anatomy.json	knowledge	anatomy	key takeaways	the initial presentation of the patient was that she was stable and in no acute distress. event and patient history, specifically her pregnancy are vital to painting the complete picture of what is possibly going on with this patient.

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how does the urinary system regulate arterial blood pressure?

urine formation renin-angiotensin system

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cns

central nervous system - responsible for thought, feeling, perception, and autonomic body functions

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pns

peripheral nervous system - responsible for transmitting information from brain to body and from body to brain

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occipital lobe of brain function

vision, and visual memory storage

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parietal lobe of brain function

storage of tactile memories, sense of touch and texture

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temporal lobe of brain function

hearing and smell language center storage of sound and odor memories

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frontal lobe - motor cortex function

voluntary muscle control storage of spatial memories

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frontal lobe - prefrontal cortex function

site of abstract intellectual functions judgement and prediction of consequences

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limbic system function

basic emotions basic reflexes

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thalamus (within the diencephalon) function

relay center for sensory and motor signals, allowing prioritization of important messages

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hypothalamus (within the diencephalon) function

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introduction

the human nervous system is broken up into the peripheral nervous system and the central nervous system. the brain, along with the spinal cord, is part of the central nervous system. there are two types of cells in the brain, nerve cells, and glial cells. nerve cells send and receive messages via nerve pathways and glial cells help provide the brain with nutrition and support.

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anatomy and physiology review

the skull protects the brain matter. the skull is made up of the cranium and the bones of the face. between the skull and the brain there are three layers of tissue. starting with the layer furthest from the brain they are the dura mater, the arachnoid mater, and the pia mater. the space between the dura mater and the arachnoid mater is called the subdural space and the space between the arachnoid mater and the pia mater is called the subarachnoid space. starting from the bottom of the brain, the spinal cord leads to the brainstem. the brainstem is made of the midbrain, pons, and medulla oblongata. the brainstem relays messages from the body to the brain and has an influence on breathing, blood pressure, and alertness. towards the back of the head is the cerebellum, a region controlling fine motor skills. above the cerebellum is the occipital lobe, which helps process visual information. the parietal lobes help receive information from all other regions of the brain, order it, and also develop memory. bordering the parietal lobes are the temporal lobes, which help recognize objects, faces, and language.

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recognition

though there are entire courses on the brain and brain anatomy, not all of that information is needed for ems professionals. when there is an issue with the brain, it generally presents as altered mental status (ams). sometimes the reason for the ams is obvious such as the patient was hit in the head with a baseball bat. sometimes it is more of a mystery to solve and working through a process can help identify the root cause of the altered mentation. frequently, the pneumonic aeiou-tips is used in the prehospital setting. a: alcoholism or acidosis e: environmental exposure, epilepsy, electrolytes, encephalopathy, endocrine disease i: infection o: oxygen deficiency, overdose u: underdose, uremia t: trauma i: insulin, intestinal p: psychogenic, poisons s: stroke, shock

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aeiou-tips pneumonic

a: alcoholism or acidosis e: environmental exposure, epilepsy, electrolytes, encephalopathy, endocrine disease i: infection o: oxygen deficiency, overdose u: underdose, uremia t: trauma i: insulin, intestinal p: psychogenic, poisons s: stroke, shock

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another pneumonic

oxygen: check oxygen saturation glucose: check blood sugar pump: check heart rhythm, rate, and 12 lead ecg s: structural such as stroke or trauma i: infection such as sepsis t: toxin such as drug overdose s: social or psych after all other causes have been thoroughly vetted

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treatment

treatment for ams starts with identifying the cause of the altered state of the patient. from that point on treatment can go from oxygen therapy to iv dextrose to rapid sequence intubation.

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scenario

you are called to a public park where there is a young man unconscious on the ground. he appears to be in his mid-twenties and there are two empty beer cans lying next to him. the scene is safe and controlled. what do you do first? after bsi and scene safety, a primary survey should be conducted. the patient is found to have a patent airway, be taking irregular breaths, and a slow, bounding radial pulse. the patient is responsive to pain. a: alcoholism or acidosis? there is some obvious alcohol use but two cans should not put a patient in this state. no obvious signs of acidosis e: environmental exposure, epilepsy, electrolytes, encephalopathy, endocrine disease? the patient is warm to the touch with no signs of hypo or hyperthermia. the patient has no bit tongue, no fistula, and no signs of hyperkalemia on the cardiac monitor as well. no obvious signs of encephalopathy or endocrine disease. i: infection? no infection site seen. o: oxygen deficiency, overdose? no track marks or drug paraphernalia found, oxygen saturation reads 99% room air. u: underdose, uremia? no pill bottles or prescriptions with patient, no signs of chf or other cause of uremia t: trauma? a full physical assessment reveals a closed skull fracture with indentation at the rear of the skull. this patient now has a suspected cause of the altered mentation. i: insulin, intestinal? capillary blood glucose is normal p: psychogenic, poisons? no sign of any toxin or foul play s: stroke, shock? the patient is inconclusive on the stroke scale but now has injury and mentation indication brain injury. due to the closed skull fracture, the patient should be transported to the largest trauma center available to transport to. obtain iv access. aggressive airway management should occur as the patient does not have the ability to protect their airway. once the patient is intubated, mild hyperventilation should take place to lower the etco2 to help lower icp and secondary brain injury from the pressure of an inflamed brain. focus on having a short scene time and rapid transport code 3 as definitive care for this patient is surgery or specialized care at a trauma center.

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final thoughts

use family and friends as a resource for patients who are exhibiting ams. they can be a wealth of knowledge for when the change in a patient occurred and/or the events going on when the patient's mentation changed. they can also answer questions like has this ever happened before? using these resources are key because once the patient is in the ambulance and you drive away you have no accurate reporter to provide additional information on the patient.

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introduction

the nervous system is one of the most complex systems in the body. it is responsible for our ability to interpret both internal needs and environmental stimuli. due to the complexity of the nervous system, it is subdivided to understand its various responsibilities better. the first two divisions are the central and peripheral nervous systems (commonly referred to as the cns and pns, respectively). the cns consists of the brain and spinal cord. the pns encompasses all nerves that branch from the cns to organs and muscles throughout the body. to better understand the pns, we further divide it into the autonomic and somatic nervous systems (ans and sns, respectively). some of our organs are "involuntary" or out of our conscious control. examples include our heart, kidneys, and digestive tract. these involuntary muscles and organs make up the ans. an easy way to remember this is that they are "automatic." other organs and muscles, however, are "voluntary" or largely within our control. these include the muscles in our legs or arms and make up the sns.

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ans overview

so…what is the ans? ans stands for the autonomic nervous system. the ans comprises the organs and muscles that are "automatic" or involuntarily controlled by our pns. what does the ans encompass? ans is responsible for involuntary functions like heart, digestive, and respiratory rates. it is broken down into two categories: the parasympathetic and sympathetic nervous systems. the parasympathetic nervous system is responsible for the relaxation or slowing of involuntary processes, such as slowing the heart rate when you sleep. the sympathetic nervous system is often called the "fight-or-flight" response and speeds up processes such as increasing the heart rate when you exercise or feel threatened.

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key terms

neuron - nerve cells that act as "messengers" by sending and receiving information throughout the body. axon - a long fiber that is an extension of the neuron. it is responsible for electrical impulses that leave the neuron. dendrites - branch-like structures that are part of the neuron. they receive information from other neurons. myelin sheath - a protective covering around the axon of each neuron. neurilemma - also known as schwann cells. these cells are responsible for the production of the myelin sheath. microglia - immune cells for the cns. they also help regulate inflammation. astrocytes - specialized glial cells that are the most abundant in the cns. schwann cells - main glial cells in the pns. neuroglia - provide support for neurons and can be found in the cns and pns.

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lessons and concepts

neurons are the foundational cells of the nervous system and are broken down based on their role and how they transmit information, i.e.: sensory or afferent neurons are found in the pns. they detect and relay information from both inside and outside the body to the cns. motor or efferent neurons are found in the cns. they send information from the cns to skeletal and smooth muscle cells. interneurons are found in the cns. they are the "go-between" for information relayed to and from sensory and motor neurons. they also play a role in coordination. nerves are found in the pns, and nerve tracts are found in the cns. sensory nerves enable us to sense the world through sight, taste, sound, touch, and smell. motor nerves relay signals from the cns to the muscles in the body to prompt movement. mixed nerves or interneurons send both sensory and motor signals.

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sympathetic and sympathetic divisions of the ans

the sympathetic division is responsible for the "fight-or-flight" response. increases heart and respiratory rate and prepares muscles for activation. decreases digestion. norepinephrine is the primary neurotransmitter of the sympathetic nervous system. it is both a hormone and a neurotransmitter and helps to elevate both blood pressure and heart rate. the parasympathetic division is responsible for the "rest & digest" response. promotes digestion. decreases heart rate and allows for a restful state. acetylcholine (ach) is the neurotransmitter found at all parasympathetic innervated organs.

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effects of the ans on organs/organ systems

eyes: sympathetic response causes dilation of pupils to help with vision. parasympathetic response cause tear production, improves close vision, and constricts pupils. skin: sympathetic response causes an increase in sweating and vasoconstriction of the blood vessels. cardiovascular system: medulla helps regulate arterial pressure through sympathetic and parasympathetic nerves. baroreceptors are part of a negative feedback system that helps regulate arterial pressure.

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autonomic dysfunction or dysautonomia

dysautonomia or autonomic neuropathy is common though the severity and onset can vary from person to person. men and women are equally affected, and symptoms may be present at birth or develop later in life. primary dysautonomia occurs when autonomic dysfunction is the main disease process. secondary dysautonomia occurs when autonomic dysfunction results from another disease process, such as diabetes. idiopathic dysautonomia occurs when there is no known disease process.

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treatment and management of dysautonomia

prioritize needs. patients experiencing dizziness or hypotension may be at greater risk for falling when standing and, therefore, may require additional resources to move/transport. initial actions: assess and manage airway, breathing, and circulation as needed. based on patient presentation, als may be necessary, so calling early is a high priority if als is not already available.

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the peripheral nervous system

to have an even better understanding of the pns, we can break it down even further. we know that some of our organs are "involuntary" or out of our conscious control. examples include our heart, kidneys, and digestive tract. these involuntary muscles and organs are innervated by the autonomic nervous system or ans. an easy way to remember this is that they are "automatic". other organs and muscles, however, are "voluntary" or within our control. these include the muscles in our legs and arms and make up the somatic nervous system or sns.

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the autonomic nervous system

the ans can again be divided into two more categories: the parasympathetic (pans) and sympathetic (sans) nervous systems.

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what is the ans?

ans stands for the autonomic nervous system. the ans makes up the organs and muscles that are "automatic" or involuntarily controlled by our pns

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what does the ans encompass?

the ans is responsible for involuntary functions, including heart rate, digestive function, and respiratory rate. it is broken down into two categories: the parasympathetic and sympathetic nervous systems

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the parasympathetic nervous system

the parasympathetic nervous system is responsible for the relaxation - or slowing - of these involuntary processes

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the sympathetic nervous system

the sympathetic nervous system is responsible for the "fight-or-flight" response, meaning it "speeds up" many involuntary processes

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neuroglial cells

there are four types of neuroglial cells: astrocytes, ependymal cells, microglial cells, and oligodendrocytes

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nerve impulses

nerve impulses are electrical signals that tell neurons to react to a stimulus. for example, you naturally withdraw from painful stimuli

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membrane potential

membrane potential is the difference between the electrical charge on the inside versus the outside of the cell

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depolarization

depolarization (first half of action potential) occurs when potassium leaves the cell, and sodium and calcium enter the cell.

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repolarization

repolarization (second half of action potential) occurs when sodium and calcium leave the cell and potassium enters the cell.

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impulse transmission

impulse transmission occurs in two different ways depending on how fast or slow the messages need to be sent and received

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distribution pattern of spinal nerves

sensory pathways. the posterior column pathway - also called the dorsal columns medial lemniscus pathway, is responsible for touch and pain sensations; it also allows for the conscious sensation of where the body is in space

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motor pathways

pyramidal system - travel through pyramids of the medulla, responsible for the voluntary control of muscles

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sympathetic division of the autonomic nervous system

"fight-or-flight" increases heart rate and respiratory rate and prepares muscles for activation

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parasympathetic division of the autonomic nervous system

"rest & digest" promotes digestion. decreases heart rate and allows for a restful state

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effects of the sympathetic and parasympathetic divisions of the ans

eyes. the sympathetic response causes dilation of pupils to help with vision. the parasympathetic response cause tear production, improves close vision, and constrict pupils

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autonomic dysfunction aka dysautonomia

damage to nerves of the ans may result in malfunction in the pans, sans, or both

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symptoms

bladder control and sensation issues. frequent urination or incontinence. difficulty regulating temperature, heart rate, and blood pressure

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treatment and management

prioritized needs: patients who are experiencing dizziness or hypotension may be at greater risk of falling when standing; therefore, you may need additional resources to help when moving the patient

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scenario

dispatch info: you are dispatched to the local high school for a 16-year-old female who had a syncopal episode.

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key takeaways

the initial presentation of the patient was stable, with no indications of acute distress. the patient's recent history during volleyball practice and the events surrounding her syncopal episode prompted ems involvement.

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tips and tricks

body functions that take place without any thought are "automatic" and therefore controlled by your autonomic nervous system

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the autonomic nervous system (ans)

to have an even better understanding of the pns, we can break it down even further. we know that some of our organs are "involuntary" or out of our conscious control. examples include our heart, kidneys, and digestive tract. these involuntary muscles and organs are innervated by the autonomic nervous system or ans. an easy way to remember this is that they are "automatic." other organs and muscles, however, are "voluntary" or within our control. these include the muscles in our legs and arms and make up the somatic nervous system or sns.

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the ans and its categories

the ans can again be divided into two more categories: the parasympathetic (pans) and sympathetic (sans) nervous systems.

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types of neuroglial cells

there are four types of neuroglial cells: astrocytes, ependymal cells, microglial cells, and oligodendrocytes microglia - immune cells for the cns. they target invaders and remove debris within the cns astrocytes - specialized glial cells that are the most abundant in the cns ependymal cells - secrete cerebrospinal fluid (csf) and encapsulate critical neural tissue oligodendrocytes - insulation of axons within cns

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neurons

neurons, the foundational cells of the nervous system, are broken down based on their role within the nervous system and how they transmit information. for example: sensory neurons, also known as afferent neurons, are found in the pns and respond to sensory information inside and outside the body. they are responsible for relaying that information to the cns think "arrive" at the cns motor neurons, also known as efferent neurons, are found in the cns and send information from the brain and spinal cord to skeletal and smooth muscle cells think "exit" from the cns interneurons are found in the cns, the "go-between" for information that is relayed to and from sensory and motor neurons, and play a role in coordination

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nerves

nerves are groupings of neurons that direct a signal to a target location sensory nerves are responsible for your ability to sense the world around you through sight, taste, sound, touch, and smell motor nerves send signals from the cns to the muscles in the body to prompt movement mixed nerves can send both sensory and motor signals. an example is the facial nerve. the facial nerve controls facial movement (motor) and taste (sensory)

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nerve tracts

nerve tracts are found in the cns, more specifically in the white matter of the brain, which is located deep to the grey matter and also makes up most of the brain tissue nerve tracts are classified into three categories based on what they connect commissural fibers connect the right and left hemispheres of the brain association fibers connect brain regions that are within the same hemisphere projection fibers connect the brain stem and spine to the cerebral cortex. these fibers are responsible for "projecting" motor and sensory signals between the cns and pns

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action potential

depolarization (first half of action potential) occurs when potassium leaves the cell, and sodium and calcium enter the cell. this action potential causes normal body functions to occur, such as a heartbeat repolarization (second half of action potential) occurs when sodium and calcium leave the cell and potassium enters the cell. this is also known as resting potential. this explains the pause between heartbeats

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effects of the sympathetic and parasympathetic divisions of the ans on various organs and systems of the body

eyes the sympathetic response causes dilation of pupils to help with vision the parasympathetic response cause tear production, improves close vision, and constrict pupils skin the sympathetic response causes an increase in sweating and vasoconstriction of the blood vessels

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cardiovascular system

the medulla helps regulate arterial pressure through sympathetic and parasympathetic nerves baroreceptors are part of a negative feedback system that helps regulate arterial pressure. there are two sites for arterial baroreceptors carotid sinus is located at the bifurcation of the external and internal carotids. small changes in mean arterial pressure (map) will activate these receptors to adjust back to normal by either increasing or decreasing map

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symptoms of dysautonomia

bladder control and sensation issues frequent urination or incontinence difficulty regulating temperature, heart rate, and blood pressure orthostatic hypotension syncope fatigue vertigo forgetfulness increase or lack of sweating chest pain shortness of breath migraines with possible noise and light sensitivity cardiac rhythm disturbances digestion issues nausea/vomiting hypoglycemia constipation sexual dysfunction erectile dysfunction increased vaginal dryness or pain during intercourse decrease in, or loss of, libido changes in vision blurriness

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ongoing treatment/treatment goals

iv/io access may be necessary for administering medications to help with blood pressure or heart rate continual cardiac monitoring (4 or 12-lead) etco2 and/or spo2 monitoring maintain/improve vital signs to within normal limits

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transport considerations

consider facilities with cardiac and stroke capabilities when patients present with acute cardiac disturbances or neurological deficits patients with difficult airways may require transport to the closest facility

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introduction

a&p of the upper and lower airway

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anatomy of the upper airway

the upper airway serves as a passageway for food, liquids, and air. it also heats, humidifies, and filters the air. the upper airway provides a path for coughing, swallowing, and speech.

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structures of the upper airway

pharynx: refers to the mouth, nasal cavity, and portion of the upper airway which all connect and lead to the esophagus and trachea. oropharynx: mouth and throat. nasopharynx: nasal cavity leading to throat. laryngopharynx: found beneath the hyoid bone, branching area where food and air pass to either the esophagus or the trachea. larynx: vocal cords or the structure marking the split between the upper and lower airway. allows for the passage of air into and out of the lungs. protects the lungs from aspiration and is involved in the production of speech. esophagus: muscular tube connecting the mouth and throat to the stomach allowing for passage of food and liquids.

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common airway terms

epiglottic vallecula: depression at the root of the tongue between tongue and epiglottis. traps food, liquids, and saliva to prevent the swallowing reflex. epiglottis: flap of elastic cartilage connected at the root of the tongue. responsible for opening and closing the entrance to the windpipe as a means to prevent aspiration. vocal cords (also known as larynx): the vocal cords are a key component in one's ability to speak, however, they are also crucial in protecting the lower airway from aspiration.

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movement of air

air passes from the upper airway and into the lower airway. it is then directed into one of two main airways, the right and left main bronchi. next, it will move into smaller passages called bronchioles, and finally into the terminal ends of the airway. the lower airway terminates in extremely small sacks where gas exchange occurs, called alveoli.

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gas exchange

gas exchange occurs by diffusion, which is molecules moving from high concentrations to low concentrations. for example, when blood reaches the pulmonary capillaries, it contains minimal amounts of oxygen and high amounts of carbon dioxide. the alveoli contain high amounts of oxygen and minimal amounts of carbon dioxide.

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lower airway structures

trachea: wind-pipe or a cartilaginous structure leading from the larynx down to the carina where it further splits into the lungs. carina: cartilaginous structure between the trachea and primary bronchi, produces a branching area separating the left and right lung. bronchus: larger airways composed primarily of cartilage leading from the trachea. these structures continue deeper into the lungs and branch into different pathways including the primary, secondary and tertiary bronchi. bronchioles: smaller, muscular structures found deep in the lungs between the bronchi and alveoli. alveoli: tiny air-sacs composed of single-layered tissue where gas exchange occurs between the lungs and the pulmonary capillaries.

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physiology

remember that the main goal of the respiratory system is gas exchange. a disruption in either the movement of air (ventilation) or gas exchange (respiration) will result in poor or inadequate perfusion. perfusion refers to an adequate volume of oxygen in the bloodstream and the ability of that oxygen to reach vital tissues.

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common physiology terms

ventilation: process of moving air in and out of the lungs. respiration: process of gas exchange across the alveoli. tidal volume: amount of airway moved in or out of the lungs in one breath, or with each respiratory cycle (inhalation or exhalation). respiratory rate: count of breaths taken per minute. perfusion: passage of blood and all of its contents through organs, tissues, and the vascular system. hypoxia: inadequate amounts of oxygen reaching tissues. hypoxemia: inadequate amounts of oxygen within the bloodstream, primarily referring to amounts within the arteries.

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introduction

anatomy and physiology overview of the cranial nerves. the human brain has 12 cranial nerves. there are three general types of cranial nerves, afferent nerves, efferent nerves, and mixed nerves. afferent nerves receive sensory input from the body and move it to the central nervous system (cns) and brain. efferent nerves pass impulses from the brain and cns to the motor system and control movement, specifically of the face.

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cranial nerves

i: olfactory nerve. (sensory) receives sensory input from the molecules in the nose and sends neural messaging back to the olfactory bulb. ii: optic nerve. (sensory) receives sensory input from eyes via nerves that meet at the optic chasm. input is sent back to the opposite side of the brain from the eye the sensory input comes from. iii: oculomotor nerve. (motor) controls motor function of eyes. also controls pupillary response as they respond to light. iv: trochlear nerve (motor) controls the oblique muscles. these muscles control outward, inward, and downward eye movements. v: trigeminal nerve (both) the largest cranial nerve. the trigeminal nerve is divided into 3 separate divisions, the maxillary (which sends sensory information from the middle of the head), the ophthalmic division (which sends sensory information from the scalp, forehead, and upper eyelids), and the mandibular division (which sends both sensory and motor information from the jaw, chin, lower lip, and tongue). vi: abducens nerve (motor) controls outwards eye motor movements. vii: facial nerve (both) transmits sensory input from the taste buds as well as controlling muscle function for tear production and saliva production. viii: vestibulocochlear nerve (sensory) consists of two divisions, the vestibular division, and the cochlear division. the vestibular division collects sensory input on balance and orientation. the cochlear branch receives sensory input from the inner ear regarding sound and pitch. ix: glossopharyngeal nerve (both) a sensory and motor nerve that carries nerve impulses for swallowing and the gag reflex. x: vagus nerve (both) the longest cranial nerve, divided into the left and right vagus nerves. a large focus of the parasympathetic response within the body involving the heart, lungs, and digestive system. xi: spinal accessory nerve (motor) a motor nerve that is associated with movement of the head, neck, and shoulders. xii: hypoglossal nerve (motor) a motor nerve that controls the movement of the tongue.

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prehospital assessment and treatment

in patients with suspected cranial nerve damage or head injury, a prehospital crania nerve assessment can be very useful for helping make a clinical impression of the injury and track changes in the patient's neurologic deficits. the cranial nerve assessment is less useful for massive head trauma or an obvious stroke with a large vessel occlusion. in those patients, it is not a hard assessment to determine that there is an injury to the brain. the cranial nerve assessment is really useful for in-between situations. a minor fall, a roll-out of bed, a patient that seems ok but just a little off. the cranial nerve assessment allows you to gather more information to help have a better guess at the severity of the injury to the patient. the pneumonic peee ffutss can be used for a complete cranial nerve assessment.

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cranial nerve assessment

pupils: use penlight to confirm pupillary response. eyes: test eye motion to all fields of direction. eyelids: have the patient close their eyes and try to keep them closed. using your fingers lightly, try to push the eyelids up so the eyes are open. they should not be able to open their eyes. ears: compare hearing in each ear and ask about ringing or other noises. facial sensation and mastication: hold the sides of the patient's mandibles and ask them to pretend like they are chewing. observe for equal strength. have the patient close their eyes and touch different parts of the face to test sensation. facial movement: have the patient smile and observe for symmetry. uvula: ask the patient to open their mouth and say 'ahhhhhh.' observe uvula to not have any traumatic damage and to be midline. tongue: ask the patient to stick out their tongue. the tongue should stick out normal. swallow: ask the patient to swallow and observe for any abnormalities. shrug: resting your hands on the patient's shoulders, have them shrug. their strength should be equal.

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scenario

you are dispatched to some sort of accident on the road. when you arrive, it looks like an electric scooter had hit a pothole at around 20 mph and the rider is sitting on the curb. there is a helmet sitting next to the rider with a solid dent in it. when making patient contact, the patient is a/o x4, gcs 15, but very slow to answer questions. the patient states they don't need to go to the hospital. you are not comfortable letting the patent sign a refusal also you ask if they will let you conduct a cranial nerve exam. the cranial exam conducted shows deficits within their shrug, eye movement, and eyelid strength. you decide to call online medical control to convince the patient to go to the hospital and they are successful. you conduct serial cranial nerve assessments throughout the transport and pick up on progressing neurological symptoms. this allows you to anticipate the need for advanced airway interventions before the patient crashes, even though the patient still has the same gcs score.

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anatomy

final thoughts

the brain is the most important part of the body and also one that is so protected it can be hard to assess. due to this, conducting cranial nerve assessments can be an extremely valuable resource to assess brain injury, but also track changes in condition of patients with a brain injury. consistent assessments of the cranial nerves throughout time of patient care can help paramedics and emts anticipate changes in the patient condition before they occur.

anatomy.json

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anatomy

introduction

the nervous system is one of the most complex systems in the body. it is responsible for our ability to interpret both internal needs and environmental stimuli. due to the complexity of the nervous system, it is subdivided to understand its various responsibilities better. the first two divisions are the central and peripheral nervous systems (commonly referred to as the cns and pns, respectively). the cns consists of the brain and spinal cord. the pns encompasses all nerves that branch from the cns to organs and muscles throughout the body. to better understand the pns, we further divide it into the autonomic and somatic nervous systems (ans and sns, respectively). some of our organs are "involuntary" or out of our conscious control. examples include our heart, kidneys, and digestive tract. these involuntary muscles and organs make up the ans. an easy way to remember this is that they are "automatic." other organs and muscles, however, are "voluntary" or largely within our control. these include the muscles in our legs or arms and make up the sns.

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anatomy

ans overview

so…what is the ans? ans stands for the autonomic nervous system. the ans comprises the organs and muscles that are "automatic" or involuntarily controlled by our pns. what does the ans encompass? ans is responsible for involuntary functions like heart, digestive, and respiratory rates. it is broken down into two categories: the parasympathetic and sympathetic nervous systems. the parasympathetic nervous system is responsible for the relaxation or slowing of involuntary processes, such as slowing the heart rate when you sleep. the sympathetic nervous system is often called the "fight-or-flight" response and speeds up processes such as increasing the heart rate when you exercise or feel threatened.

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anatomy

key terms

neuron - nerve cells that act as "messengers" by sending and receiving information throughout the body. axon - a long fiber that is an extension of the neuron. it is responsible for electrical impulses that leave the neuron. dendrites - branch-like structures that are part of the neuron. they receive information from other neurons. myelin sheath - a protective covering around the axon of each neuron. neurilemma - also known as schwann cells. these cells are responsible for the production of the myelin sheath. microglia - immune cells for the cns. they also help regulate inflammation. astrocytes - specialized glial cells that are the most abundant in the cns. schwann cells - main glial cells in the pns. neuroglia - provide support for neurons and can be found in the cns and pns.

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anatomy

lessons and concepts

neurons are the foundational cells of the nervous system and are broken down based on their role and how they transmit information, i.e.: sensory or afferent neurons are found in the pns. they detect and relay information from both inside and outside the body to the cns. motor or efferent neurons are found in the cns. they send information from the cns to skeletal and smooth muscle cells. interneurons are found in the cns. they are the "go-between" for information relayed to and from sensory and motor neurons. they also play a role in coordination.

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anatomy

sympathetic and sympathetic divisions of the ans

the sympathetic division is responsible for the "fight-or-flight" response. increases heart and respiratory rate and prepares muscles for activation. decreases digestion. norepinephrine is the primary neurotransmitter of the sympathetic nervous system. it is both a hormone and a neurotransmitter and helps to elevate both blood pressure and heart rate. the parasympathetic division is responsible for the "rest & digest" response. promotes digestion. decreases heart rate and allows for a restful state. acetylcholine (ach) is the neurotransmitter found at all parasympathetic innervated organs.

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anatomy

effects of the ans on organs/organ systems

eyes: sympathetic response causes dilation of pupils to help with vision. parasympathetic response cause tear production, improves close vision, and constricts pupils. skin: sympathetic response causes an increase in sweating and vasoconstriction of the blood vessels.

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anatomy

autonomic dysfunction or dysautonomia

dysautonomia or autonomic neuropathy is common though the severity and onset can vary from person to person. men and women are equally affected, and symptoms may be present at birth or develop later in life. primary dysautonomia occurs when autonomic dysfunction is the main disease process. secondary dysautonomia occurs when autonomic dysfunction results from another disease process, such as diabetes.

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anatomy

treatment and management of dysautonomia

prioritize needs. patients experiencing dizziness or hypotension may be at greater risk for falling when standing and, therefore, may require additional resources to move/transport. initial actions: assess and manage airway, breathing, and circulation as needed.

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anatomy

scenario

dispatch info - you are dispatched to the local movie theater for a 28-year-old pregnant female who had a syncopal episode. scene info - when you arrive, her friends wave you into a theatre and tell you that after the movie, your patient passed out almost immediately upon standing up to exit.

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key takeaways

the initial presentation of the patient was that she was stable and in no acute distress. event and patient history, specifically her pregnancy are vital to painting the complete picture of what is possibly going on with this patient.