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Remember: increased ICP has symptoms opposite of shock

Increase in blood pressure

In a non-displaced fracture, the bone cracks with the broken pieces still in alignment. The injury is not visible from the outside, but shows up as a line or crack on a x-ray.

In a displaced fracture, the bone breaks in two or more pieces that have moved out of alignment. The distortion is visible from the outside and the break often causes severe pain.

An open fracture [often called a compound fracture] is one in which the bone breaks through the skin; it may then recede back into the wound and not be visible through the skin. There is a risk for deep bone infection here.

A closed fracture is when the bone breaks but there is no puncture or open wound in the skin.

Did your heart just skip a beat? Then you must love this heart anatomy print. This Valentines day print is a great gift for any one that you love who loves human anatomy!

12 lead chart, know what you’re looking at.

Capnography

Capnography

Capnography (end-tidal CO2 monitoring) is a non-invasive measurement of carbon dioxide…

Dr. Jeffrey M. Goodloe delivered a very informative speech on the basic uses of capnography and made his case that it shouldn’t be a purely paramedic skill set. The information was very concise and delivered a few distinct key points that I am going to try to convey to you all.

The cardiac cycle is a term referring to all or any of the events related to the flow or blood pressure that occurs from the beginning of one heartbeat to the beginning of the next. The frequency of the cardiac cycle is described by the heart rate. Each beat of the heart involves five major stages. The first two stages, often considered together as the ventricular filling stage, involve the movement of blood from atria into ventricles. The next three stages involve the movement of blood from the ventricles to the pulmonary artery (in the case of the right ventricle) and the aorta (in the case of the left ventricle).

DRUGS…So, how do they work?

The rate at which a drug can exert effects on the body depends on the method of drug delivery.

In terms of the speed of delivery and onset of drug action, intravenous injections are faster than intramuscluar injections, while both methods are faster than oral absorption.

Each delivery method has its advantages and disadvantages and one must consider the type of drug, the target tissue, and the best means to minimize side effects when choosing a means of drug delivery.

Pyschoactive drugs act on the central nervous system (CNS) to alter mood or behavior. In order to affect the CNS, the drugs must cross the tight junctions governing the blood brain barrier as well as the fatty glial sheath.

Therefore, such drug molecules are small and lipid soluble. Often these drugs have unintended interactions with blood proteins, causing them to stay within the blood vessel instead of interacting with their target site. In the blood vessels permeating the majority of the body (the blood brain barrier tight junctions being an exception), there is frequent diffusion through capillary beds, as the pores lining the capillaries are 9-15 nm across, which is larger than most drug molecules.

Elimination of drugs occurs by four different mechanisms:

1- The kidneys

2- The lungs

3- Bile

4-Skin/sweat

The kidneys alone cannot eliminate psychoactive drug products because the high amount of water reabsorbed by the body (the kidneys normal function) causes the drug metabolites to concentrate within the kidneys before re-entering the blood.

The lungs do not contribute much to drug elimination, though for volatile substances like alcohol, it is easier to observe…or should I say, sniff.

Bile does not truly eliminate drugs so much as reabsorb them via the small intestine.

Skin and sweat account for 10-15% of drug elimination and are also highly ineffective at getting rid of active drug metabolites.

Thus, the real hero of the story is…THE LIVER

The liver does an amazing job at biotransformation, turning highly active, small, lipid soluble psychoactive drug metabolites into bulky, water soluble metabolites that the kidney can more easily excrete. The majority of this fantastic enzymatic activity is due to our friend the cytochrome P 450 family.

So thank your liver and go easy on it next weekend, eh?

Sources:

A primer of drug action, Robert M. Julien, M.D., Ph.D

What is an EKG?

An electrocardiogram (EKG or ECG) is a test that checks for problems with the electrical activity of your heart. An EKG translates the heart’s electrical activity into line tracings on paper. The spikes and dips in the line tracings are called waves. See a picture of the EKG components and intervals .

The heart is a muscular pump made up of four chambers . The two upper chambers are called atria, and the two lower chambers are called ventricles. A natural electrical system causes the heart muscle to contract and pump blood through the heart to the lungs and the rest of the body. See a picture of the heart and its electrical system.

An electrocardiogram (EKG or ECG) is done to:

Check the heart’s electrical activity.

Find the cause of unexplained chest pain, which could be caused by a heart attack, inflammation of the sac surrounding the heart (pericarditis), or angina.

Find the cause of symptoms of heart disease, such as shortness of breath,dizziness, fainting, or rapid, irregular heartbeats (palpitations).

Find out if the walls of the heart chambers are too thick (hypertrophied).

Check how well medicines are working and whether they are causing side effects that affect the heart.

Check how well mechanical devices that are implanted in the heart, such aspacemakers, are working to control a normal heartbeat.

Check the health of the heart when other diseases or conditions are present, such as high blood pressure, high cholesterol, cigarette smoking, diabetes, or a family history of early heart disease.

source

How To Read An EKG

An EKG is a graph (thusly named an electrocardiograph) tracing the strength and direction of this electrical signal. Leads equipped with conductive goo are placed on different parts of the body allowing a view of the heart from different angles.   If the electrical activity of the heart at any given moment is traveling toward the lead being viewed, the line on the graph goes up (positive deflection).  If the electrical activity is traveling away from the lead, the line goes down (negative deflection). This graph is being traced by a stylus on a moving piece of graph paper.  In a normal healthy heart, an EKG representing one complete heartbeat looks about like the second photo:

 That first petite little hump, affectionately called the P wave, represents the electrical signal that starts in a group of cells called the Sinoatrial Node. This signal then travels through the atria (the smaller and upper two chambers of the heart) causing them to contract and push blood in to the larger and more powerful ventricles below.

The “PR Interval” segment represents a delay in the signal at another grouping of cells called the AtrioVentricular Node.  This delay allows time for the atria to completely deliver their bounty into the Ventricles. With perfect timing this signal continues through the Bundle of His.  The signal splits and speeds along down the left and right bundle branches, making its way to the Purkinje fibers and turning north again. This stimulates those Ventricular beefcakes to contract and deliver their payload to the lungs and body (if hearts had biceps, the left ventricle would be the proverbial “gun show”….it’s such a glory hog!).

The journey causing this second contraction through the ventricles is represented by the QRS portion of the EKG. The larger T wave which then finishes off our heartbeat is the repolarization of the ventricles.  I know what you’re thinking, either “what in the what now goes where?” or hopefully, “what wave represents the repolarization of the atria”?  Well, the repolarization of the atria is buried in the larger signal of the QRS and therefore not visible on the graph.

This pattern is called normal sinus rhythm.  It is the basic EKG of any normal healthy heart.  Naturally, there are variations of normal within the healthy population. For example, my boyfriend is very fit and has a *huge* R wave (hands off his big left ventricle ladies, it’s all mine!  And don’t get me started on his early repolarization…and no…being early in this case is definitely not a bad thing).

12 Lead EKG recognition. Taking a 12 lead EKG course, and I’m learning so much about reading 12 lead EKGs. Love it. :)

Circumflex (Cx) - I, aVL - Reads lateral MI’s

Right Coronary Artery (RCA) - II, III, aVF - Reads inferior, post Left Vent MI’s.