The given scenario involves a patient that was brought to the Emergency Department and had two arrow wounds. The first arrow is on the left side and it entered anteriorly between the 7th and 8th ribs through a 15-degree angle and then protruded posteriorly. The second wound is located at the posterior of the cervical angle. The provided case scenario provides a way to critically analyze the different parts of the patient that experienced the injury. The analysis of the different body parts and organs was done as shown in the questions below.
Question 1.
What serosal cavities have been penetrated by the first arrow? Explain the location, the microscopic cellular components of the serous membrane, and the purpose of the serous membrane.
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The serosal cavities which appear to have been penetrated by the first arrow are the left pleural cavity which is found on the thoracic cavity. The left pleural cavity within the thoracic cavity also contains the serous membranes. The serous membrane is a mesothelial tissue that lines the body’s internal cavities and thus forms a transparent and smooth two-layered membrane (Isaza-Restrepo et al., 2018). The membrane is lubricated by fluid that has been derived from serum. The serous membrane is thus surrounded by a thin layer of areolar connective tissue that is rich in lymphatic vessels and blood. One of the functions of the serous membrane is to protect the surrounding body organs. It also functions to decrease the friction between its surfaces. The mesothelium is also made of microscopic cells making it permeable for fluids to easily diffuse through it and thus maintains moisture and thus ensures homeostatic equilibrium (Kastelein et al., 2019). The transudate fluid is the fluid that keeps the serous membrane slippery and moist. For the given scenario, the arrow has penetrated the left pleural cavities and this can result in several complications since the volume of transudate could increase and this may result in several other complications. The arrow also threatens the left pleural space and could potentially cause the lung to collapse.
Question 2
Describe the Autonomic Nervous System and explain how the patient’s ANS reacts to the arrow attack and how it will affect the patient’s vital signs (P, BP, R, T).
The function of the autonomic nervous system is to regulate various physiological systems of the body such as the respiratory system, body temperature, digestive system, coordination of the cardiovascular system, and excretory system (Idiaquez, Benarroch, & Nogues, 2018). The ANS works in conjunction with the parasympathetic nervous system and the sympathetic nervous system to achieve its functions. For the given scenario, after the arrow attack, the body will have to react to the trauma and the sympathetic and parasympathetic sections will have to function simultaneous in order to adapt to the conditions and challenges. The reaction will be observed through changes in the vital signs. The heart rate or pulse (P) could speed up and be higher than usual in order to offset the loss of blood and trauma. The increased heart rate could function to increase the body temperature. The Blood Pressure (BP) could drop as a result of the internal bleeding and the symptoms of shock. The location of the arrow indicated that it moved upwards and downwards the pleural spaces and this could result in changes in the respiratory rate (R) with difficulty in breathing. The reduced breathing could reduce the body temperature since oxygen would not be transported to the core tissues. In the long-term, the effects of a high heart rate and a low blood pressure would result in a reduced tissue perfusion (Domizi et al., 2019). Blood would also splint to the major internal organs such as the brain, liver, spleen, and heart.
Question 3
Describe the trajectory of the first arrow using directional terms and anatomical planes. Identify and describe the organs and any other membranes that may have been affected by the first arrow.
From the given scenario, the trajectory that was taken by the first arrow is that it entered anteriorly between the 7th and 8th ribs with a 15-degree angle. The posture of the patient could be supine by lying down and facing upwards or in an anatomical position by standing up in a normal posture. The anterior ventral view would show the tip of the arrow stick out to laterally superior to the navel at the left. The arrowhead would be protruding posteriorly and should be seen superficially about 4 inches underneath the left areola and at an inferior angle to the scapula.
The first arrow would affect several organs with the main organ being affected is the lung. Other organs that would be of concern are the liver, heart, spleen, pleural space, and intestines. The direction of the arrow endangers the pleural space and it could introduce air to the pleural cavity causing pneumothorax and this could lead to the collapsing of the lungs (Ganaie et al., 2019). The membrane that could be affected are the serosal cavities that pass the serous membranes and this could affect the frictional movement between the lungs and heart. There could be muscles and blood vessels that were affected such as the serratus anterior, the rectus abdominis, and the diaphragm.
Question 4
Describe the cardiovascular system and explain how both the pulmonary and systemic circuits will be affected by both arrows. Include the effect on the Hematocrit and Hemoglobin values.
The cardiovascular system is highly affected by the autonomic nervous system. The autonomic nervous system works with the local regulatory mechanism and this regulates the force and the rate at which the heart contracts and thus the blood flow. The activation of the ANS can result in the heart rate speeding up and blood pressure dropping. The first arrow located on the left side of the lung would cause the right lung to work as hard in order to sustain the body. The pulmonary circuit and systemic circuits would be affected by the nervous system as there will be a consistent decrease in the blood that is taken in the lungs and that which is distributed in the entire body. This would cause the blood to be pumped faster and the rate of respiration would also be high. The second arrow is located at the posterior cervical triangle and the spinal accessory nerve and the subclavian artery and the external jugular vein located in the area would be impacted (Bonali et al., 2017). The overall effect of blood loss would mean that blood does not reach the necessary organs.
The arrow protruding the thoracic cavity would result in blood loss and this would result in changes in the hemoglobin and hematocrit levels. The levels of hemoglobin and hematocrit from both sites of the arrow would thus be impacted. The 2nd arrow could penetrate a critical vein or artery and this could cause a severe trauma leading to a significant reduction in the hemoglobin levels.
Question 5
Identify the possible neuromuscular effects of the second arrow and explain your reasoning. Describe the components of a neuromuscular junction including key organelles.
The neuromuscular effect of the second arrow is that he nerves and the blood vessels which supply the muscle fibers would be injured. The second arrow could possible pass several nerves and their plexus such as spinal accessory nerve, phrenic nerve, and cervical plexus. The posterior triangle muscle crosses above the clavicle and it could be affected. Damage to the cranial nerve could result in a loss of one’s ability to raise arms above head or shrug one’s shoulders. Damage could also be done to the cervical vertebrae and deep muscles of the neck and cause paralysis of the face and the neck. There could also be a loss in the functions of the arms, shoulder, and necks as a result of the damage.
The neuromuscular junction is made of neurons that come from the spinal cord and exit and they function to simulate the muscle contraction. Electrical signals passed from the brain to spinal cord travel through the axon then braches and connects to the specific muscle fibers at the neuromuscular junction (Jones et al., 2017). Every muscle fiber is supplied by a single motor neuron and thus any interruptions can make difficult in the movement of the muscles and thus body organs.
Question 6
Identify and describe the three labeled tissue types found in the tracheal slide (Slide 2) below. Include the subcategories and cellular components for each tissue type. How will the injuries affect this area?
The different types of tissues were identified as (1) Hyaline Cartilage, (2) Ciliated pseudostratified epithelium, and (3) smooth muscle. The different tissues were identified as follows.
Hyaline Cartilage . This is a glass-like and translucent cartilage that is usually found on several joint surfaces and can also be found on the larynx, nose and trachea. The main cell type are chondrocytes and it is usually covered at the external surface by the perichondrium which is a fibrous membrane (Bianchi et al., 2017). The hyaline cartilage has significant amount of collagen and does not contain any blood vessels or nerves making its structure to become quite simple.
The Epithelium Trachea Lining. The left section of the hyaline cartilage is the mucosa and a ciliated epithelium. It also includes goblet cells that are mucus-secreting and is usually about a cell-layer thick. The epithelial cells produce mucus that protect and moisten the airways.
Lamina propria . This is a thin connective tissue layer that also forms part of the moist linings referred to as mucosa along with the epithelium. The connective is loose but rich in cells. It contains glands that has duct openings at the mucosal epithelium which secrete serous secretions and mucus.
In case of an injury, a trauma that penetrates to the neck or chest would result in an obstruction of the airways and this leads to respiratory insufficiency causing a life-threatening situation. The position of the second arrow would also cause damage to the given sections of the trachea. The excessive damage would result in excessive bleeding and one would require immediate treatment.
References
Bianchi, V. J., Weber, J. F., Waldman, S. D., Backstein, D., & Kandel, R. A. (2017). Formation of hyaline cartilage tissue by passaged human osteoarthritic chondrocytes. Tissue Engineering Part A , 23 (3-4), 156-165.
Bonali, M., Soloperto, D., Cavazza, E. A., Ghirelli, M., & Presutti, L. (2017). Anatomy of the Neck. In Atlas of Craniocervical Junction and Cervical Spine Surgery (pp. 27-46). Springer, Cham.
Domizi, R., Damiani, E., Scorcella, C., Carsetti, A., Castagnani, R., Vannicola, S., ... & Donati, A. (2019). Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study. PloS one , 14 (3).
Idiaquez, J., Benarroch, E., & Nogues, M. (2018). Anatomy, Physiology, and Pharmacology of the Autonomic Nervous System (ANS). In Evaluation and Management of Autonomic Disorders (pp. 3-18). Springer, Cham.
Isaza-Restrepo, A., Martin-Saavedra, J. S., Velez-Leal, J. L., Vargas-Barato, F., & Riveros-Dueñas, R. (2018). The peritoneum: beyond the tissue–a review. Frontiers in physiology , 9 , 738.
Jones, R. A., Harrison, C., Eaton, S. L., Hurtado, M. L., Graham, L. C., Alkhammash, L., ... & Simmen, M. W. (2017). Cellular and molecular anatomy of the human neuromuscular junction. Cell reports , 21 (9), 2348-2356.
Kastelein, A. W., Vos, L. M., de Jong, K. H., van Baal, J. O., Nieuwland, R., van Noorden, C. J., ... & Lok, C. A. (2019, August). Embryology, anatomy, physiology and pathophysiology of the peritoneum and the peritoneal vasculature. In Seminars in cell & developmental biology (Vol. 92, pp. 27-36). Academic Press.
