M06_LIMM4554_13_SE_C06.indd Page 111 24/12/14 8:35 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Anatomy and Physiology 6

Related Chapters References:

Medical Terms
The following chapters and reference section provide Anatomy and Physiology Illustrations
additional information related to topics discussed in
this chapter: Standard
5 Medical Terminology Anatomy and Physiology
7 Ventilation, Perfusion, and Shock: Understanding
Pathophysiology Competency
9 Airway Management Applies fundamental knowledge of the anatomy and
function of all human systems to the practice of EMS.
10 Respiration and Artificial Ventilation
17 Respiratory Emergencies Core Concept
18 Cardiac Emergencies • The structure and function of major body systems
19 Diabetic Emergencies and Altered Mental Status
Objectives
22 Abdominal Emergencies
After reading this chapter, you should be able to:
24 Hematologic and Renal Emergencies
6.1. Define key terms introduced in this chapter.
25 Bleeding and Shock
6.2. Describe the structures and functions of each
26 Soft-Tissue Trauma
of the following body systems:
27 Chest and Abdominal Trauma a. Musculoskeletal (pp. 115–117, 121–124)
28 Musculoskeletal Trauma b. Respiratory (pp. 117, 124–127)
c. Cardiovascular (pp. 117, 127–137)
29 Trauma to the Head, Neck, and Spine d. Nervous (pp. 118, 137–139)
32 Obstetric and Gynecologic Emergencies e. Digestive (pp. 119, 139–140)
f. Integumentary (pp. 119, 140)

111
M06_LIMM4554_13_SE_C06.indd Page 112 24/12/14 8:35 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

g. Endocrine (pp. 119, 140–143) e. Skin (p. 141)

h. Renal (pp. 120, 143) f. Endocrine (p. 142)
i. Male and female reproductive (pp. 120, 143–146) g. Renal/urinary (p. 144)
h. Male and female reproductive (pp. 145–146)
6.3. Given a series of models or diagrams, label the
anatomical structures of each of the following body 6.4. Describe the differences in the respiratory anatomy of
systems: children as compared to adults (pp. 126–127)
a. Skeletal (p. 116) 6.5. Apply understanding of anatomy and physiology to
b. Respiratory (p. 125) explain the function of the life support chain
c. Cardiovascular (pp. 134–136) (pp. 133, 137)
d. Nervous (p. 138)

Key Terms
acetabulum, p. 120 diaphragm, p. 124 muscles, p. 113 shock, p. 131
acromioclavicular joint, diastolic blood pressure, musculoskeletal system, skeleton, p. 113
p. 121 p. 131 p. 113 skin, p. 138
acromion process, p. 121 digestive system, p. 137 nasal bones, p. 119 skull, p. 119
alveoli, p. 124 dorsalis pedis artery, p. 128 nasopharynx, p. 122 small intestine, p. 137
anatomy, p. 113 endocrine system, p. 138 nervous system, p. 135 spleen, p. 138
aorta, p. 128 epidermis, p. 138 orbits, p. 119 sternum, p. 120
appendix, p. 138 epiglottis, p. 122 oropharynx, p. 122 stomach, p. 137
arteriole, p. 128 epinephrine, p. 139 ovaries, p. 141 subcutaneous layers,
artery, p. 127 exhalation, p. 124 pancreas, p. 138 p. 138
atria, p. 125 femoral artery, p. 128 patella, p. 121 systolic blood pressure,
automaticity, p. 122 femur, p. 121 pelvis, p. 120 p. 131
autonomic nervous system, fibula, p. 121 penis, p. 141 tarsals, p. 121
p. 135 gallbladder, p. 138 perfusion, p. 131 tendons, p. 113
bladder, p. 141 humerus, p. 121 peripheral nervous system testes, p. 141
blood pressure, p. 131 hypoperfusion, p. 131 (PNS), p. 135 thorax, p. 120
brachial artery, p. 128 ilium, p. 120 peripheral pulses, p. 130 thyroid cartilage, p. 113
bronchi, p. 124 inhalation, p. 124 phalanges, p. 121 tibia, p. 121
calcaneus, p. 121 insulin, p. 139 pharynx, p. 122 trachea, p. 124
capillaries, p. 128 involuntary muscle, p. 121 physiology, p. 113 ulna, p. 121
cardiac conduction system, ischium, p. 120 plasma, p. 129 ureters, p. 141
p. 127 joint, p. 121 platelets, p. 130 urethra, p. 141
cardiac muscle, p. 122 kidneys, p. 141 posterior tibial artery, p. 128 uterus, p. 141
cardiovascular system, large intestine, p. 137 pubis, p. 120 vagina, p. 141
p. 125 larynx, p. 122 pulmonary artery, p. 128 valve, p. 127
carotid artery, p. 128 ligaments, p. 113 pulmonary vein, p. 129 vein, p. 129
carpals, p. 121 liver, p. 137 pulse, p. 130 venae cavae, p. 125
central nervous system lungs, p. 124 radial artery, p. 128 ventilation, p. 124
(CNS), p. 135 lymphatic system, p. 135 radius, p. 121 ventricles, p. 125
central pulses, p. 131 malleolus, p. 121 red blood cells, p. 130 venule, p. 129
clavicle, p. 121 mandible, p. 119 renal system, p. 141 vertebrae, p. 119
coronary arteries, p. 127 manubrium, p. 120 reproductive system, p. 141 voluntary muscle, p. 121
cranium, p. 119 maxillae, p. 119 respiration, p. 125 white blood cells, p. 130
cricoids cartilage, p. 122 metacarpals, p. 121 respiratory system, p. 122 xiphoid process, p. 120
dermis, p. 138 metatarsals, p. 121 scapula, p. 121 zygomatic arches, p. 119

The sciences of anatomy and physiology are like the where vital structures
owner’s manual to the body. When a mechanic works on are located, how the body
your car, he often refers to the manual to help him better functions, and how injuries and
understand where the specific parts are placed and what illnesses affect the body in general.
those parts do. As an EMT, you will use a knowledge of Anatomy is the study of body structure. A
the body’s anatomy and physiology to better understand working knowledge of anatomy will help you

112 [Link]
M06_LIMM4554_13_SE_C06.indd Page 113 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

understand where organs and organ systems are located You should use basic understanding to help you assess
and also how external injuries may impact internal and treat ill or injured patients. As you assess, ask
systems. Physiology, the study of body function, will yourself, “What organs and organ systems could be
give you a baseline idea of how the body should work affected, and what does affecting these organs do to
normally. Understanding this will help you identify normal body function?” Think of it as referring to the
abnormal function and predict the impact of challenges owner’s manual. While studying this chapter, also refer
to normal function. to “Reference: Anatomy and Physiology Illustrations” at
Anatomy and physiology will be helpful guides to the back of this book.
decision making throughout your experience as an EMT.

anatomy
the study of body structure.
Locating Body Organs and Structures physiology
the study of body function.
There are two ways to help locate organs and structures of the body. The first is visualizing,
or being able to picture, organs and structures inside the body as you look at the external thyroid (THI-roid) cartilage
the wing-shaped plate of cartilage
body. The second is topography, or external landmarks, such as notches, joints, and “bumps” that sits anterior to the larynx and
on bones. Some external landmarks are obvious (e.g., the navel, the nipples), some you forms the Adam’s apple.
know by other names but will learn their medical terms (e.g., the “Adam’s apple,” which is
properly called the thyroid cartilage), and some will probably be new to you (e.g., the
Core Concept
xiphoid process—the inferior part of the sternum, or breastbone, as described later in this
chapter). It is important to learn where internal organs and structures are in relation to The structure and function of
major body systems
these landmarks, which you can easily see or feel from outside the body.

musculoskeletal (MUS-kyu-lo-

Body Systems
SKEL-e-tal) system
the system of bones and skeletal
muscles that support and protect the
Refer to Table 6-1 as you read the following sections about the various body systems. body and permit movement.

skeleton
Musculoskeletal System the bones of the body.

Unlike many other systems, the musculoskeletal system extends into all parts of the body. muscle
The skeleton consists of the skull and spine, ribs and sternum, shoulders and upper extrem- tissue that can contract to allow
movement of a body part.
ities, and the pelvis and lower extremities (Figure 6-1). Interacting with the skeletal system
are muscles, ligaments (which connect bone to bone), and tendons (which connect muscle ligament
to bone). tissue that connects bone to bone.

tendon
tissue that connects muscle to bone.

Point of View
“I had a stroke. It wasn’t a big stroke, but it sure scared
me. Of all the memories from my medical care—and I got a
lot of it that day—the one that stands out the most is the
EMTs who came to my house. I’ll never forget how kind
and caring they were. They checked all kinds of things: my
face, my speech, and they shined a light in my eyes. I’m a
diabetic so I thought it might be that. Somehow they
seemed to know it was a stroke pretty early and told the
hospital so they could be ready. I fully recovered thanks to
them. I always respected the EMTs, but I guess now I am
just amazed at how much they need to know to do what
they do.”

Chapter 6 | Anatomy and Physiology 113

M06_LIMM4554_13_SE_C06.indd Page 114 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-1 The skeleton.

Skull

Maxilla
Mandible

Cervical vertebrae

Clavicle
Scapula

Sternum
Humerus
Ribs

Thoracic
vertebrae

Ulna
Lumbar
vertebrae Radius

Ilium Sacrum
Coccyx
Pubis
Carpals
Metacarpals
Phalanges

Ischium

Femur

Patella

Tibia
Fibula

Tarsals
Metatarsals
Phalanges

114 [Link]
M06_LIMM4554_13_SE_C06.indd Page 115 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

TABLE 6-1 Systems and Structures of the Human Body

System Structures Functions
Musculoskeletal • Bones Skeleton supports and protects the body, forms blood cells, and
• Joints stores minerals. Muscles produce movement.
• Muscles

Respiratory • Nasal cavity Obtains oxygen and removes carbon dioxide from the body.
• Pharynx
• Larynx
• Trachea
• Bronchial tubes
• Lungs

Cardiovascular • Heart Pumps blood throughout the entire body to transport nutrients,
• Arteries oxygen, and wastes.
• Veins

(continued)

Chapter 6 | Anatomy and Physiology 115

M06_LIMM4554_13_SE_C06.indd Page 116 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

TABLE 6-1 Systems and Structures of the Human Body (continued)

System Structures Functions
Blood • Plasma Transports oxygen, protects against pathogens, and promotes
• Red blood cells clotting to control bleeding.
• White blood cells
• Platelets

Lymphatic • Tonsils/adenoids Helps to maintain the fluid balance of the body and contributes
• Thymus gland to the body’s immune system.
• Spleen
• Lymph nodes
• Lymphatic vessels

Nervous • Brain Receives sensory information and coordinates the body’s

• Spinal cord response.
• Nerves

116 [Link]
M06_LIMM4554_13_SE_C06.indd Page 117 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

TABLE 6-1 Systems and Structures of the Human Body (continued)

System Structures Functions
Digestive • Oral cavity Ingests, digests, and absorbs nutrients for the body.
• Pharynx
• Esophagus
• Stomach
• Small intestine
• Large intestine
(colon)
• Liver
• Gallbladder
• Pancreas

Integumentary • Skin Forms protective barrier and aids in temperature regulation.

• Hair
• Nails
• Sweat glands

Endocrine • Pituitary gland Regulates metabolic/hormonal activities of the body.

• Pineal gland
• Thyroid gland
• Parathyroid glands
• Thymus gland
• Adrenal glands
• Pancreas
• Testes
• Ovaries

(continued)

Chapter 6 | Anatomy and Physiology 117

M06_LIMM4554_13_SE_C06.indd Page 118 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

TABLE 6-1 Systems and Structures of the Human Body (continued)

System Structures Functions
Renal/Urinary • Kidneys Filters waste products out of the blood and removes them from
• Ureters the body.
• Urinary bladder
• Urethra

Male • Testes Produces sperm for reproduction.

Reproductive • Epididymis
• Vas deferens
• Penis
• Seminal vesicles
• Prostate gland

Female • Ovaries Produces eggs for reproduction and provides place and nutrients
Reproductive • Fallopian tubes for growing baby.
(oviducts)
• Uterus
• Vagina
• Vulva
• Breasts

118 [Link]
M06_LIMM4554_13_SE_C06.indd Page 119 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-2 The skull consists of the cranium and face.

Frontal bone

Parietal bone
Suture

Sphenoid bone
Temporal bone
Nasal bone
Lacrimal bone
Orbit
Occipital bone

Maxilla

Zygomatic bone

Mandible

The musculoskeletal system has three main functions:

1. To give the body shape
2. To protect vital internal organs
3. To provide for body movement
In addition to these functions, the marrow inside the bone produces blood cells and
stores certain nutrients.
skull
Skull the bony structure of the head.
To list the parts of the skeleton from top to bottom, you would begin with the skull
­(Figure 6-2). The skull is the bony structure of the head. A main function of the skull is to cranium
the top, back, and sides of the skull.
enclose and protect the brain. The cranium consists of the top, back, and sides of the skull.
The face is the front of the skull. mandible (MAN-di-bul)
The bones of the anterior cranium connect to facial bones, including the mandible the lower jaw-bone.
(lower jaw), maxillae (fused bones of the upper jaw), and the nasal bones (which provide
maxillae (mak-SIL-e)
some of the structure of the nose). These bones form the facial structures. Some of these the two fused bones forming the
structures consist of multiple bones, such as the orbits, which surround the eyes, and the upper jaw.
zygomatic arches, which form the structures of the cheeks.
nasal (NAY-zul) bones
the nose bones.
Spinal Column
The spinal column provides structure and support for the body and houses and protects the orbits
spinal cord. the bony structures around the eyes;
the eye sockets.
The spinal column (also referred to simply as the spine) consists of thirty-three vertebrae,
the separate bones of the spine. Like building blocks, vertebrae are stacked one upon the zygomatic (ZI-go-MAT-ik)
other to form the spinal column. Vertebrae are open in the middle, somewhat like doughnuts, arches
creating a hollow center for the spinal cord. Since the spinal cord is essential for movement, bones that form the structure of the
sensation, and vital functions, injuries to the spine have the potential to damage the cord, cheeks.
possibly resulting in paralysis or death. For this reason, you will see references throughout vertebrae (VER-te-bray)
this text to “spinal precautions” for some patients. the thirty-three bones of the spinal
The five divisions of the spine are listed in Table 6-2 and shown in Figure 6-3. column.

Chapter 6 | Anatomy and Physiology 119

M06_LIMM4554_13_SE_C06.indd Page 120 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

TABLE 6-2 The Divisions of the Spine

Division Corresponding Anatomy Number of Vertebrae
Cervical Neck 7
Thoracic Thorax, ribs, upper back 12
Lumbar Lower back 5
Sacral Back wall of pelvis 5
Coccyx Tailbone 4

thorax (THOR-ax) The anatomy of the body allows some vertebrae to be injured more easily than others.
the chest. Since the head is large and heavy, resting on the slender neck, incidents such as car crashes
sternum (STER-num) may cause the head to whip back and forth or strike an object such as the windshield. This
the breastbone. frequently causes injuries to the cervical spine. An injury to the spinal cord at this level may
be fatal because control of the muscles of breathing, such as the diaphragm and the muscles
manubrium (man-OO-bre-um) between the ribs, arise from the spinal cord in the cervical region. The lumbar region is also
the superior portion of the sternum.
subject to injury because it is not supported by other parts of the skeleton. The thoracic
xiphoid (ZI-foid) process spine, to which the ribs are attached, and the sacral spine and coccyx, which are supported
the inferior portion of the sternum by the pelvis, are less easily injured.
(breastbone).

pelvis Thorax
the basin-shaped bony structure that The thorax is the chest. The bones of the thorax form an internal space called the thoracic
supports the spine and is the point cavity. This cavity contains the heart, lungs, and major blood vessels. An important function
of proximal attachment for the lower
of the thorax is to protect these vital organs. This is accomplished by the twelve pairs of ribs
extremities.
that attach to the twelve thoracic vertebrae of the spine. In the front, ten of these pairs of
ilium (IL-e-um) ribs are attached to the sternum (breastbone) and two are called “floating ribs” since they
the superior and widest portion of have no anterior attachment. You will remember the sternum from your CPR training. This
the pelvis.
flat bone is divided into three sections: the manubrium (superior portion), the body (center
ischium (ISH-e-um) portion), and the xiphoid process (inferior tip).
the lower, posterior portions of the
pelvis. Pelvis
pubis (PYOO-bis) The pelvis is sometimes referred to by laypeople as the hip, although the hip is actually the
the medial anterior portion of the joint where the femur (thigh bone) and pelvis join. The pelvis contains bones that are fused
pelvis. together. The ilium is the superior bone that contains the iliac crest, which is the wide bony
wing that can be felt near the waist. The ischium is the inferior, posterior portion of the
acetabulum
pelvis. The pubis is formed by the joining of the bones of the anterior pubis. The pelvis is
(AS-uh-TAB-yuh-lum)
the pelvic socket into which the ball
joined posteriorly to the sacral spine.
at the proximal end of the femur fits The hip joint consists of the acetabulum (the socket of the hip joint) and the ball at the
to form the hip joint. proximal end of the femur.

Figure 6-3 The divisions of

the spine.

Atlas (C1)
Axis (C2) Cervical 1-7

Thoracic 1-12

Lumbar 1-5

Sacrum
Coccyx

120 [Link]
M06_LIMM4554_13_SE_C06.indd Page 121 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Lower Extremities femur (FEE-mer)

the large bone of the thigh.
The pelvis and hip joint, described previously, may be considered part of the lower
extremities. Moving downward from the hip, the large thigh bone is the femur. The femur, patella (pah-TEL-uh)
the largest long bone in the body, has a slight bend at its proximal end where it attaches to the kneecap.
the pelvis. This bend is a frequent site of fractures and is commonly what breaks when a tibia (TIB-e-uh)
patient “breaks a hip.” Progressing down the leg, the patella, or kneecap, sits anterior to the medial and larger bone of the
the knee joint. The knee connects with the femur superiorly and with the bones of the lower leg.
lower leg, the tibia and fibula, inferiorly. The tibia is the medial and larger bone of the fibula (FIB-yuh-luh)
lower leg, also referred to as the shinbone. The fibula is the lateral and smaller bone of the lateral and smaller bone of the
the lower leg. lower leg.
The ankle connects the tibia and fibula with the foot. Two distinct landmarks are the malleolus (mal-E-o-lus)
malleolus at each side of the ankle: the lateral malleolus (at the lower end of the fibula) and protrusion on the side of the ankle.
The lateral malleolus, at the lower
the medial malleolus (at the lower end of the tibia). These are the protrusions that you see
end of the fibula, is seen on the
on the lateral and medial aspects of your ankles. The ankle consists of bones called tarsals. outer ankle; the medial malleolus, at
The foot bones are called metatarsals. The heel bone is called the calcaneus. The toe bones the lower end of the tibia, is seen on
are the phalanges. the inner ankle.
tarsals (TAR-sulz)
Upper Extremities the ankle bones.
Each shoulder consists of several bones: the clavicle, the scapula, and the proximal metatarsals (MET-uh-TAR-sulz)
humerus. The clavicle, or collarbone, is located anteriorly. The scapula, or shoulder blade, the foot bones.
is located posteriorly. The acromion process of the scapula is the highest portion of the
calcaneus (kal-KAY-ne-us)
shoulder. It forms the acromioclavicular joint with the clavicle and is a frequent area of the heel bone.
shoulder injury.
phalanges (fuh-LAN-jiz)
The upper arm and forearm consist of three bones connected at the elbow. The bone
the toe bones and finger bones.
between the shoulder and the elbow is the humerus. The radius and ulna are the two bones
between the elbow and the hand. The radius is the lateral bone of the forearm. It is always clavicle (KLAV-i-kul)
the collarbone.
aligned with the thumb. (The radial pulse is taken over the radius.) The ulna is the medial
forearm bone. scapula (SKAP-yuh-luh)
The wrist consists of several bones called carpals. The bones of the hand are the meta- the shoulder blade.
carpals. The finger bones, like the toe bones, are called phalanges. acromion (ah-KRO-me-on)
By this point in the chapter, you are realizing the importance of anatomical terms such process
as superior, inferior, medial, lateral, anterior, and posterior. These terms will be used through- the highest portion of the shoulder.
out the text, and you will need to use them correctly to properly document and report your acromioclavicular (ah-KRO-
patient’s injuries and complaints. me-o-klav-IK-yuh-ler) joint
the joint where the acromion and
Joints the clavicle meet.

Joints are formed when bones connect to other bones. There are several types of joints, humerus (HYU-mer-us)
including ball-and-socket joints and hinge joints. The hip is an example of a ball-and-socket the bone of the upper arm, between
joint, in which the ball of the femur rotates in a round socket in the pelvis. The elbow is an the shoulder and the elbow.
example of a hinge joint in which the angle between the humerus and ulna—which are con- radius (RAY-de-us)
nected by ligaments—bends and straightens, as the name suggests, like a hinge. the lateral bone of the forearm.

ulna (UL-nah)
Muscles the medial bone of the forearm.
Like the skeleton, the muscles protect the body, give it shape, and allow for movement. carpals (KAR-pulz)
There are three types of muscle (Figure 6-4): voluntary muscle, involuntary muscle, and the wrist bones.
cardiac muscle. metacarpals (MET-uh-KAR-pulz)
Voluntary muscle, or skeletal muscle, is under conscious control of the brain via the the hand bones.
nervous system. Attached to the bones, the voluntary muscles form the major muscle mass
joint
of the body. They are responsible for movement. Voluntary muscle can contract upon vol- the point where two bones come
untary command of the individual. For example, if you want to, you can reach to pick up an together.
item or walk away. These are examples of voluntary muscle use.
voluntary muscle
Involuntary muscle, or smooth muscle, is found in the gastrointestinal system, lungs, muscle that can be consciously
blood vessels, and urinary system and controls the flow of materials through these struc- controlled.
tures. Involuntary muscles respond automatically to orders from the brain. You do not have
involuntary muscle
to consciously think about using them to breathe, digest food, or perform other functions muscle that responds automatically
that occur under their control. In fact, we have no direct control over involuntary muscles. to brain signals but cannot be
Involuntary muscles do respond to stimuli such as stretching, heat, and cold. consciously controlled.

Chapter 6 | Anatomy and Physiology 121

M06_LIMM4554_13_SE_C06.indd Page 122 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-4 Three types of

muscle.

Skeletal
muscle

Cardiac
muscle

Smooth
cardiac muscle
muscle
specialized involuntary muscle found
only in the heart.

automaticity
(AW-to-muh-TISS-it-e)
the ability of the heart to generate and
conduct electrical impulses on its own.

respiratory (RES-pir-ah-tor-e)
system
the system of nose, mouth, throat, Cardiac muscle, a specialized form of involuntary muscle, is found only in the heart.
lungs, and muscles that brings
Cardiac muscle is extremely sensitive to decreased oxygen supply and can tolerate an inter-
oxygen into the body and expels
carbon dioxide. Also called the ruption of its blood supply for only very short periods. The heart muscle has its own blood
pulmonary system. supply through the coronary artery system.
The heart also has a property called automaticity. This means that the heart has the
oropharynx (OR-o-FAIR-inks)
ability to generate and conduct electrical impulses on its own. The heartbeat (contraction)
the area directly posterior to the
mouth. is controlled by these electrical impulses.

nasopharynx
(NAY-zo-FAIR-inks) Respiratory System
the area directly posterior to the nose. The purposes of the respiratory system, also known as the pulmonary system, are ventila-
pharynx (FAIR-inks) tion and oxygenation. Oxygen (O2) is moved into the bloodstream through inhalation, and
the area directly posterior to the carbon dioxide (CO2) is picked up by the blood and excreted through exhalation.
mouth and nose. It is made up of the
oropharynx and the nasopharynx. Respiratory Anatomy
epiglottis (EP-i-GLOT-is) A number of structures make up the respiratory system (Figure 6-5). Air enters the body
a leaf-shaped structure that prevents through the mouth and nose. It moves through the oropharynx (the area directly posterior
food and foreign matter from to the mouth) and the nasopharynx (the area directly posterior to the nose). The pharynx is
entering the trachea. the area that includes both the oropharynx and the nasopharynx.
larynx (LAIR-inks) From the pharynx, air moves on a path toward the lungs. A leaf-shaped structure called
the voice box. the epiglottis closes over the glottis, the opening to the trachea, to prevent foods and for-
cricoid (KRIK-oid) cartilage eign objects from entering the trachea during swallowing. The larynx, or voice box, contains
the ring-shaped structure that forms the vocal cords. The cricoid cartilage, a ring-shaped structure, forms the lower portion of
the lower portion of the larynx. the larynx.

122 [Link]
M06_LIMM4554_13_SE_C06.indd Page 123 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-5 The respiratory system.

nasal cavity

pharynx & larynx

Cleanses, warms, and

humidifies inhaled air

Carries air to the trachea bronchial tubes

and produces sound

trachea

Air passageways inside

the lung

Transports air to and from lungs

lungs

Site of gas exchange between

air and blood

Chapter 6 | Anatomy and Physiology 123

M06_LIMM4554_13_SE_C06.indd Page 124 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

trachea (TRAY-ke-uh) The trachea, or windpipe, is the tube that carries inhaled air from the larynx down
the “windpipe”; the structure that toward the lungs. It is formed and protected by sixteen C-shaped (incomplete) rings of car-
connects the pharynx to the lungs. tilage. At the level of the lungs, the trachea splits (bifurcates) into two branches called the
lungs bronchi. One “mainstem” bronchus goes to each lung. Inside each lung, the bronchi con-
the organs where exchange of tinue to branch and split (the branches are called bronchioles), like the branches of a tree,
atmospheric oxygen and waste and the air passages get smaller and smaller. Eventually each branch ends at a group of
carbon dioxide take place.
alveoli. The alveoli are the small sacs within the lungs where gas exchange—the exchange
bronchi (BRONG-ki) of oxygen and carbon dioxide—takes place with the bloodstream.
the two large sets of branches that The diaphragm is a structure that divides the chest cavity from the abdominal cavity. It
come off the trachea and enter the is a large muscle that is primarily controlled by the phrenic nerve. During a normal respira-
lungs. There are right and left
bronchi. Singular bronchus.
tory cycle, the diaphragm and other parts of the body work together to allow the body to
inhale and exhale. The role of the diaphragm and other muscles in the respiratory cycle is
alveoli (al-VE-o-li) described next.
the microscopic sacs of the lungs
where gas exchange with the
Respiratory Physiology
bloodstream takes place.
Inhalation is an active process. The muscles of the rib cage (intercostal muscles) and the
diaphragm (DI-uh-fram) diaphragm contract. The diaphragm lowers, and the ribs move upward and outward. This
the muscular structure that divides
the chest cavity from the abdominal
expands the size of the chest and thereby creates a negative pressure inside the chest cavity.
cavity. A major muscle of respiration. This negative pressure pulls air into the lungs.
Exhalation is a passive process during which the intercostal muscles and the diaphragm
inhalation (IN-huh-LAY-shun) relax. The ribs move downward and inward, while the diaphragm rises. This movement
an active process in which the
intercostal (rib) muscles and the causes the chest to decrease in size and positive pressure to build inside the chest cavity.
diaphragm contract, expanding the This positive pressure pushes air out of the lungs.
size of the chest cavity and causing During inhalation, air is moved through the airway and into the alveoli. These tiny sacs
air to flow into the lungs. in the lungs are the site of gas exchange between air and blood. Each single alveolus is sur-
exhalation (EX-huh-LAY-shun) rounded by pulmonary capillaries. The pulmonary capillaries bring circulating blood to the
a passive process in which the outside of the alveoli. Through the very thin walls of the alveoli and the capillaries, oxygen
intercostal (rib) muscles and the is transferred from the air inside the alveoli to the bloodstream and carbon dioxide is moved
diaphragm relax, causing the chest from the bloodstream into the air within the alveoli. This movement of gases to and from
cavity to decrease in size and air to
flow out of the lungs.
the alveoli is called ventilation.
Oxygenated blood is carried from the lungs to the heart so it can be pumped into the
ventilation body’s circulatory system. As the blood leaves the heart, it travels through a branching
the process of moving gases (oxygen
series of arteries that gradually become smaller and finally connect to capillaries. Just as
and carbon dioxide) between
inhaled air and the pulmonary happened with the capillaries that pass by the alveoli of the lungs, the capillaries that pass
circulation of blood. by the cells throughout the body’s tissues conduct a gas exchange. At a cellular level, oxy-
gen that was picked up from the lungs and carried by the blood is now transferred through
the capillary walls and across cell membranes into the cells. Waste carbon dioxide from the
cells moves in the opposite direction, out of the cells and into the capillaries. Capillaries

Pediatric Note
There are a number of special aspects of the respiratory anatomy of infants and
children (Figure 6-6). In general, all structures in a child are smaller than in an
adult. A child’s tongue takes up proportionally more space in the pharynx than
does an adult’s. The trachea is relatively narrower than in adults and, there-
fore, more easily obstructed by swelling or foreign matter. The trachea is also
softer and more flexible in infants and children, so more care must be taken
during any procedure when pressure might be placed on the neck, such as in
applying a cervical collar. The cricoid cartilage is also less developed and less
rigid in infants and children. The rib cage of an infant or small child is not as
curved inward at the bottom as is an adult’s. This makes generating that nega-
tive pressure used to breathe a bit more difficult. The chest wall is also softer
and more flexible, so infants and children tend to rely more on the diaphragm
when they are having breathing difficulty. This causes a visible “seesaw”
breathing pattern in which the chest and abdomen alternate movement.
Special procedures that take into account the respiratory anatomy of infants
and children will be discussed in later chapters on the airway and respiration.

124 [Link]
M06_LIMM4554_13_SE_C06.indd Page 125 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-6 Comparison of child and adult respiratory anatomies.

Child has smaller nose

and mouth.

In child, more space is

taken up by tongue.

Child’s trachea is narrower.

Cricoid cartilage is less rigid and

less developed.

Airway structures are more easily

obstructed.

then connect to veins and veins return blood to the heart, where it can be pumped to the
respiration (cellular)
lungs to get rid of the waste carbon dioxide and pick up oxygen, completing the cycle of gas the process of moving oxygen and
exchange. The process of moving gases (and other nutrients) between the cells and the carbon dioxide between circulating
blood is called respiration. blood and the cells.
The exchange of gases, both in the lungs and at the body’s cells, is critical to support life.
Oxygen is essential to sustain normal cellular function, and the removal of carbon dioxide cardiovascular (KAR-de-o-
helps regulate the body’s pH, or relative acidity. In general, the body regulates its pH VAS-kyu-ler) system
through the buffer system, and the removal of carbon dioxide is an extremely important ele- the system made up of the heart
ment of this system. (cardio) and the blood vessels
Breathing (the process of inhaling and exhaling air) may be classified as adequate or (vascular); the circulatory system.
inadequate. Simply stated, adequate breathing is sufficient to support life. Inadequate
breathing is not. Adequate and inadequate breathing, and how you as an EMT should
assess and care for breathing problems, will be discussed in detail in the “Respiratory
Emergencies” chapter.

Cardiovascular System
The cardiovascular system consists of the heart, the blood, and the blood vessels. It is also
atria (AY-tree-ah)
called the circulatory system. the two upper chambers of the
heart. There is a right atrium (which
Anatomy of the Heart receives unoxygenated blood
The human heart is a muscular organ about the size of your fist, located in the center of the returning from the body) and a left
thoracic cavity. The heart has four chambers: two upper chambers called atria and two atrium (which receives oxygenated
blood returning from the lungs).
lower chambers called ventricles (Figure 6-7A).
Singular atrium.
Blood is circulated through the heart and out to the body via a very specific pathway
(Figure 6-7B). This pathway is governed by the chambers of the heart, as follows: ventricles (VEN-tri-kulz)
the two lower chambers of the heart.
• Right atrium. The venae cavae (the superior vena cava and the inferior vena cava) are There is a right ventricle (which sends
the two large veins that return blood to the heart. The right atrium receives this blood oxygen-poor blood to the lungs) and
and, upon contraction, sends it to the right ventricle. a left ventricle (which sends oxygen-
rich blood to the body).
• Right ventricle. The right ventricle receives blood from the chamber above it, the
right atrium. When the right ventricle contracts, it pumps this blood out to the lungs via venae cavae (VE-ne KA-ve)
the superior vena cava and the
the pulmonary arteries. Remember, this blood is very low in oxygen and is carrying inferior vena cava. These two major
waste carbon dioxide that was picked up as the blood circulated through the body. While veins return blood from the body to
this blood is in the lungs, the carbon dioxide is excreted (taken out of the blood and, the right atrium. Singular vena cava.

Chapter 6 | Anatomy and Physiology 125

M06_LIMM4554_13_SE_C06.indd Page 126 24/12/14 8:36 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-7 (A) Cross-section of the heart showing chambers, layers, valves, and
major associated blood vessels.

Superior vena cava

Aorta

Pulmonary trunk
Left atrium
Aortic valve
Right atrium
Mitral valve
Pulmonary valve
Left ventricle
Tricuspid valve

Right ventricle Endocardium

Myocardium

Pericardium
Inferior vena cava

Figure 6-7 (B) The path of blood flow through the heart.

From body

Aorta To lung
Superior vena cava Left pulmonary artery
(branches)

To lung
Right pulmonary From lung
artery (branches)
Left pulmonary vein
(branches)

Pulmonary valve Left atrium

4
From lung Aortic valve
Right pulmonary
vein (branches) 5 Mitral (bicuspid) valve
1
6
Right atrium Left ventricle
Tricuspid valve
2 3
Interventricular
septum
Right ventricle
Myocardium
(heart muscle)

Inferior vena cava

Apex

From body Descending aorta

To body

126 [Link]
M06_LIMM4554_13_SE_C06.indd Page 127 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-8 The cardiac conduction system.

Aorta
Superior vena cava

Left atrium
1. Sinoatrial node
(pacemaker)

Internodal pathway
2. Atrioventricular node Purkinje fibers

3. Atrioventricular bundle
(Bundle of His)
Interventricular
4. Bundle branches
septum
5. Purkinje fibers

when the person exhales, carried out of the body), and oxygen is obtained (taken into
the blood from air the person has inhaled). The oxygen-rich blood is now returned to
the left atrium via the pulmonary veins.
• Left atrium. The left atrium receives the oxygen-rich blood from the lungs. When it
contracts, it sends this blood to the left ventricle.
• Left ventricle. The left ventricle receives oxygen-rich blood from the chamber above
it, the left atrium. When it contracts, it pumps this blood into the aorta, the body’s largest
artery, for distribution to the entire body. Since the blood must reach all parts of the
body, the left ventricle is the most muscular and strongest part of the heart.
Between each atrium and ventricle is a one-way valve that prevents blood in the ven- valve
tricle from being forced back up into the atrium when the ventricle contracts. The pulmo- a structure that opens and closes to
permit the flow of a fluid in only one
nary artery has a one-way valve so that blood in the artery does not return to the right
direction.
ventricle. The aorta also has a one-way valve to prevent backflow to the left ventricle. This
system of one-way valves keeps the blood moving in the correct direction along the path of
circulation.
The contraction, or beating, of the heart is an automatic, involuntary process. The heart
has its own natural “pacemaker” and a system of specialized muscle cells that conduct elec-
trical impulses that stimulate the heart to beat. This network is called the cardiac conduction cardiac conduction system
system (Figure 6-8). Regulation of rate, rhythm, and force of heartbeat comes, in part, from a system of specialized muscle tissues
the cardiac control centers of the brain. Nerve impulses from these centers are sent to that conducts electrical impulses that
stimulate the heart to beat.
the pacemaker and conduction system of the heart. These nerve impulses and chemicals
(epinephrine, for example) released into the blood control the heart’s rate and strength
of contractions.

Circulation of the Blood

When the blood leaves the heart, it travels throughout the body through several types of
blood vessels. Blood vessels are described by their function, location, and whether they
carry blood away from or to the heart.
The kind of vessel that carries blood away from the heart is called an artery. There are artery
several arteries that are important to know: any blood vessel carrying blood
away from the heart.
• Coronary arteries. The coronary arteries (Figure 6-9) branch off from the aorta and
coronary (KOR-o-nar-e) arteries
supply the heart muscle with blood. Although the heart has blood constantly moving
blood vessels that supply the muscle
through it, it receives its own blood supply from the coronary arteries. Damage, severe of the heart (myocardium).
narrowing, or blockage to these arteries usually results in chest pain.

Chapter 6 | Anatomy and Physiology 127

M06_LIMM4554_13_SE_C06.indd Page 128 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-9 The coronary arteries.

Base (superior)

Left coronary artery

Right coronary artery

Anterior descending branch

Apex (inferior)

aorta (ay-OR-tah)
the largest artery in the body. It
• Aorta. The aorta is the largest artery in the body. It begins at its attachment to the left
transports blood from the left ventricle, travels superiorly, then arches inferiorly in front of the spine through the tho-
ventricle to begin systemic circulation. racic and abdominal cavities. At the level of the navel, it splits into the iliac arteries.
pulmonary (PUL-mo-nar-e) • Pulmonary artery. The pulmonary artery begins at the right ventricle. It carries
arteries ­ xygen-poor blood to the lungs. You may notice that this is an exception to the rule that
o
the vessels that carry deoxygenated arteries carry oxygen-rich blood and veins carry oxygen-poor blood. It does, however,
blood from the right ventricle of the follow the rule that arteries carry blood away from the heart while veins carry blood to
heart to the lungs. the heart.
carotid (kah-ROT-id) arteries • Carotid artery. The carotid artery is the major artery of the neck. You will be familiar
the large neck arteries, one on each with this vessel from your CPR class. It is the artery that is palpated during CPR pulse
side of the neck, that carry blood
from the heart to the head.
checks for adults and children. It carries the main supply of blood for the head. There is
a carotid artery on each side of the neck. Never palpate both at the same time because
femoral (FEM-o-ral) artery of the danger of interrupting the supply of blood to the brain.
the major artery supplying the leg.
• Femoral artery. The femoral artery is the major artery of the thigh. You can relate
brachial artery the name femoral to the bone in the thigh, the femur. Pulsations for this artery can be
artery of the upper arm; the site of
felt in the crease between the abdomen and the groin. This artery is the major source of
the pulse checked during infant CPR.
blood supply to the thigh and leg.
radial artery • Brachial artery. The brachial artery in the upper arm is the pulse checked during
artery of the lower arm; the artery
felt when taking the pulse at the infant CPR. Its pulse can be felt anteriorly in the crease over the elbow and along the
thumb side of the wrist. medial aspect of the upper arm. It is also the artery that is used when determining blood
pressure with a blood pressure cuff and a stethoscope.
posterior tibial (TIB-ee-ul) artery
artery supplying the foot, behind the • Radial artery. This artery travels through, and supplies, the lower arm. The radial
medial ankle. artery is the artery felt when taking a pulse at the thumb side of the wrist. Again, you can
dorsalis pedis (dor-SAL-is relate the name radial to the radius, a bone in the forearm that the radial artery is near.
PEED-is) artery • Posterior tibial artery. This artery is often used when determining the circulatory
artery supplying the foot, lateral to status of the lower extremity. The posterior tibial artery may be palpated on the poste-
the large tendon of the big toe. rior aspect of the medial malleolus.
arteriole (ar-TE-re-ol) • Dorsalis pedis artery. The dorsalis pedis artery lies on the top (dorsal portion) of the
the smallest kind of artery. foot, lateral to the large tendon of the big toe.
capillary (KAP-i-lair-e) Arteries begin with large vessels, like the aorta. They gradually branch into smaller and
a thin-walled, microscopic blood
vessel where the oxygen/carbon
smaller vessels. The smallest branch of an artery is called an arteriole. These small vessels
dioxide and nutrient/waste exchange lead to the capillaries. Capillaries are tiny blood vessels found throughout the body. As
with the body’s cells takes place. explained earlier, the capillaries are where gases, nutrients, and waste products are

128 [Link]
M06_LIMM4554_13_SE_C06.indd Page 129 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-10 Arteries,

Vein Artery capillaries, and veins.

Valve

Arterioles
Venules

Capillary bed

From the heart, oxygen-rich blood is carried out

into the body by arteries. The arteries gradually
branch into smaller arteries called arterioles. The
arterioles gradually branch into tiny vessels called
capillaries.
In the capillaries, the blood gives up oxygen and
nutrients, which move through the thin walls of the
capillaries into the body’s cells. At the same time,
carbon dioxide and other wastes move in the
opposite direction, from the cells and through the
capillary walls, to be picked up by the blood.
On its return journey to the heart, the oxygen-
poor blood, now carrying carbon dioxide and other
wastes, flows from the capillaries into small veins
called venules which gradually merge into larger
veins.

exchanged between the body’s cells and the bloodstream. From the capillaries the blood
begins its return journey to the heart by entering the smallest veins. One of these small
veins is called a venule (Figure 6-10). venule (VEN-yul)
The kind of vessel that carries the blood from the capillaries back to the heart is called the smallest kind of vein.
a vein. Remember that the blood flow from the heart started in the largest arteries and vein
moved into smaller and smaller arteries until it reached the capillaries. The blood takes an any blood vessel returning blood to
the heart.
opposite course through the veins. The blood travels from the smaller to the larger vessels
on its return trip to the heart. Immediately after leaving the capillaries, the blood enters
venules, the smallest veins. From the venules, the veins get gradually larger, eventually
reaching the venae cavae.
There are two venae cavae. The superior vena cava collects blood that is returned from
the head and upper body. The inferior vena cava collects blood from the portions of the
body below the heart. The superior and inferior venae cavae meet to return blood to the
right atrium, where the process of circulation begins again.
The pulmonary vein carries oxygenated blood from the lungs to the left atrium of the heart. pulmonary veins
This is an exception to the rule that veins carry oxygen-poor blood. However, it does follow the the vessels that carry oxygenated
blood from the lungs to the left
rule that arteries carry blood away from the heart while veins return blood to the heart.
atrium of the heart.
Composition of the Blood
The blood is made up of several components: plasma, red and white blood cells, and plate-
lets (Figure 6-11).
• Plasma. Plasma is a watery, salty fluid that makes up more than half the volume of the plasma (PLAZ-mah)
blood. The red and white blood cells and platelets are carried in the plasma. Waste car- the fluid portion of the blood.
bon dioxide from the cells also dissolves in plasma to be transported back to the lungs.

Chapter 6 | Anatomy and Physiology 129

M06_LIMM4554_13_SE_C06.indd Page 130 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-11 Blood consists of plasma, red and white blood cells, and platelets.

Blood
separated

Five types of white blood cells

Eosinophil

Plasma

Basophil

Monocyte

Red blood cells

Lymphocyte
Platelets

Neutrophil

red blood cells • Red blood cells. Red blood cells are also called RBCs, erythrocytes, or red corpuscles.
components of the blood. They carry Their primary function is to carry oxygen to the tissues. The hemoglobin molecules on
oxygen to and carbon dioxide away these cells also provide the red color to the blood.
from the cells.
• White blood cells. White blood cells are also called WBCs, leukocytes, or white cor-
white blood cells puscles. They are involved in destroying microorganisms (germs) and producing sub-
components of the blood. They
produce substances that help the
stances called antibodies, which help the body resist infection.
body fight infection. • Platelets. Platelets are membrane-enclosed fragments of specialized cells. When
platelets these fragments are activated, they release chemical clotting factors needed to form
components of the blood; blood clots.
membrane-enclosed fragments of
specialized cells.
As you can see, the blood has a variety of functions. It is used to transport gases such as
oxygen and carbon dioxide and also can serve as a reservoir for oxygen dissolved in its
plasma. Blood also plays a role in fighting infection and the production of clotting factors.
Other functions include the regulation of body pH through chemicals transported in the
blood (otherwise known as the blood buffer).

Pulse
pulse A pulse is formed when the left ventricle contracts, sending a pressure wave of blood
the rhythmic beats caused as waves through the arteries. The pulse is felt by compressing an artery over a bone. This allows you
of blood move through and expand
to feel the wave of blood, or pulse, as it comes through the artery.
the arteries.
Earlier in this chapter, several arteries were named. Among them were the primary
arteries where a pulse is taken for vital signs or CPR: the carotid, brachial, and radial arter-
peripheral pulses ies. You will also use the pulses at the ankles and feet (posterior tibial and dorsalis pedis) to
the radial, brachial, posterior tibial,
and dorsalis pedis pulses, which can
check for adequate circulation to the lower extremities.
be felt at peripheral (outlying) points The radial, brachial, posterior tibial, and dorsalis pedis pulses are called peripheral
of the body. pulses because they can be felt on the periphery, or outer reaches, of the body. The carotid

130 [Link]
M06_LIMM4554_13_SE_C06.indd Page 131 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

and femoral pulses are called central pulses because they can be felt in the central part of central pulses
the body. Because they are larger vessels closer to the heart, the carotid and femoral pulses the carotid and femoral pulses,
can be felt even when peripheral pulses are too weak to be felt. which can be felt in the central part
of the body.

Blood Pressure blood pressure

The force blood exerts against the walls of blood vessels is known as blood pressure. Usually the pressure caused by blood
exerting force against the walls of
arterial blood pressure (pressure in an artery) is measured.
blood vessels. Usually arterial blood
Each time the left ventricle of the heart contracts, it forces blood out into circulation. pressure (the pressure in an artery) is
The pressure created in the arteries by this blood is called the systolic blood pressure. When measured. There are two parts:
the left ventricle of the heart is relaxed and refilling, the pressure remaining in the arteries diastolic blood pressure and systolic
is called the diastolic blood pressure. The systolic pressure is reported first, the diastolic blood pressure.
second, as in “120 over 80,” which is written as 120/80. systolic (sis-TOL-ik) blood
pressure
Perfusion the pressure created in the arteries
when the left ventricle contracts and
The movement of blood through the heart and blood vessels is called circulation. In healthy forces blood out into circulation.
individuals, circulation is adequate. That is, there is enough blood within the system and
there is a means to pump and deliver it to all parts of the body efficiently (Figure 6-12). The diastolic (di-as-TOL-ik) blood
adequate supply of oxygen and nutrients to the cells of the body, with the removal of waste pressure
the pressure in the arteries when the
products, is called perfusion.
left ventricle is refilling.
Hypoperfusion (inadequate perfusion), also known as shock, is a serious condition.
With hypoperfusion, there is inadequate circulation of blood through one or more organs perfusion
or structures. Blood is not reaching and filling all the capillary networks of the body, which the supply of oxygen and nutrients
means that oxygen will not be delivered to, and waste products will not be removed from, to and removal of wastes from the
all the body’s tissues. Hypoperfusion can lead to death. It is important to understand what cells and tissues of the body as a
result of the flow of blood through
hypoperfusion is, how it occurs, and how to recognize it. This will be discussed in more
the capillaries.
depth in the chapter titled “Bleeding and Shock.”
hypoperfusion
inability of the body to adequately
circulate blood to the body’s cells to
Life Support Chain supply them with oxygen and
The respiratory system and the cardiovascular system together make up the cardiopulmo- nutrients. A life-threatening condition.
nary system. The interaction of these two systems is essential to life. Also called shock. See also perfusion.
Oxygen and glucose are necessary to the cells. Glucose is converted by the cells into shock
energy in the form of adenosine triphosphate (ATP). Oxygen is a necessary component See hypoperfusion.
of this conversion process. When oxygen is present, glucose is converted in a process
called aerobic metabolism. This process produces efficient amounts of energy and mini-
mal waste products, such as carbon dioxide and water. If oxygen is not present in suffi-
cient supply, the process will shift to anaerobic metabolism. This process produces less
energy and more waste products, such as lactic acid. Waste products, in turn, make the
body more acidotic. Acidosis injures the body’s cells and limits the blood’s ability to
carry oxygen.
The movement of oxygen from the blood into the cells, coupled with the removal of
waste products, is referred to as perfusion. As stated previously, perfusion is essential to
normal cell function. Perfusion depends on the cardiopulmonary system, as described next.
In order for cells to be oxygenated and carbon dioxide to be removed, a variety of fac-
tors must be working properly. First and foremost, air must be reaching the alveoli of the
lungs and, once there, must be matched up with a sufficient supply of blood in the pulmo-
nary capillaries. If, for example, air is obstructed from getting to the alveoli, as in a foreign
body obstruction, gas exchange cannot occur. Similarly, if there is not enough blood passing
through the pulmonary capillaries, as in the case of severe external bleeding, gas exchange
cannot occur. This coupling of a sufficient amount of air with a sufficient amount of blood is
called a ventilation perfusion match and abbreviated as a V/Q match.
There are other critical elements to normal perfusion as well. The heart must pump
effectively. If the pump fails, blood will not move. There must be sufficient oxygen in the air
that is breathed. There must be an effective capability to carry oxygen in the blood (anemia
is a condition that in some cases reduces the number of oxygen-carrying red blood cells).
Furthermore, if the mechanics of respiration are disrupted, air will not move. All of these
elements are critical components to perfusion.

Chapter 6 | Anatomy and Physiology 131

M06_LIMM4554_13_SE_C06.indd Page 132 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-12 (A) The major arteries of the body.

Right common carotid artery Left common carotid artery

Right subclavian artery

Left subclavian artery

Ascending aorta Aortic arch

Brachial artery

Renal artery
Abdominal aorta
Common iliac artery

Radial artery
Internal iliac artery
Ulnar artery

External iliac artery

Femoral artery

Popliteal artery

Peroneal artery
Anterior tibial artery

Posterior tibial artery

132 [Link]
M06_LIMM4554_13_SE_C06.indd Page 133 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-12 (B) The major veins of the body.

External jugular vein

Internal jugular vein

Subclavian vein
Right and left brachiocephalic veins
Superior vena cava

Cephalic vein

Brachial vein

Hepatic portal vein Basilic vein

Median cubital vein

Superior mesenteric vein
Inferior vena cava
Renal vein
Ulnar vein
Radial vein
Common iliac vein
External iliac vein
Internal iliac vein

Digital veins

Femoral vein

Great saphenous vein

Popliteal vein

Posterior tibial vein

Anterior tibial vein

Fibular vein

Chapter 6 | Anatomy and Physiology 133

M06_LIMM4554_13_SE_C06.indd Page 134 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-13 The lymphatic system.

tonsil, p. 196

thymus, p. 196

Protects against pathogens in

the pharynx

Necessary for development of

immune system spleen, p. 196

lymph node, p. 194

Cleanses blood and removes

old red blood cells

Cleanses lymph fluid

lymphatic vessel, p. 193

Transports lymph fluid

134 [Link]
M06_LIMM4554_13_SE_C06.indd Page 135 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

There are other potential perfusion problems; to simplify things, consider anything that
threatens the normal function of the cardiopulmonary system to be a threat to quality
perfusion. Threats to perfusion will be discussed in greater detail in the chapter titled “Ven-
tilation, Perfusion, and Shock: Understanding Pathophysiology.”

Lymphatic System
The lymphatic system (Figure 6-13) is a collaboration of organs, tissues (nodes), thin-walled lymphatic (lim-FAT-ik) system
vessels, and fluids that are found throughout the entire body. One chief function of the lym- the system composed of organs,
tissues, and vessels that help to
phatic system is to capture fluid (called lymph) that escapes from cells and tissues and
maintain the fluid balance of the
return it to the bloodstream. In this way, the lymphatic system functions to maintain a bal- body and contribute to the body’s
ance of fluids within the body. The associated lymphoid organs also have an immune func- immune system.
tion, producing lymphocytes and other white blood cells that fight infection. In fact, the
lymphatic system is a critical part of the body’s immune system.
Lymphoid organs include the adenoids, tonsils, spleen, and thymus. Some sources
include the appendix as a lymphoid organ because of the density of lymph tissue found
there. The lymphatic system also consists of nodes (commonly referred to as lymph nodes)
that are normally soft and round or irregularly shaped. These nodes filter lymphatic fluid of
bacteria and foreign cells as well as making lymphocytes and other infection-fighting cells.
You may recall your physician feeling the lymph nodes in your neck. He or she was looking
for enlargement, which may be a sign of infection.
Women who have had a breast removed (total mastectomy) because of breast cancer
will often be instructed not to allow a blood pressure to be taken on the arm on the same
side as the mastectomy. This is because a mastectomy often includes removal of lymphic
tissue from the armpit area. The compression of an inflated blood pressure cuff on the
upper arm can potentially damage the fragile remaining lymphatic tissue. As an EMT, you
must avoid taking a blood pressure on the side of a woman’s body where a mastectomy has
been performed.

Nervous System
The nervous system (Figure 6-14) consists of the brain, spinal cord, and nerve tissue. It nervous system
transmits impulses that govern sensation, movement, and thought. It also controls the the system of brain, spinal cord, and
nerves that govern sensation,
body’s voluntary and involuntary activity. It is subdivided into the central and peripheral
movement, and thought.
nervous systems.
The central nervous system (CNS) is composed of the brain and the spinal cord. The central nervous system (CNS)
brain could be likened to a powerful computer that receives information from the body the brain and spinal cord.
and, in turn, sends impulses to different areas of the body to respond to internal and exter-
nal changes. The spinal cord rests within the spinal column and stretches from the brain to
the lumbar vertebrae. Nerves branch from each part of the cord and reach throughout the
body. A key function of the central nervous system is consciousness. The reticular activating
system is a series of nervous pathways in the brain and is essentially responsible for keeping
one awake.
The peripheral nervous system (PNS) consists of two types of nerves: sensory and peripheral nervous system (PNS)
motor. The sensory nerves pick up information from throughout the body and transmit it to the nerves that enter and leave the
spinal cord and travel between the
the spinal cord and brain. If you touch something hot, your sensory nerves transmit this to
brain and organs without passing
the spinal cord and brain so immediate action may be taken. The motor nerves carry mes- through the spinal cord.
sages from the brain to the body.
The autonomic nervous system is the division of the peripheral nervous system that autonomic (AW-to-NOM-ik)
controls involuntary motor functions and affects such things as digestion and heart rate. nervous system
The autonomic nervous system can be further broken down into the sympathetic and the division of the peripheral nervous
system that controls involuntary
parasympathetic nervous systems. The sympathetic nervous system function is often
motor functions.
referred to as the fight-or-flight response. This system is engaged when the body is in
crisis. Stimulation of sympathetic tone causes the heart to beat faster, the lungs to
breathe deeper, and the blood vessels to constrict. Imagine all the responses you might
need if you had to run away from a potential threat. The parasympathetic nervous ­system

Chapter 6 | Anatomy and Physiology 135

M06_LIMM4554_13_SE_C06.indd Page 136 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-14 The nervous system.

brain

spinal cord
Coordinates body functions

nerves
Transmits messages to and
from the brain

Brain
Spinal nerves
Transmit messages to and
of the
from the central nervous
system peripheral Central
nervous nervous
system system

Spinal
cord

136 [Link]
M06_LIMM4554_13_SE_C06.indd Page 137 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

asserts an opposite effect. It is engaged in times of relaxation and is often referred to as

the feed-or-breed response. Parasympathetic tone causes increased blood flow to the
digestive tract and to the reproductive organs. It also can cause the heart to slow down
and the blood vessels to dilate.
digestive system
system by which food travels
Digestive System through the body and is digested, or
broken down into absorbable forms.
The digestive system provides the mechanisms by which food travels through the body
and is digested, or broken down into absorbable forms. Food enters the mouth and is stomach
broken down by both saliva and chewing. The food passes from the mouth through the muscular sac between the esophagus
oropharynx and into the esophagus, where it is transported to the stomach. Except for and the small intestine where
digestion of food begins.
the mouth and the esophagus, all of the organs of digestion are contained in the abdom-
inal cavity. small intestine
the muscular tube between the
• Stomach. The stomach is a hollow organ that expands as it fills with food. In the stom- stomach and the large intestine,
ach, acidic gastric juices begin to break food down into components that the body will divided into the duodenum, the
be able to convert into energy. jejunum, and the ileum, which
receives partially digested food from
• Small intestine. The small intestine is divided into three parts: the duodenum, the the stomach and continues
jejunum, and the ileum. This organ receives food from the stomach and continues to digestion. Nutrients are absorbed by
break it down for absorption. These nutrients are absorbed by the body through the the body through its walls.
wall of the small intestine. large intestine
• Large intestine (colon). The large intestine removes water from waste products as the muscular tube that removes
they move toward elimination from the body. Anything not absorbed from this point is water from waste products received
from the small intestine and moves
moved through the colon and excreted as feces.
anything not absorbed by the body
Several organs located outside of the stomach–intestines continuum assist in the food toward excretion from the body.
breakdown process. liver
the largest organ of the body, which
• Liver. The liver produces bile, which is excreted into the small intestine to assist in the produces bile to assist in breakdown
breakdown of fats. The liver has many additional functions, including detoxifying harm- of fats and assists in the metabolism
ful substances, storing sugar, and assisting in production of blood products. of various substances in the body.

Inside Outside
Recognizing Sympathetic Nervous for an unknown reason, no chest pain is present. He does,
however, feel weak and nauseated. Despite his obscure
System Response symptoms, his body is reacting. His brain engages the
sympathetic nervous system to respond to the challenge. His
Recognizing a sympathetic nervous system response can be
heart beats a bit faster, he breathes a bit quicker. His blood
an important part of a patient assessment. Often a patient’s
vessels constrict and divert blood away from the skin.
sympathetic nervous system will be engaged as the result of
injury or illness, and recognizing its signs can help alert you to
a problem even when the immediate cause is unknown. Let’s Outside
use the example of a sixty-two-year-old male having an acute
myocardial infarction: Although he is presenting atypically, that is, in an unusual
fashion, your assessment reveals a few red flags. You notice he
Inside is pale and sweaty (a result of constricted blood vessels). You
also observe the elevated heart rate and respiratory rate. By
In this patient something very wrong is happening. A noticing these signs, you recognize a “sympathetic discharge”
coronary artery is blocked, and his heart is not getting the and know that the body is responding to a serious problem.
oxygen supply it desperately needs. In most people this will This may be more than an upset stomach.
cause chest pain, but in this case the patient is diabetic and,

Chapter 6 | Anatomy and Physiology 137

M06_LIMM4554_13_SE_C06.indd Page 138 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

gallbladder • Gallbladder. The gallbladder serves as a storage system for bile from the liver.
a sac on the underside of the liver
• Pancreas. Perhaps best known for production of the hormone insulin, which is
that stores bile produced by the liver.
involved in the regulation of sugar in the bloodstream, the pancreas also secretes juices
pancreas that assist in breaking down proteins, carbohydrates, and fat.
a gland located behind the stomach
that produces insulin and juices that • Spleen. Acting as a blood filtration system, the spleen filters out older blood cells. It
assist in digestion of food in the has many blood vessels and at any given time holds significant quantities of blood
duodenum of the small intestine. reserves the body can use in case of significant blood loss.
spleen • Appendix. Located near the junction of the small and large intestines, the appendix is
an organ located in the left upper made up of lymphatic tissue. Its exact function is not well understood, but it is often
quadrant of the abdomen that acts considered with the digestive system because an infected appendix (appendicitis) is a
as a blood filtration system and a
common cause of abdominal pain.
reservoir for reserves of blood.

appendix
a small tube located near the Integumentary System
junction of the small and large The integumentary system consists primarily of the skin. The skin performs a variety of
intestines in the right lower quadrant
functions, such as protection, water balance, temperature regulation, excretion, and shock
of the abdomen, the function of
which is not well understood. Its absorption.
inflammation, called appendicitis, is
• Protection. The skin serves as a barrier to keep out microorganisms, debris, and
a common cause of abdominal pain.
unwanted chemicals. Underlying tissues and organs are protected from environmental
skin contact. This helps preserve the chemical balance of body fluids and tissues.
the layer of tissue between the body
and the external environment. • Water balance. The skin helps prevent water loss and stops environmental water
from entering the body.
• Temperature regulation. Blood vessels in the skin can dilate (increase in diame-
ter) to carry more blood to the skin, allowing heat to radiate from the body. When the
body needs to conserve heat, these vessels constrict (decrease in diameter) to prevent
heat loss. The sweat glands found in the skin produce perspiration, which will evapo-
rate and help cool the body. The fat layer beneath the skin also serves as a thermal
insulator.
• Excretion. Salts and excess water can be released through the skin.
• Shock (impact) absorption. The skin and its layers of fat help protect the underlying
organs from minor impacts and pressures.
The skin has three major layers: the epidermis, dermis, and subcutaneous layers (Fig-
epidermis (ep-i-DER-mis) ure 6-15). The outer layer of the skin is called the epidermis. It is composed of four layers
the outer layer of skin. (strata) everywhere except at the palms of the hands and soles of the feet. These two regions
have five skin layers. The outermost layers of the epidermis are composed of dead cells,
which are rubbed off or sloughed off and replaced. The pigment granules of the skin and
living cells are found in the deeper layers. The cells of the innermost layer actively divide,
replacing the dead cells of the outer layers. Note that the epidermis contains no blood ves-
sels or nerves. Except for certain types of burns and injuries due to cold, injuries of the
epidermis present few problems in EMT-level care.
dermis (DER-mis) The layer of skin below the epidermis is the dermis, which is rich with blood vessels,
the inner (second) layer of skin, rich nerves, and specialized structures such as sweat glands, sebaceous (oil) glands, and hair fol-
in blood vessels and nerves, found licles. Specialized nerve endings are also found in the dermis. They are involved with the
beneath the epidermis.
sense of touch and reactions to cold, heat, and pain. Once the dermis is opened to the out-
side world, contamination and infection become major problems. These wounds can be
serious, accompanied by profuse bleeding and intense pain.
subcutaneous (SUB-ku-TAY- The layers of fat and soft tissue below the dermis makes up the subcutaneous layers.
ne-us) layers Shock absorption and insulation are major functions of this layer. Again, there are the prob-
the layers of fat and soft tissues lems of tissue and bloodstream contamination, bleeding, and pain when these layers are
found below the dermis. injured or exposed.
endocrine (EN-do-krin) system
system of glands that produce
chemicals called hormones that help
Endocrine System
to regulate many body activities and The endocrine system (Figure 6-16) produces chemicals called hormones that help to regu-
functions late many body activities and functions.

138 [Link]
M06_LIMM4554_13_SE_C06.indd Page 139 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-15 The layers of the skin.

Epidermis
Sensory receptors

Sebaceous gland
Arrector pili muscle
Dermis
Hair

Nerve
Subcutaneous Vein
layer Artery

Sweat gland

The pancreas is a key organ of the endocrine system. Among other functions, it secretes insulin (IN-suh-lin)
the hormone insulin. Insulin is critical to the body’s use of glucose, a sugar that fuels the a hormone produced by the
body. (Insulin will be discussed in greater detail in the chapter titled “Diabetic Emergencies pancreas or taken as a medication by
many diabetics.
and Altered Mental Status.”)
The adrenal glands are also an essential component of the endocrine system. They epinephrine (EP-uh-NEF-rin)
secrete epinephrine (also known as adrenaline) and norepinephrine. These chemicals serve a hormone produced by the body.
As a medication, it dilates respiratory
as neurotransmitters (chemical messengers) and engage the sympathetic nervous system
passages and is used to relieve severe
through a series of chemical receptors located in specific organ systems. For example, when allergic reactions.

Critical Decision Making

Identifying Possible Areas of Injury
Your knowledge of anatomy is a critical foundation for mak-
ing solid clinical decisions in the field. For each of the
patients in the following list, identify what organ or body system may be involved in
that patient’s complaint. This exercise requires no knowledge of diseases or condi-
tions—just the anatomy of the body.
1. Your patient falls in an icy parking lot. She tries to catch herself and breaks the
bones of the arm just above the wrist. What are these bones called?
2. Your patient was the driver of a car that was hit in a “T-bone,” or side-impact, crash.
He was the driver. He complains of pain in the left upper abdominal quadrant.
What organ is located in this area that can cause severe internal bleeding?
3. Your patient was riding a motorcycle and was thrown over the handlebars in a
crash. She has broken the large bone in her right thigh. What bone is this, and would
you expect blood loss from the fracture?

Chapter 6 | Anatomy and Physiology 139

M06_LIMM4554_13_SE_C06.indd Page 140 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-16 The endocrine system.

pineal gland pituitary gland

Pineal
gland

Regulates circadian rhythm Regulates many other

endocrine glands

thyroid and
parathyroid glands thymus gland

Thyroid

Parathyroid

Regulates metabolic rate and Development of

regulates blood calcium levels immune system

adrenal glands
ovaries

Cortex
Medulla

Ovary

Regulates water and

Regulates female
electrolyte levels
reproductive system

pancreas testis

Regulates blood sugar levels Regulates male

reproductive system

140 [Link]
M06_LIMM4554_13_SE_C06.indd Page 141 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

the fight-or-flight response is engaged, norepinephrine is released. It activates receptors in

the lungs (called beta 2 receptors), which stimulate the bronchioles to dilate and therefore
move more air. Receptors in the heart (called beta 1 receptors) are activated to increase
heart rate and increase the force of contraction.
The endocrine system is a complex system of chemical messaging that also interacts
with many other body systems.

Renal System
The renal system, also called the urinary system (Figure 6-17), helps the body regulate renal system
fluid levels, filter chemicals, and adjust body pH. Fluid balance is essential to a healthy the body system that regulates fluid
body. An average adult excretes roughly a liter and a half of urine per day. The renal sys- balance and the filtration of blood.
Also called the urinary system.
tem can adjust this fluid movement to account for changes in fluid intake or fluid loss
such as bleeding.
The kidneys are the principal organs of the renal system. They help filter a waste prod- kidneys
uct called urea from the blood and provide fluid balance by regulating the uptake of sodium organs of the renal system used to
and the excretion of urine. The kidneys also assist the buffer system with the production of filter blood and regulate fluid levels
in the body.
bicarbonate for the blood. Bicarbonate is an essential substance used to help regulate acid-
ity or pH in the body. bladder
The renal system also includes the bladder and its connecting passages. The bladder the round saclike organ of the renal
system used as a reservoir for urine.
is a round, hollow sac that serves as a fluid reservoir for urine. It receives urine from the
kidneys via small tubes called ureters. Urine is excreted from the bladder to the outside ureters (YER-uh-terz)
world through a tube called the urethra. In males, the urethra passes through the penis. the tubes connecting the kidneys to
In females, the urethra is shorter and emerges from the body just above the vaginal the bladder.
opening. urethra (you-RE-thra)
tube connecting the bladder to the
vagina or penis for excretion of urine.

Reproductive System
The reproductive system is a group of organs and glands designed for the specific purpose reproductive system
of reproduction. It is important to note here, and as you probably already know, the repro- the body system that is responsible
for human reproduction.
ductive systems of men and women vary greatly and contain different organs. The female
reproductive system will be discussed in more detail in the “Obstetric and Gynecologic
Emergencies” chapter.

Male Reproductive System

The primary organs of the male reproductive system (Figure 6-18A) are the testes and the testes (TES-tees)
penis. The testes produce sperm, the male component of reproduction, and are housed out- the male organs of reproduction
side the body in the scrotum. The testes are connected to the penis through a small tube used for the production of sperm.
called the epididymis. The penis is the external reproductive organ of the male and is used penis
for both sexual intercourse and urination. the organ of male reproduction
responsible for sexual intercourse
and the transfer of sperm.
Female Reproductive System
The primary organs of the female reproductive system (Figure 6-18B) are the ovaries, the
uterus, and the vagina. The ovaries are located bilaterally in the lower quadrants of a ovaries
female’s abdomen and serve to produce ova (eggs) for reproduction. The ovaries are con- egg-producing organs within the
female reproductive system.
nected to the uterus via the fallopian tubes, also called the oviducts. The fallopian tubes are
the site where sperm fertilizes the descending ovum. The uterus is a muscular organ located uterus (YOU-ter-us)
along the midline in the lower quadrants of a female abdomen. The uterus is designed to female organ of reproduction used
to house the developing fetus.
contain the developing fetus through the forty weeks of pregnancy. Although it is a small
organ, it has a huge potential to grow as pregnancy develops. It is also highly vascular and at
times of pregnancy can be prone to serious bleeding. The uterus connects to the vagina, or vagina (vuh-JI-na)
birth canal. The vagina serves not only as the exit route for the fetus but also as the female the female organ of reproduction
used for both sexual intercourse and
reproductive organ and site of sexual intercourse.
as an exit from the uterus for the fetus.

Chapter 6 | Anatomy and Physiology 141

M06_LIMM4554_13_SE_C06.indd Page 142 24/12/14 8:37 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-17 The renal/urinary system.

kidney

Hypophysis Pineal gland

(pituitary) gland
ureter

Filters blood and

produces urine and
Thyroid Thymus gland
parathyroid gland Ureter

urinary bladder Transports urine to the bladder

Adrenal Pancreas
gland
Urinary
bladder

male urethra

Urethra
Stores urine
Testis (male) Ovary (female)

female urethra
Urinary
bladder

Transports urine to exterior

Rectum
Vaginal Urethra Clitoris
canal

Transports urine to exterior

142 [Link]
M06_LIMM4554_13_SE_C06.indd Page 143 24/12/14 8:38 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-18 (A) The male reproductive system.

[LZ[LZ LWPKPK`TPZ

;LZ[LZ
,WPKPK`TPZ

7YVK\JLZZWLYTHUKZLJYL[LZ :[VYLZZWLYT
[LZ[VZ[LYVUL

]HZKLMLYLUZ ZLTPUHS]LZPJSLZ

:LTPUHS
]LZPJSLZ
=HZ
KLMLYLUZ

;YHUZWVY[ZZWLYT[V\YL[OYH :LJYL[LZÅ\PKMVYZLTLU

WYVZ[H[LNSHUK I\SIV\YL[OYHSNSHUK

7YVZ[H[L
NSHUK

WLUPZ
)\SIV\YL[OYHS
NSHUK

:LJYL[LZÅ\PKMVYZLTLU :LJYL[LZÅ\PKMVYZLTLU

7LUPZ

+LSP]LYZZLTLUK\YPUN
PU[LYJV\YZL

Chapter 6 | Anatomy and Physiology 143

M06_LIMM4554_13_SE_C06.indd Page 144 24/12/14 8:38 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Figure 6-18 (B) The female reproductive system.

breast uterus

Uterus

Produces milk Site of development of fetus

fallopian tube ovary

Fallopian
tube

Ovary

Transports ovum to uterus Produces ova and secretes

estrogen and progesterone

vagina vulva
Urinary
bladder

Rectum
Vagina Urethra Clitoris Vulva

Receives semen during Protects vaginal orifice

intercourse; birth canal and urinary meatus

144 [Link]
M06_LIMM4554_13_SE_C06.indd Page 145 24/12/14 8:38 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Chapter Review
Key Facts and Concepts
• As an EMT, your knowledge of the anatomy, or structure,
and the functions, or physiology, of the body will be impor-
tant in allowing you to assess your patient and communicate • Nervous system
your findings with other EMS personnel and hospital staff • Digestive system
accurately and efficiently. • Integumentary system
• Major body systems with which you should be familiar: • Endocrine system
• Musculoskeletal system • Renal system
• Respiratory system • Reproductive systems (male and female)
• Cardiovascular system

Key Decisions
• Can I identify critical organs and structures that reside in an
area where a patient has a complaint or traumatic injury?

Chapter Glossary
acetabulum (AS-uh-TAB-yuh-lum) the pelvic socket into which bladder the round sac-like organ of the renal system used as a
the ball at the proximal end of the femur fits to form the hip joint. reservoir for urine.
acromioclavicular (ah-KRO-me-o-klav-IK-yuh-ler) joint blood pressure the pressure caused by blood exerting force
the joint where the acromion and the clavicle meet. against the walls of blood vessels. Usually arterial blood pressure
acromion (ah-KRO-me-on) process the highest portion of (the pressure in an artery) is measured. See also diastolic blood
the shoulder. pressure; systolic blood pressure.

alveoli (al-VE-o-li) the microscopic sacs of the lungs where gas brachial artery artery of the upper arm; the site of the pulse
exchange with the bloodstream takes place. checked during infant CPR.

anatomy the study of body structure. bronchi (BRONG-ki) the two large sets of branches that come
off the trachea and enter the lungs. There are right and left bron-
aorta (ay-OR-tah) the largest artery in the body. It transports
chi. Singular bronchus.
blood from the left ventricle to begin systemic circulation.
calcaneus (kal-KAY-ne-us) the heel bone.
appendix a small tube located near the junction of the small and
large intestines in the right lower quadrant of the abdomen, the capillary (KAP-i-lair-e) a thin-walled, microscopic blood ves-
function of which is not well understood. Its inflammation, called sel where the oxygen/carbon dioxide and nutrient/waste exchange
appendicitis, is a common cause of abdominal pain. with the body’s cells takes place.

arteriole (ar-TE-re-ol) the smallest kind of artery. cardiac conduction system a system of specialized muscle tissues
that conducts electrical impulses that stimulate the heart to beat.
artery any blood vessel carrying blood away from the heart.
cardiac muscle specialized involuntary muscle found only in
atria (AY-tree-ah) the two upper chambers of the heart. There
the heart.
is a right atrium (which receives unoxygenated blood returning
from the body) and a left atrium (which receives oxygenated cardiovascular (KAR-de-o-VAS-kyu-ler) system the system
blood returning from the lungs). Singular atrium. made up of the heart (cardio) and the blood vessels (vascular).
Sometimes called the circulatory system.
automaticity (AW-to-muh-TISS-it-e) the ability of the heart
to generate and conduct electrical impulses on its own. carotid (kah-ROT-id) arteries the large neck arteries, one on
each side of the neck, that carry blood from the heart to the head.
autonomic (AW-to-NOM-ik) nervous system the division of
the peripheral nervous system that controls involuntary motor carpals (KAR-pulz) the wrist bones.
functions. central nervous system (CNS) the brain and spinal cord.
Chapter 6 | Anatomy and Physiology 145
M06_LIMM4554_13_SE_C06.indd Page 146 24/12/14 8:38 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

central pulses the carotid and femoral pulses, which can be felt kidneys organs of the renal system used to filter blood and regu-
in the central part of the body. late fluid levels in the body.
clavicle (KLAV-i-kul) the collarbone. large intestine the muscular tube that removes water from
coronary (KOR-o-nar-e) arteries blood vessels that supply waste products received from the small intestine and moves any-
the muscle of the heart (myocardium). thing not absorbed by the body toward excretion from the body.

cranium the top, back, and sides of the skull. larynx (LAIR-inks) the voice box.
cricoid (KRIK-oid) cartilage the ring-shaped structure that ligament tissue that connects bone to bone.
forms the lower portion of the larynx. liver the largest organ of the body, which produces bile to assist
dermis (DER-mis) the inner (second) layer of skin, rich in in breakdown of fats and assists in the metabolism of various sub-
blood vessels and nerves, found beneath the epidermis. stances in the body.
diaphragm (DI-uh-fram) the muscular structure that divides lungs the organs where exchange of atmospheric oxygen and
the chest cavity from the abdominal cavity. A major muscle of waste carbon dioxide take place.
respiration. lymphatic (lim-FAT-ik) system the system composed of
diastolic (di-as-TOL-ik) blood pressure the pressure in the organs, tissues, and vessels that help to maintain the fluid balance
arteries when the left ventricle is refilling. of the body and contribute to the body’s immune system.
digestive system system by which food travels through the body malleolus (mal-E-o-lus) protrusion on the side of the ankle.
and is digested, or broken down into absorbable forms. The lateral malleolus, at the lower end of the fibula, is seen on the
outer ankle; the medial malleolus, at the lower end of the tibia, is
dorsalis pedis (dor-SAL-is PEED-is) artery artery supply-
seen on the inner ankle.
ing the foot, lateral to the large tendon of the big toe.
mandible (MAN-di-bul) the lower jaw-bone.
endocrine (EN-do-krin) system system of glands that produce
chemicals called hormones that help to regulate many body manubrium (man-OO-bre-um) the superior portion of the
activities and functions. sternum.
epidermis (ep-i-DER-mis) the outer layer of skin. maxillae (mak-SIL-e) the two fused bones forming the upper
jaw.
epiglottis (EP-i-GLOT-is) a leaf-shaped structure that pre-
vents food and foreign matter from entering the trachea. metacarpals (MET-uh-KAR-pulz) the hand bones.
epinephrine (EP-uh-NEF-rin) a hormone produced by the metatarsals (MET-uh-TAR-sulz) the foot bones.
body. As a medication, it dilates respiratory passages and is used muscle tissue that can contract to allow movement of a body part.
to relieve severe allergic reactions.
musculoskeletal (MUS-kyu-lo-SKEL-e-tal) system the
exhalation (EX-huh-LAY-shun) a passive process in which system of bones and skeletal muscles that support and protect
the intercostal (rib) muscles and the diaphragm relax, causing the the body and permit movement.
chest cavity to decrease in size and air to flow out of the lungs.
nasal (NAY-zul) bones the nose bones.
femoral (FEM-o-ral) artery the major artery supplying the leg.
nasopharynx (NAY-zo-FAIR-inks) the area directly poste-
femur (FEE-mer) the large bone of the thigh. rior to the nose.
fibula (FIB-yuh-luh) the lateral and smaller bone of the lower leg. nervous system the system of brain, spinal cord, and nerves that
gallbladder a sac on the underside of the liver that stores bile govern sensation, movement, and thought.
produced by the liver. orbits the bony structures around the eyes; the eye sockets.
humerus (HYU-mer-us) the bone of the upper arm, between oropharynx (OR-o-FAIR-inks) the area directly posterior to
the shoulder and the elbow. the mouth.
hypoperfusion inability of the body to adequately circulate blood ovaries egg-producing organs within the female reproductive
to the body’s cells to supply them with oxygen and nutrients. A system.
life-threatening condition. Also called shock. See also perfusion.
pancreas a gland located behind the stomach that produces
ilium (IL-e-um) the superior and widest portion of the pelvis. insulin and juices that assist in digestion of food in the duodenum
inhalation (IN-huh-LAY-shun) an active process in which the of the small intestine.
intercostal (rib) muscles and the diaphragm contract, expanding patella (pah-TEL-uh) the kneecap.
the size of the chest cavity and causing air to flow into the lungs.
pelvis the basin-shaped bony structure that supports the spine
insulin (IN-suh-lin) a hormone produced by the pancreas or and is the point of proximal attachment for the lower extremities.
taken as a medication by many diabetics.
penis the organ of male reproduction responsible for sexual
involuntary muscle muscle that responds automatically to intercourse and the transfer of sperm.
brain signals but cannot be consciously controlled.
perfusion the supply of oxygen to and removal of wastes from
ischium (ISH-e-um) the lower, posterior portions of the pelvis. the cells and tissues of the body as a result of the flow of blood
joint the point where two bones come together. through the capillaries.

146 [Link]
M06_LIMM4554_13_SE_C06.indd Page 147 24/12/14 8:38 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

peripheral nervous system (PNS) the nerves that enter and stomach muscular sac between the esophagus and the small
leave the spinal cord and travel between the brain and organs intestine where digestion of food begins.
without passing through the spinal cord. subcutaneous (SUB-ku-TAY-ne-us) layers the layers of fat
peripheral pulses the radial, brachial, posterior tibial, and dor- and soft tissues found below the dermis.
salis pedis pulses, which can be felt at peripheral (outlying) points systolic (sis-TOL-ik) blood pressure the pressure created in
of the body. the arteries when the left ventricle contracts and forces blood out
phalanges (fuh-LAN-jiz) the toe bones and finger bones. into circulation.
pharynx (FAIR-inks) the area directly posterior to the mouth tarsals (TAR-sulz) the ankle bones.
and nose. It is made up of the oropharynx and the nasopharynx.
tendon tissue that connects muscle to bone.
physiology the study of body function.
testes (TES-tees) the male organs of reproduction used for the
plasma (PLAZ-mah) the fluid portion of the blood. production of sperm.
platelets components of the blood; membrane-enclosed frag- thorax (THOR-ax) the chest.
ments of specialized cells.
thyroid (THI-roid) cartilage the wing-shaped plate of carti-
posterior tibial (TIB-ee-ul) artery artery supplying the foot, lage that sits anterior to the larynx and forms the Adam’s apple.
behind the medial ankle.
tibia (TIB-e-uh) the medial and larger bone of the lower leg.
pubis (PYOO-bis) the medial anterior portion of the pelvis.
torso the trunk of the body; the body without the head and the
pulmonary (PUL-mo-nar-e) arteries the vessels that carry extremities.
deoxygenated blood from the right ventricle of the heart to the
lungs.
trachea (TRAY-ke-uh) the “windpipe”; the structure that con-
nects the pharynx to the lungs.
pulmonary veins the vessels that carry oxygenated blood from
the lungs to the left atrium of the heart. ulna (UL-nah) the medial bone of the forearm.
pulse the rhythmic beats caused as waves of blood move through ureters (YER-uh-terz) the tubes connecting the kidneys to the
and expand the arteries. bladder.

radial artery artery of the lower arm; the artery felt when tak- urethra (you-RE-thra) tube connecting the bladder to the
ing the pulse at the thumb side of the wrist. vagina or penis for excretion of urine.

radius (RAY-de-us) the lateral bone of the forearm. uterus (YOU-ter-us) female organ of reproduction used to
house the developing fetus.
red blood cells components of the blood. They carry oxygen to
and carbon dioxide away from the cells. vagina (vu-JI-na) the female organ of reproduction used for
both sexual intercourse and as an exit from the uterus for the fetus.
renal system the body system that regulates fluid balance and
the filtration of blood. Also called the urinary system. valve a structure that opens and closes to permit the flow of a
fluid in only one direction.
reproductive system the body system that is responsible for
human reproduction. vein any blood vessel returning blood to the heart.
respiration (cellular) the process of moving oxygen and car- venae cavae (VE-ne KA-ve) the superior vena cava and the
bon dioxide between circulating blood and the cells. inferior vena cava. These two major veins return blood from the
respiratory (RES-pir-ah-tor-e) system the system of nose, body to the right atrium. Singular vena cava.
mouth, throat, lungs, and muscles that brings oxygen into the ventilation the process of moving gases (oxygen and carbon
body and expels carbon dioxide. dioxide) between inhaled air and the pulmonary circulation of
scapula (SKAP-yuh-luh) the shoulder blade. blood.

shock See hypoperfusion. ventricles (VEN-tri-kulz) the two lower chambers of the
heart. There is a right ventricle (which sends oxygen-poor blood
skeleton the bones of the body.
to the lungs) and a left ventricle (which sends oxygen-rich blood to
skin the layer of tissue between the body and the external envi- the body).
ronment.
venule (VEN-yul) the smallest kind of vein.
skull the bony structure of the head.
vertebrae (VER-te-bray) the thirty-three bones of the spinal
small intestine the muscular tube between the stomach and the column.
large intestine, divided into the duodenum, the jejunum, and the
ileum, which receives partially digested food from the stomach voluntary muscle muscle that can be consciously controlled.
and continues digestion. Nutrients are absorbed by the body white blood cells components of the blood. They produce sub-
through its walls. stances that help the body fight infection.
spleen an organ located in the left upper quadrant of the abdo- xiphoid (ZIF-oid) process the inferior portion of the sternum
men that acts as a blood filtration system and a reservoir for (breastbone).
reserves of blood. zygomatic (ZI-go-MAT-ik) arches bones that form the struc-
sternum (STER-num) the breastbone. ture of the cheeks.

Chapter 6 | Anatomy and Physiology 147

M06_LIMM4554_13_SE_C06.indd Page 148 24/12/14 8:38 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

Preparation for Your Examination and Practice

Short Answer Thinking and Linking
1. List the three functions of the musculoskeletal system. Linking your knowledge of medical terminology with anatomy will
2. Name the five divisions of the spine, and describe the location help you not only better understand body systems but will provide
of each. practice for better understanding some compound terms. Identify
the following organs and structures, and list what body system they
3. Describe the physical processes of inhalation and exhalation.
are associated with.
4. List four places a peripheral pulse may be felt.
The hepatic vein
5. Describe the central nervous system and peripheral nervous The pulmonic valve
system. The gallbladder
6. List three functions of the skin. The coronary arteries
The renal artery
The esophagus
The aorta

Critical Thinking Exercises

Understanding anatomy and physiology is one thing, but apply- wounds. The first wound is found at the nipple line at the
ing it to patient care is another. Use the lessons of this chapter to intersection of the midclavicular line. The second wound is
apply anatomic structure to the injuries described below. Use the found just below the rib cage in the upper right abdominal
location of key organs to predict the likely damage that has been quadrant. The third wound is found in the center of the left
inflicted. upper quadrant of the abdomen. All three penetrations
have corresponding exits wounds on the posterior side of
• A thirty-one-year-old male was involved in a shooting. You
the patient. Use your knowledge of anatomy to describe the
arrive to find him lying on the ground unconscious. After
organs and organ systems likely involved with these three
assuring a patent airway and adequate breathing, you visu-
wounds.
alize his chest and abdomen and observe three penetrating

Street Scenes
“Respond to Elm Street near the intersection on Central Avenue The mother tells you she is fine. “Just take care of Peter. He’s
for a report of a motor-vehicle crash. Third-party call from a pass- only six years old.” You get into the vehicle next to the child and
erby on a cell phone. The time is now 1505 hours.” Your response hear that he has snoring respirations. You remember that the tongue
time is relatively fast, and you arrive before the dispatcher can is the most likely cause, so you manually stabilize the head and neck
provide any additional information. As you approach the scene, to prevent any further injury to his head and cervical spine. As you
you see that two vehicles are involved in the crash. It appears the do so, you push Peter’s jaw forward to move the tongue in the direc-
truck rear-ended the four-door sedan. A police officer on-scene tion of the mandible. It works and the snoring sound stops. Your
has already taken charge of traffic control. You ask him, “How partner prepares for extrication to the backboard.
many patients?” He replies, “Three.” You find an open area to
place the ambulance. Once assured that the scene is safe, you
begin your assessment.
Street Scene Questions
The driver of the truck is walking around the scene. The other 1. As you assess your young patient, how does his anatomy
vehicle had two occupants—a mother and her son, who was impact the process?
belted in the backseat. The mother is tending to the child, who 2. What should you be alert to when examining the child’s
appears to be unresponsive. It doesn’t look as if the impact speed abdomen?
was great, but the child hit his head fairly hard on the arm rest Before rotating Peter onto the backboard, you apply a cervi-
and you can still see the dent. An Emergency Medical Response cal collar. Then you rotate him onto the board. Remembering
unit is also on-scene, and they tell you they will check on the that a child’s head is larger in proportion to the rest of the body
driver of the truck. You turn your attention to the child. than an adult’s, you place a folded towel under Peter’s shoulders

148 [Link]
M06_LIMM4554_13_SE_C06.indd Page 149 24/12/14 8:38 AM f-w-155-user /205/PH01782/9780134024554_LIMMER/LIMMER_LIMMER_EMERGENCY_CARE13_SE_9780134024554 ...

in order to keep his head in a neutral position with the airway You take another set of vital signs and find that Peter has an
open. Your partner calls out to Peter to see if his mental status increase in pulse and respiration rates. You perform a reassess-
has changed. Peter responds to painful stimuli only. ment and find there is still pain in the left upper quadrant of the
Once Peter has been moved into the ambulance, you perform abdomen. As you run your hands over the patient’s back, you are
a head-to-toe exam. When you get to the abdomen, you palpate concerned by his apparent pain in the lumbar region of the spine,
all four quadrants and observe a bruise, probably caused by the which may have been caused by the force of the crash.
lap portion of the seat belt. Peter reacts as if in pain when you Your partner tells you the ETA to the hospital is ten minutes
touch the left upper quadrant, and you think that his spleen may and notifies emergency department personnel by radio. The
have been injured. transmission gives an overview of the injuries and the vital signs,
En route to the hospital, you find the patient is breathing at a noting the change in the last ten minutes. He mentions how the
rate of 32 and has a pulse of 150. You call out to Peter, and this patient’s mental status has changed and describes the abdominal
time he responds to your voice. and lumbar pain and location.
When the patient is being wheeled into the trauma room, the
Street Scene Questions staff do a quick assessment and check the abdomen. The emer-
3. What are the significant findings based on the assessment gency department physician tells you that because of assessment
and your knowledge of the human body? findings given in the radio report, she has a surgeon on the way to
4. Do you have any concerns about additional injuries to this check Peter.
patient? If so, what are they? “You did good!” she adds.

Chapter 6 | Anatomy and Physiology 149