A patient was brought to the Emergency Department by ambulance with two arrow wo

Question

A patient was brought to the Emergency Department by ambulance with two arrow wounds. One arrow is still in the patient on the left side; entering anteriorly between the 7th and 8th ribs in a 15 degree angle, the arrow head protruding posteriorly. The second wound is located in the posterior cervical triangle.  
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Question 4

a.Describe the cardiovascular system and explain how both the pulmonary and systemic circuits will be affected by both arrows. Include the effect on the Hematocrit and Hemoglobin values.

b. Identify the possible neuromuscular effects of the second arrow and explain your reasoning.   Describe the components of a neuromuscular junction including key organelles.

Explanation / Answer

a, one arrow entering anteriorly between th 7th and 8th ribs in a 15degree angle,second wound is located in the posterior cervicle triangle..
Arrow located 7th and 8th ribs between 15degree angle means it will affect the left ventricle(LV) of the heart,then on to the systemic circulation will be affected..
Human pulmonary circulation or systemic circulation:
   Blood enters into the Right atrium that is deoxygenated blood returning to the heart from superior vena cava and inferior vena cava..blood pumps into right ventricle from right atrium..during contraction from left ventricle it sends the oxygen-depleted blood to the lungs through pulmonary artery..this artery branches left and right pulmonary artries..In the lung co2 blood is exchanged for o2 at lung alveoli..alveoli are small airsacs..now o2-rich blood is transported back to the heart by pulmonary veins..pulmonary circuits completed when pulmonary veins return blood tothe left atrium of the heart..when the heart contracts to begin blood pumped from the left atrium to the left ventricle and later to systemic circulation,after moving to the pulmonary circuit,O2 rich blood inthe left ventricle leaves the heart through aorta..The blood circulated from the aorta to the rest of the body by various major arteries..so in this case blood circulation from the aorta get affected because left ventricle got affected..it can not pump blood to aorta..
   There are amjor blood vessels in the cervicle spinal region including internal jugular vein,subclavian vein and external jugular vein and right common carotid artery..in posterior triangle area external jugular vein located on either side of the neck it carry deoxygenated blood from the brain back toward the heart..
   Due to blood loss there will be alter hemoglobin and hemotocrit values because fluid loss reduces blood volume..when heart and lung affects it causes low oxygen levels can also affect blood values..
b, posterior triangle area is one of the important area of the body because of presence of brachial plexus,the dorsal scapula nerve and proximal parts of the brachial plexus of nerves supplying the upper limb..The sternocledomastoid and the trapezius muscles and middle part of the cervicle from the boundaries of the posterior triangle..A line connecting the junction between the upperthird and the lower two-thirds of the posterior border of the sternocleidomastiod to a point two fingers 5cm above the clavicle on the anterior border of the trapezius is the surface marking of the accessary nerve..
Neuromuscular effect like accessory nerve disorder or spinal accessory nerve palsy can occur..

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