serous mesothelium (serosa)

lines the walls of the chamber

• covers mediastinal chamber
• mediastinum containes heart which has it's own fibrous pericardium sac

• covers the lungs
• serous nature helps in keeping the lungs expanded due to "surface tension"

• moves air from external environment----> lungs and from lungs----> external environment
• NO GAS exchange

Components:

Nasal Pasageway (pseudostratiefied ciliated columnar epithelium)

Funtions:

1. filter
2. warming
3. humidy

Components of Conducting Airway

(Pharynx)

Components of Conducting Airway

(Larynx)

primary role is to PROTECT the airway by CLOSING the airway with the 'epiglottis'

Components of Conducting Airway

(Trachea)

• Cricoid Cartilage -superior to trachea
• Thyroid Cartilage-(Adam's apple)
• Cricothyroid Membrane- bw thyroid and cricoid cartilage (site of cricothyotomy 'conyotomy')
• Primary Airway
• Splits---> left & right Bronchi

Components of Conducting Airway

(Bronchi)

Primary (L/R)

Right has less of an angle so when we swallow something it will go down RIGHT lung

Corina- the small flap in the middle of the primary bifurcation

Secondary (Lobar)

1. Right Secondary- 3 lobes

2. Left Secondry- 2 lobes

Tertiary (Segmental)

10 segments in each lung

Components of Conducting Airway

(Bronchioles)

Primary->Terminal Bronchioles-->Respiratory Bronchioles

Primary Bronchioles

1. Modify airflow through the lung

2. Lose cartilage

3. Gain C.T. & Smooth Muscle

GAS EXCHANGE

Respiratory Bronchioles

-NO cartilage or smooth muscle & very little C.T.

Alveolar Ducts

-branches of Respiratory Bronchioles

Alveoli

-functional unit of the lungs

-Type II cells

   -secrete "lipoprotein surfactant"

   -surfactant keeps alveoli from collapsing

Nasal passageway→Pharynx→Larynx→Trachea→Bronchi→Secondary Bronchi→Tertiary Bronchi→Primary Bronchioles→Terminal Bronchioles→Respiratory Bronchioles→Alveolar Ducts→Alveoli

List

• Nasal passageway
• Pharynx
• Larynx
• Trachea
• Primary Bronchi
• Secondary Bronchi
• Tertiary Bronchi
• Primary Bronchioles
• Terminal Bronchioles
• Respiratory Bronchioles
• Alveolar Ducts
• Alveoli

Heart & Great Vessels

Mediastinal Region

demarcated

superiorly by sternal angel @ level of T4

inferiorly by diaphragm

Heart & Great Vessels

Superior to Sternal Angle

@level of T4

*BATTS*

• Brachiocephalic Vein
• Aortic Arch & its branches (deep to sternal angle)
• Trachea
• Thymus Gland
• Superior Vena Cava

Heart & Great Vessels

Inferior

(inferiorly by diaphrapm)

Anterior

• contains CT bw pericardial sack and deep surface of the sternum
• contains internal thoracic artery & vein

Middle

• contains Heart & Associated Structures

Posterior *EATT*

• Esophagus
• Azygous System of Veins
• Thoracic Aorta
• Throacic Duct (primary lymphatic duct in the body)
  • drains into brachiocephalic junction superiorly and cisterna chyli inferiorly
    • Nerves
      • Intercostal
      • Autonomic
      • ****VAN****

Pericardial Sack

OUTER

Fibrous Pericardium

• surrounds the heart and holds it in place so it can beat
• inferiorly attached to the diaphragm

Pericardial Sack

INNER

Serous Pericardium

• Parietal
  • Against the inner surface of the fibrous pericardium
• Visceral (Epicardium)
  • covers surface of heart

Pericardial Sack

Cardiac Tamponade

Layers around the heart from

"Superficial→to Deep"

• space between the Ascending Aorta and the Pulmonary Trunk
• More medially placed within the heart

• cul-de-sac bw the Posterior Wall of the heart, Pulmonary Veins & Parietal Layer of Serous Pericardium
• More laterally placed

• 4 chambered muscular pump
• circulates blood through Pulmonary circulation & systemic circulation
• cardiac muscle cells are striated and capable of Spontaneous Depolarization
  • cells connected by Intercalated Disks
  • cells communicated with one another by Gap Junction (tight junctions)

Functional Syncytium

• Electrically connected heart cells which function in unity

Functional Vortex

• cardiac muscle fibers arise from dense C.T. cardiac skeleton at the base and spiral around the heart to its apex
• facilitates Ejection of Blood

• intersection between rough and smooth atrial walls
• aka "Sulcus Terminalis" on outside of the heart

• attached from the ventricular walls →atrioventricular valve flaps
• fx to hold AV valves shut during ventricular contraction
• help prevent backflow

Intrinsic Innervation of the Heart

Sino-Atrial Node (Pacemaker)

 most rapid rate of deplorization

Sino-Atrial Node (Pacemaker) Components

Bachman Fibers

Sino-Atrial Node (Pacemaker) Component

Internodal Fibers

Intrinsic Innervation of the Heart

Atrio-Ventricular Node

Instrinsic Innervation of the Heart

Bundle of His

• only cardiac muscle which interconnects the Atrium to the Ventricles
• pass from atrium into septum of ventricles
• divides into left and right bundle branches
• carries the interventricular septum

Intrinsic Innervation of Heart

Left and Right Bundle Branches

Instrinsic Innervation of the Heart

Purkinje Fibers

• HR and ejection volumes are controlled by the autonomic nervous system

• Parasympathetic and Sympathetic components from Cardiac Plexus

Extrinsic Innervation of the Heart

Parasympathetic

• N: vagus nerve
• innervates @ SA node
• slows HR and reduces cardiac output
• (-) Negative Chronotropism
• (+) Positive Iontropism

Extrinsic Innervation of the Heart

Sympathetic

• N: superior, middle, and inferior chain ganglia
• terminate near the SA and AV nodes
• speeds HR
• Increase cardiac output
• positive chronotropism
• negative iontropism
• positive dromotropism

moving impulse faster or slower (rate of conduction)

Sympathetic N.S.

Coronary Circulation

Arteries

*LAC*  *RPM*

• Left coronary artery (1st direct branch off the aorta)
• Anterior interventricular
• Circumflex

• Right coronary artery (1st direct branch off the Aorta)
• Posterior Interventricular
• Marginal

Coronary Circulation

Veins

• Interventricular veins
• Great Cardiac (anterior)
• Middle Cardiac (posterior)
• Small Cardiac (runs with Circumflex)
• Thebesian
  • run superficial→deep
  • small veins which drain like lymphatics into all cardiac chambers
  • helps prevent fluid from building up bw chambers of the heart

Coronary Circulation

Coronary Sinus

• site where all coronary veins coalesce and drain into right atrium
• located in close proximity to the IVC

• RA (Right Atrium)
• RV (Right Ventricles)
• PT→4 PA (Pulmonary Trunk)
• PA (Pulmonary Arteries)
• Lungs
• PV (Pulmonary Veins)
• LA (Left Atrium)
• LV (Left Ventricles)
• Aorta
• Into Systemic Circulation

Fetal Circulation

Primary Flow

Umbilical Vein -attached to placenta (filter){Ligamentum Teres in Adult}

Ductus Venosus (bypass the liver) {Ligamentum Venosum in Adult}

IVC

Right Atrium

Foramen Ovale {Fossa Ovalis in Adults}

Left Atrium

Left Ventricle

Aorta

Into Systemic Circulation

Fetal Circulation

Secondary Flow

• Umbilical Vein
• Ductus Venosis
• IVC
• Right Atrium
• Right Ventricle
• Pulmonary Trunk
• Ductus Arteriosis {Ligamentum Arteriosum in Adults}
• Aorta
• Into Systemic Circulation

IVC & SVC→RA→Tricuspid Valve→RV→Pulmonary Semi-lunar Valve→PT→PA→Lungs→PV→LA→Bicuspid (Mitral) Valves→LV→Aortic Semi-lunar Valve→Aortic Arch→Aorta→Systemic Circulation

Back Muscles

Extrinsic Muscles

• attach upper extremity to the vertebral column
• involved in respiration or moving the arms
• do not move spine

Back Muscles

Intrinsic Muscles

• maintain posture
• move vertebral column and spine

• gap in musculature of the back
• is used to listen to the posterior segments of lungs
• Borders
  • Lateral
    • Vertebral border of Scapula
  • Inferior
    • Latissimus dorsi muscle
  • Superior
    • Trapezius Muscle

Trapezius

Rhomboid Major

Rhomboid Minor

Latissimus Dorsi

Pectorales Major

Serratus Anterior

Levator Scapulae

Muscles used for

Elevation

• Upper Trapezius
• Rhomboid Major & Minor
• Levator Scapulae

Muscles used for

Depression

• Lower Trapezius
• Lower Serratus Anterior

Muscles used for

Upward Rotation

• Serratus Anterior
• Upper Trapezius
• Lower Trapezius

Muscles used for

Downward Rotation

• Rhomboids
• Levator Scapulae

Muscles used for

Abduction (away from body)

• Serratus Anterior

Muscles used for

Adduction (close to body)

• Trapezius
• Rhomboids

Trapezius

(Origin)

• Superior Nuchal line
• Ex. Occipital protuberance
• Spinous processes of C7-T12

Trapezius

(Insertion)

• lateral 1/3 of clavicle
• acromion
• spine of scapula

Trapezius

(Action)

• upper 1/3 elevates scapula
• middle 1/3 retracts scapula
• lower 1/3 depress scapula

Trapezius

(Nerve Supply)

Spinal Root

C3- C4 of Accessory Nerve (CN XI)

Latissimus Dorsi

{Origin}

• Spinous Process of T7-T12
• Iliac Crest
• Thoracolumbar Fascia

Latissimus Dorsi

{Insertion}

Latissimus Dorsi

Action

• extends, adducts, and medially rotates humerus
• raises body toward arms during climbing

Latissimus Dorsi

Nerve Supply

Thoracodorsal nerve C6, C7, C8

(Middle Subscapular Nerve)

Rhomboid Minor

Origin

Rhomboid Minor

Insertion

Rhomboid Minor

Action

• retract scapula
• tilts glenoid inferiorly
• fixes scapula to thoracic wall

Rhomboid Minor

Nerve Supply

Rhomboid Major

Origin

Rhomboid Major

Insertion

Rhomboid Major

Action

• retract scapula
• tilts glenoid inferiorly
• fixes scapula to thoracic wall

Rhomboid Major

NS

Levator Scapulae

Origin

Levator Scapulae

Insertion

Levator Scapulae

Action

• elevates scapula
• tilts glenoid cavity inferiorly

Levator Scapulae

NS

Serratus Posterior Superios

Origin

Serratus Posterior Superior

Insertion

Serratus Posterior Superior

Action

• elevates ribs
• increases diameter of thorax
• aid in inspiration

Serratus Posterior Superior

NS

Serratus Posterior Inferior

Origin

Serratus Posterior Inferior

Insertion

Serratus Posterior Inferior

Action

• depresses ribs
• increases diameter of thorax
• aids in inspiration

Serratus Posterior Inferior

NS

Superficial

Splenius Capitus and Cervicis

Origin

Superficial

Splenius Capitus

Insertion

1. mastoid process
2. lateral aspect of superior nuchal line

Superficial

Cervicis

Origin

Superficial

Splenius Capitus and Cervicis

Action- ALONE

Superficial

Splenius Capitus and Cervicis

Action- TOGETHER

Superficial

Splenius Capitus and Cervicis

Nerve Supply

Intermediate

Erector Spinae (3 Columns)

Origin

(Lateral)- Iliocostalis

(Intermediate)-Longissimus

(Medial)-Spinalis

1. broad tendon from iliac crest & sacrum
2. inferior lumbar spinus processes

Intermediate

Erector Spinae (3 Columns)

Insertion

(Lateral)- Iliocostalis

1. ribs
2. cervical transverse processes

Intermediate

Erector Spinae (3 Columns)

Insertion

(Lateral)- Iliocostalis

*CHIEF EXTENSOR of vertebral column

Intermediate

Erector Spinae (3 Columns)

Nerve Supply

(Lateral)- Iliocostalis

Intermediate

Erector Spinae (3 Columns)

Insertion

(Intermediate)-Longissimus

1. ribs
2. cervical & thoracic transverse processes
3. mastoid process

Intermediate

Erector Spinae (3 Columns)

Action-ALONE

(Intermediate)-Longissimus

Intermediate

Erector Spinae (3 Columns)

Nerve Supply

(Lateral)- Iliocostalis

(Intermediate)-Longissimus

(Medial)-Spinalis

Intermediate

Erector Spinae (3 Columns)

Action-TOGETHER

(Lateral)- Iliocostalis

(Intermediate)-Longissimus

(Medial)-Spinalis

Intermediate

Erector Spinae (3 Columns)

Insertion

Deep

Semispinalis Capitis, Cervicis, and Thoracis

Origin

Deep

Semispinalis Capitis, Cervicis, and Thoracis

Insertion

1. occipital bone
2. cervical and thoracic spinous processes

Deep

Semispinalis Capitis, Cervicis, and Thoracis

Action

Deep

Semispinalis Capitis, Cervicis, and Thoracis

Nerve Supply

Multifidus

Origin

1. sacrum
2. ilium
3. cervical and thoracic transverse process

Multifidus

Insertion

Multifidus

Action

• stablize vertebrae
• extends and laterally bends vertebral column

Multifidus

Nerve Supply

1. Superior Vena Cava
2. Aorta
3. Pulmonary Artery
4. Left Atrium
5. Right Atrium
6. Right Ventricle
7. Left Ventricle
8. Right Coronary Vein
9. Right Coronary Artery
10. Apex

1. SA Node
2. Left Atrium
3. Left Ventricle
4. Apex
5. Perkinje Fibers
6. L/R Bundle Branches
7. Atrioventricular bundle
8. Atrioventricular AV Nodes

1. Right common carotid
2. Right internal jugular
3. Right Subclavian A
4. Brachiocephalic Artery
5. Brachiocephalic Vein
6. SVC
7. Left Common carotid
8. Left internal jugular
9. Left subclavian
10. Aortic