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Data collection for trauma

1.      General routine information system- not specific to health

Population registers- record births and deaths along side age, gender and cause of deaths

Census is another example

2.      Routine health information system- set of data collected at clinic or hospital level for example rate of injuries.

3.      Specific surveillance system- surveys, research or routinely collected

Used by New Zealand ICU doctors to advocate for change- enforcement of seat belts

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Functional classifications are synarthrosis (immovable joint), amphiarthrosis (slightly movable joint) and diarthrosis (freely movable joint). The structural classifications are fibrous, synovial, cartilaginous and bony

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Fractures and factors influencing repair

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Fractures and factors influencing repair

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1. Fractures can be compound or simple which are internal and can only be seen on x-ray or they can be open or compound fractures which are fractures that project through the skin. Furthermore, fractures can be complete or incomplete fractures. Greenstick fracture is an incomplete fracture and it is a fracture on one side of the bone which causes a bend on the bone on the other side. Hairline Fracture is an incomplete simple fracture. This is minimal trauma to the bone and surrounding soft tissues and the crack extends into the outer layer of the bone but not completely through the bone. Transverse fracture is a complete simple fracture which is a fracture at a right angle to the bone’s long axis. An oblique fracture is a complete simple fracture which the break is at an angle to the bone’s long axis. There are other fractures such as displace fractures which produce new and abnormal bone arrangements. Non-displaced fractures retain the normal alignment of the bones or fragments. Compression fractures occur in vertebrae subjected to extreme stresses and are often associated with osteoporosis. Spiral fractures are produced by twisting stresses that spread along the length of the bone. Epiphyseal fractures tend to occur where the bone matrix is undergoing calcification and chondrocytes are dying. Comminuted fractures shatters the affected area into a multitude of bony fragments. A Colles fracture is a break in the distal portion of the radius and a Pott’s fracture occurs at the ankle and affects the medial malleolus and the distal tibia and the lateral malleolus of distal fibula.

Factors Affecting Bone Strength and Fracture Healing include age, physical stress/exercise, hormone levels, minerals, vitamins and genetic and environmental factors. Exercise promotes mineral recycling which allows bones to adapt to stress. Heavily stressed bones become thicker and stronger. Bones degenerate with age and lack of use. They degenerate quickly and up to one third of bone mass can be lost in a few weeks of inactivity. Normal bone growth and maintenance depend on nutritional and hormonal factors. A diet requires a source of calcium and phosphate salts as well as small amounts of magnesium, fluoride, iron, and manganese. Vitamin C is required for collagen synthesis, and stimulation of osteoblast differentiation. Vitamin A stimulates osteoblast activity. Vitamins K and B12 help synthesize bone proteins. Growth hormone and thyroxine stimulate bone growth. Estrogens and androgens stimulate osteoblasts. Calcitonin and parathyroid hormone regulate calcium and phosphate levels.

Fractures will only heal if blood supply and cellular components of periosteum and endosteum survive.

additional resources:
- https://courses.lumenlearning.com/boundless-biology/chapter/bone/

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1. In both ossification and fracture healing there is compact bone formation. Cells of the periosteum divide to form compact bone.

Ossification is the process of bone formation. There are two forms of ossification – endochondral ossification and intramembranous ossification.

1. Endochondral ossification – It begins with the formation of hyaline cartilage model.

Cartlidge enlarges, chondrocytes near the centre of the shaft increase in size. The matrix is reduced to a series of small struts that soon begins to calcify. The chondrocytes die and disintegrate which leaves cavities in the cartilage.

Blood vessels grow around the edges of the cartilage and the cells of the perichondrium convert to osteoblasts. The shaft becomes ensheathed in a superficial layer of bone.

Blood vessels penetrate the cartilage and invade the central region. Fibroblasts migrating with the blood vessels differentiate into osteoblasts and begin producing spongy bone at primary ossification centre. Bone formation spreads along the shaft towards both ends of the cartilage model.

Remodelling occurs as growth continues which creates a medullary cavity. The osseous tissue of the shaft becomes thicker and the cartilage near each epiphysis is replaced by shafts of bones.

Capillaries and osteoblasts migrate into the epiphyses which create secondary ossification centres.

The epiphyses become filled with spongy bone. The epiphyseal plate separates the epiphysis from the diaphysis. On the shaft side of the metaphysis, osteoblasts invade the cartilage and replace it with bone. New cartilage is produced at the same rate on the epiphyseal side.

At puberty the rate of epiphyseal cartilage production slows and the rate of osteoblasts activity accelerates. Epiphyseal cartilage gets narrower and narrower and then disappears (epiphyseal closure). Only an epiphyseal line remains. A thin cap of the original cartilage remains which is exposed to the joint cavity (articular cartilage).

Appositional growth – A superficial layer of bone forms early on in endochondral ossification. Developing bone increases in diameter the rough appositional growth at the outer surface. The cells of the inner layer of the periosteum differentiate into osteoblasts and deposit superficial layers of bone matrix. These osteoblasts become surrounded by matrix and differentiate into osteocytes. Over much of the surface, appositional growth adds a series of layers that form circumferential lamellae. The deepest circumferential lamellae are recycled and replaced by osteons of compact bone. Blood vessels and collagen fibres of periosteum can become enclosed within the matrix produced by the osteoblasts. Osteons form around small vessels. Bone matrix is being added to the outer surface of the growing bones, osteoclasts are removing bone matrix at the inner surface. As a result, the medullary cavity gradually enlarges as the bone gets larger in the diameter.

1. Intramembranous ossification

Mesenchymal cells aggregate and differentiate into osteoblasts and start to secrete organic components of the matric. The resulting osteoid becomes mineralized with calcium salts which forms the bone matrix.

Osteoblasts are trapped inside bony pockets where they differentiate into osteocytes. The developing bone grows outwards from the ossification centred in spicules.

Blood vessels branch within the region and grow between spicules. The rate of bone growth accelerates with oxygen and a reliable source of nutrients. As spicules interconnect they trap blood vessels within the bone

Continued deposition of bone by osteoblasts located close to blood vessels results in a plate of spongy bone with blood vessels weaving throughout

Remodelling around blood vessels produces osteons typical of compact bone. Osteoblasts on the bone surface along with connective tissue around the bone become the periosteum.

Fracture healing

After fracture, extensive bleeding occurs and a fracture hematoma soon closes off the injured vessels and leaves a fibrous meshwork in the damaged area. This disruption kills local osteocytes which broadens the area affected. Dead bone soon extends along the shaft in either direction.

The cells of the endosteum and periosteum undergo rapid cycles of cell divisions and the daughter cells migrate into the fracture zone. An internal callus forms as a network of spongy bone unites the inner edges of the fracture. An external callus of cartilage and bone encircles and stabilizes the outer edges of the fracture.

Osteoblasts replace central cartilage of the external callus with spongy bone which unites broken ends. Fragments of dead bone and areas of bone closest to the break are reabsorbed and replaced. The ends of the fracture are held firmly in place and can withstand normal stresses from muscle contractions.

A swelling initially marks the location of the fracture and this region is slowly remodelled by osteoblasts and osteoclasts. Under comparable stresses a second fracture will generally occur at a different site.

additional resources:
- https://www.ncbi.nlm.nih.gov/books/NBK539718/
- https://www.intechopen.com/chapters/64747

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how impulses are generated and conducted

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how impulses are generated and conducted

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1. All plasma membranes produce electrical signals by ion movements. Membranes are selectively permeable. They do not have an even distribution of ions across cell membrane (ECF – high [Na+] and [Cl-] and ICF – high [K+] and negatively charged proteins). Ions enter or leave cell is membrane channels and this difference in charge across membranes results in a transmembrane potential.  At rest the membrane is impermeable to anionic cytoplasmic proteins, very slightly permeable to Na+, very permeable to K+ and freely permeable to Cl-. There are passive forces acting across the plasma membrane – chemical gradients (concentration gradients of ions), electrical gradients (separate charges of positive and negative ions 🡪 potential difference) and electrochemical gradient (causes movement of ion across the membrane). There are also active forces across the membrane (sodium-potassium ATPase). Transmembrane potential rises and falls in response to temporary chance in membrane permeability resulting from opening and closing specific membrane channels. Passive channels are always open but permeability changes with conditions and active channels open and close in response to stimuli. These gated channels are either be close but capable of opening, open (activated) or deactivated (closed but not capable of opening). Chemically-gated channels open in presence of specific chemicals at a binding site and are found on neuron cell body and dendrites. Voltage gated channels respond to changes in transmembrane potential. They have activation gates and inactivation gates. Voltage-gated channels are characteristic of excitable membranes and are found in neural axons, skeletal muscle sarcolemma and cardiac muscle. Mechanically gated channels respond to membrane distortion and are found in sensory receptors. There are five main processes in neural activities. The first is resting potential which is the transmembrane potential of a resting cell. The second is graded potential which is then causes by a stimulus. It is temporary and it is localized changes in resting potential. Any stimulus that opens a gated channel produces a graded potential. The changes in transmembrane potential can’t be spread far from the site of stimulation. The graded change in transmembrane potential may involve either depolarization or hyperpolarization. Opening of sodium channels causes depolarization and opening of potassium channels causes hyperpolarization. The stronger the stimulus, the greater the change in the transmembrane potential. This then triggers specific cell functions at cell dendrites or cell bodies. At the motor end plate Ach is releases into synaptic cleft.  The third is action potential. This is an electrical impulse and it’s produced by graded potential. Initial stimulus. A graded depolarization of axon hillock large enough to change resting potential to threshold level of voltage-gated sodium channels. Transition from graded potential to action potential takes place in the axon hillock. It only occurs if grade potential or sum of graded potentials is above threshold. It appears when region of excitable membrane depolarizes to threshold. Voltage-gated Na+ channels open and Na+ enters cell. Voltage-gated K+ channels begin to open slowly. Rapid Na+ entry depolarizes cell. Na+ channels close and slower K+ channels open. K+ moves from cell to extracellular fluid.  K+ channels remain open and additional K+ leaves cell 🡪 hyperpolarizes it. Voltage-gated K+ channels close. Some K+ enters cell through leak channels. Cell returns to resting ion permeability and resting membrane potential. There is the refractory period – the period of time after neuron has generated an action potential when the neuron cannot be stimulated to generate another action potential. There are two phases the absolute refractory period is when no additional stimulus s able to produce an additional action potential. This coincides with voltage-gated sodium channels being activated and inactivated. Sodium channels may not be activated until they return to their resting states with activation gates closed and inactivation gates open. After the absolute refractory period there is the relative refractory period. Only a strong stimulus can produce an action potential. Voltage-gated sodium channels are able to open again and potassium channels are activated and membrane is repolarizing and hyperpolarizing. Propagation moves action potentials generated in axon hillock along entire length of axon.   This electrical impulse is propagated along the surface of the axon to the synapse. Type A fibres carry rapid information to/from CNS and are in sensory and motor axons associated with skeletal muscle and joints. Type B fibres carry intermediate signals and are found in efferent fibres of ANS and some sensory axons. Type C fibres carry slower information and they include efferent fibres of ANS and sensory axons. Unmyelinated axons have an entire axon membrane in contact with ECF. They have a low resistance to current leak and has ion channels through which current can leak. Each action potential initiates an identical action potential in the adjacent membrane segment to the end of the axon. This is known as continuous propagation. Saltatory propagation involves myelinated axons. Myelin provides high resistance to current leak prevents ion flow out of cytoplasm. Myelin limits amount on membrane in contact with ECF. AP (only at nodes of Ranvier) leaps the myelinated segments. High concentration of Na+ channels at nodes open at depolarization and keeps amplitude of AP constant from node to node. The fourth is synaptic activity. The presynaptic neuron conducts impulses towards the synapse and the postsynaptic neuron transmits signal away from the synapse.  Electrical synapses occur between cells that are electrically coupled via gap junctions. Axolemmas of each cell nearly touch. Gap junctions align channels that form pores/connexons that small substances can flow through. Chemical synapses are more efficient. They convert electrical signals into chemical signals so no signal strength is lost. Cells are not in direct contact and the signal is transmitted across the gap by chemical neurotransmitters. An action potential depolarizes the axon terminal and this opens voltage-gated Ca2+ channels and Ca2+ enters the cell. Calcium entry triggers exocytosis of synaptic vesicles contents. Neurotransmitters diffuses across the synaptic cleft and binds with receptors on postsynaptic cell.  Ion channels open leading to a local potential and possibly an action potential. Neurotransmitters can be returned to axon terminals for use or transported into glial cells. Enzymes inactivate neurotransmitters. Neurotransmitters can diffuse out of synaptic cleft. Excitatory neurotransmitters cause depolarization of postsynaptic membranes and promotes action potentials. Excitatory postsynaptic potential occurs if neurotransmitter depolarizes the cell. It causes Na+ channels to open which reduces membrane potential.  Inhibitory neurotransmitters cause hyperpolarization of postsynaptic membranes and suppresses action potential. Inhibitory postsynaptic potential occurs if neurotransmitter hyperpolarizes the cell. It causes K+ channels or anion channels to open which increase membrane potential. A single EPSP cannot induce an AP in postsynaptic neuron. EPSPs can summate to influence the activity of postsynaptic neuron (total depolarization produced determines generation of AP). There is temporal summation which is the addition occurring in rapid succession at a single synapse that is active repeatedly. Small EPSPs summate to produce a much greater depolarization of postsynaptic membrane. There is also spatial summation where the postsynaptic membrane is stimulated at the same time by a large number of terminals from the same or different neurons. Large numbers of receptors bind neurotransmitter and simultaneously initiate EPSPs – summate – enhance depolarization. The fifth is the information processing which is the integration of stimuli 🡪 response of postsynaptic cell.

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Anatomy of spinal cord and neural reflex

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Anatomy of spinal cord and neural reflex

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-The adult spinal cord is about 45cm long which a width of about 14mm. The posterior surface has a shallow, longitudinal groove – posterior median sulcus. There is a deeper groove along the anterior surface (the anterior median fissure).  The amount of grey matter is greatest in segments of spinal cord dedicated to sensory and motor control of limbs. The entire spinal cord can be divided into 31 segments on the basis of the origins of the spinal nerves. The segments are named according to the vertebral level at which the spinal nerves originate Every spinal segment is associated with a pair of spinal nerves. Dorsal and ventral roots on each side of the spine join to form the spinal nerve. The ventral roots contain the axons of motor neurons that extend to the periphery to control somatic and visceral effectors. The dorsal roots contain axons of sensory neurons which brings sensory information to the spinal cord. Dorsal root ganglion lies between the pedicles of the adjacent vertebrae. The spinal nerve divides into the dorsal and ventral rami.

five steps in a neural reflex.

1. Arrival of stimulus – The receptor is activated by a chemical or physical change.

2. Activation of sensory receptor – This is due to graded depolarization

3. The information is processed by postsynaptic cells (interneuron) – This is triggered by neurotransmitters.

4. Activation of motor neuron – Action potential involved

5. Response of peripheral effector – Triggered by neurotransmitters.

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Anatomical structural and functional divisions

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Anatomical structural and functional divisions

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-Anatomical divisions of the nervous system:

There are two divisions of the nervous system – the central nervous system and the peripheral nervous system.

The central nervous system: This consists of the brain and the spinal cord. These organs include neural tissue, blood vessels and connective tissues that protect and support. It is responsible for integrating, processing and coordinating sensory from inside and outside of the body and motor commands controlling peripheral organs. It also controls higher functions like intelligence, memory, learning, emotions and consciousness.
The peripheral nervous system:  This consists of all neural tissue outside the CNS. It consists of cranial nerves which are connected to the brain and spinal nerves which are attached to the spinal cord. Bundles of axons or nerve fibres carry sensory information and motor commands.

Function divisions of the nervous systems

The PNS can be divided into afferent and efferent divisions

1. The afferent division brings sensory information to the CNS from receptors in peripheral tissue and organs.

2. The efferent division carries motor commands from the CNS to the muscles, glands and adipose tissues (effectors). The efferent division can be further divided into somatic division system which controls skeletal muscle contractions. Contractions are under voluntary control or involuntary control. The second division is the autonomic nervous system (visceral motor system) which automatically regulates smooth muscle, cardiac muscle, glandular secretions and adipose tissue at subconscious level. The ANS includes the sympathetic division and the parasympathetic division which have antagonistic effects.

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EQUITY-provision of more resources to more vulnerable people compared to the ones who are advantaged

EQUALITY-provision of the same resources to everyone-some resources

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CLASSIFICATION OF JOINTS AND STRUCTURE OF SYNOVIAL JOINTS

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CLASSIFICATION OF JOINTS AND STRUCTURE OF SYNOVIAL JOINTS

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FUNCTIONAL CLASSIFICATION
• Based on the range of motion
• Immobile – synarthrosis
• Slightly mobile – amphiarthrosis
• Freely mobile – diathrosis

STRUCTURAL CLASSIFICATION
• Based on the tissue type and anatomical organization
of joint
- Fibrous
• Connected by fibrous connective tissue (no joint
cavity)
- Cartilaginous
• Connected by cartilage (no joint cavity)
- Synovial
• Most common
• Joint capsule filled with synovial fluid
- Bony

SYNOVIAL JOINT

• Posses joint cavity
• Enclosed articulating ends of bone
• Fibrous capsule
• Outer fibrous capsule
• Inner synovial membrane
• Joint capsule doesn't cover articular cartilage
• Filled with synovial fluid
• Secreted by synovial membrane
• Reduced friction, distributes nutrients and absorbs shock
• Articular surfaces of bones covered by hyaline
cartilage
• Can sometimes be divided : articular disc/menisci

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TYPES OF FRACTURES AND FACTORS THAT INFLUENCE REPAIR

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TYPES OF FRACTURES AND FACTORS THAT INFLUENCE REPAIR

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TYPES OF FRACTURES
1.transverse
2.linear
3.oblique(non displaced)
4.oblique displacement
5.spiral
6.greenstic
7.comminuted

factors affecting fracture repair
1. Age
2. Physical stress
3. Vitamin and minerals
- calcium and phosphorus
- vitamin C, K and B12
4. Hormone levels
5. Genetic and environmental
factors

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BONE MARKINGS SPECIFIC TO EACH BONE OR GROUP OF BONES

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BONE MARKINGS SPECIFIC TO EACH BONE OR GROUP OF BONES

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DEPRESSIONS
1.FOSSA-a shallow depression
2.SILCUS-narrow groove

OPENINGS
1.FORAMEN-rounded passageway through a bone
2.MEATUS-passage way through bone
3.FEISSURE-elogated cleft or slit
4.SINUS-chamber within a bone normally filled with air

ELEVATIONS AND PROJECTIONS
1.process-any projection or bump
2.ramus-an extension of a bone making an angle with the rest of the structure.

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CLASSIFICATION OF BONE MARKINGS AND FUNCTIONAL SIGNIFICANCE

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CLASSIFICATION OF BONE MARKINGS AND FUNCTIONAL SIGNIFICANCE

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1.elevations and projection
• Where tendons and ligaments attach
• At articulations with other bones

2. Depressions or grooves
• Where blood vessels and nerves run along the bone surface

3. Openings
Where blood vessels and nerves enter bone

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MACROSCOPIC AND MICROSCOPIC STRUCTURE OF LONG BONES

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MACROSCOPIC AND MICROSCOPIC STRUCTURE OF LONG BONES

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MACROSCOPIC

CONSIST OF:
1.DIAPHYSIS-heavy wall of compact bone with a central space called the medullary cavity
2.METHAPHYSIS-where epiphysis and diaphysis meet
3.EPIPHYSIS(distal/proximal)-wide part at the end of each bone
4.has articular cartilage which layers the bone
5.compact bone and spongy bone
6.yellow bone marrow in the medullary cavity

MICROSCOPIC

CONSIDT OF:
1. Osteoprogenitor cells-
• Mesenchymal stem cells
• Found in the inner cellular layer of periosteum
• Function in fracture repair or early bone remodeling

2. Osteoblasts (associated with remodeling)
• Immature bone cells
• Found beneath the periosteum
• Secrete bone matrix through osteogenesis
• Once miniralised it becomes osteoid

3. Osteocytes
• Mature bone cells (can’t divide)
• Surrounded by mineralized bone matrix
• Have cytoplasmic channels called canaliculi
• Have lacuna centrally
• Maintain bone protein and mineral content of bone matrix and aid in
repair of damaged bone

4. Osteoclasts
• breakdown bone matrix
• On edges of osteons close to the medullary canal
• Secrete acids and protein digesting enzymes
• Dissolves bone matrix (osteolysis)
• Releases stored minerals

5.compact bone
• Made up of multiple parallel
osteons
• No spaces between osteons
• Osteons provide strength

6.spongy bone

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1.support/scaffolding
-support of the body
-framework for the attachment of soft tissues and organs

2.storage of minerals and vitamins
-stores calcium and phosphorus
-stores lipids in the yellow marrow

3.Blood cell production
-red blood cells and white blood cells are produced in the bone marrow

4.protection
-protects internal organs e.g ribs protect lungs, heart and other thoracic and abdominal cavity organs.

5.levers
-facilitate movement by changing the magnitude and direction of forces generated by muscles.

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-Organised into two divisions
-Axial division and Appendicular division.

AXIAL division
-skull
-vertebrae
-sternum
-hyold bone

APPENDICULAR division
-pectoral girdle
-pelvic girdle
-upper and lower limbs

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RESUSCITATION:
A-AIRWAYS-check the airways
B-BREATHING-check the patients    breathing
C-CIRCULATION /CARDIAC-check the                                             patients pulse
D-DRIPS/DRUGS- administer a drip or drugs to the patient

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EPIDEMIOLOGY OF OF MOTOR VEHICLE CRASHES

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EPIDEMIOLOGY OF OF MOTOR VEHICLE CRASHES

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DETERMINATS-unworthy cars on the road, bad roads and driving while drunk

DISTRIBUTION-

PREVENTION-servicing of cars, fixing roads and introduction of limitations to alcohol consumption

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MIGRATION-movement of people from one area to another
UBERNISATION-movement of people from rural areas to urban areas

BAD EFFECTS
-overpopulation
-Riskier sex
-more accidents
-more sedentary styles
-increase rates of obesity due to intake of processed and unhealthy food
-asthma due to pollution

BENEFITS
-better access to health care-
-better access to nutrition
-better opportunities for rapid SES improvement leading to better health care.