2
UNIT ONE
EMERGENCY
called homeostasis. Judith’s blood tests revealed that her body had not yet recov-
ered from the accident. Levels of clotting factors her liver produced were falling
and blood oozed from her incision, a sign of impaired clotting. Judith’s blood glu-
cose level remained elevated, as it had been on arrival. Her body was still reacting
to the injury.
Based on Judith’s blood tests, heart rate, blood pressure, reports of pain,
and the physical exam, the doctor sent her back to the operating room. Sure
enough, the part of her liver where the injured portion had been removed was
still bleeding. When the doctors placed packing material at the wound site, the
oozing gradually stopped. Judith returned to the recovery room. When her con-
dition stabilized, she continued recovering in a private room. This time, all went
well, and a few days later, she was able to go home. The next time she drove,
Judith wore her seat belt!
Imagine yourself as one of the health-care professionals who helped iden-
tify Judith R.’s injury and got her on the road back to health. How would you
know what to look, listen, and feel for? How would you place the signs and
symptoms into a bigger picture that would suggest the appropriate diagnosis?
Nurses, doctors, technicians, and other integral members of health-care teams
must have a working knowledge of the many intricacies of the human body.
How can they begin to understand its astounding complexity? The study of
human anatomy and physiology is a daunting, but fascinating and ultimately
life-saving, challenge.
J
udith R. had not been wearing a seat belt when the accident
occurred because she had to drive only a short distance. She
hadn’t anticipated the intoxicated driver in the oncoming lane who
swerved right in front of her. Thrown several feet, she now lay near
her wrecked car as emergency medical technicians immobilized
her neck and spine. TerriF
ed, Judith tried to assess her condition. She didn’t
think she was bleeding, and nothing hurt terribly, but she felt a dull ache in
the upper right part of her abdomen.
Minutes later, in the emergency department, a nurse checked Judith’s
blood pressure, pulse and breathing rate, and other vital signs that reflect
underlying metabolic activities necessary for life. Assessing vital signs is impor-
tant in any medical decision. Judith’s vital signs were stable, and she was alert,
knew who and where she was, and didn’t have obvious life-threatening injuries,
so transfer to a trauma center was not necessary. However, Judith continued
to report abdominal pain. The attending physician ordered abdominal X rays,
knowing that about a third of patients with abdominal injuries show no out-
ward sign of a problem. As part of standard procedure, Judith received oxygen
and intravenous ±
uids, and a technician took several tubes of blood for testing.
A young physician approached and smiled at Judith as assistants
snipped o²
her clothing. The doctor carefully looked and listened and gen-
tly poked and probed. She was looking for cuts; red areas called hematomas
where blood vessels had broken; and treadmarks on the skin. Had Judith
been wearing her seat belt, the doctor would have checked for characteristic
“seat belt contusions,” crushed bones or burst hollow organs caused by the
twisting constrictions that can occur at the moment of impact when a per-
son wears a seat belt. Had Judith been driving fast enough for the air bag to
have deployed, she might have su²
ered abrasions from not having the seat
belt on to hold her in a safe position. ³inally, the doctor measured the girth
of Judith’s abdomen. If her abdomen swelled later on, this could indicate a
complication, such as infection or internal bleeding.
On the basis of a hematoma in Judith’s upper right abdomen and the
continued pain coming from this area, the physician ordered a computed
tomography (CT) scan. It revealed a lacerated liver. Judith underwent emer-
gency surgery to remove the small torn portion of this vital organ.
When Judith awoke from surgery, a di²
erent physician was scanning her
chart, looking up frequently. The doctor was studying her medical history for
any notation of a disorder that might impede healing. Judith’s history of slow
blood clotting, he noted, might slow her recovery from surgery. Next, the phy-
sician looked and listened. A bluish discoloration of Judith’s side might indi-
cate bleeding from her pancreas, kidney, small intestine, or aorta (the artery
leading from the heart). A bluish hue near the navel would indicate bleeding
from the liver or spleen. Her umbilical area was somewhat discolored.
The doctor gently tapped Judith’s abdomen and carefully listened to
sounds from her digestive tract. A drumlike resonance could mean that a hol-
low organ had burst, whereas a dull sound might indicate internal bleeding.
Judith’s abdomen produced dull sounds throughout. In addition, her abdo-
men had become swollen and the pain intensiF
ed when the doctor gently
pushed on the area. With Judith’s heart rate increasing and blood pressure
falling, bleeding from the damaged liver was a deF
nite possibility.
Blood tests conF
rmed the doctor’s suspicions. Blood is a complex mixture
of cells and biochemicals, so it serves as a barometer of health. Injury or illness
disrupts the body’s maintenance of specific levels of various biochemicals,
The di²
erence between life and death may depend on a health-care
professional’s understanding of the human body.
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