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The transcription discusses different types of muscles in the body, including cardiac, skeletal, and smooth muscles. It also explains the properties of muscle fibers and the automaticity of the heart. The transcript then goes on to talk about skeletal muscles, how they attach to bones, and their role in movement and blood flow. It mentions that skeletal muscles can become achy when infected. The transcript also mentions the skeletal system, including the number of bones in the body, their functions, and the different parts of the skeleton. Finally, it briefly touches on the hand, foot, and pelvic bones and their functions. and the mechanism. I fell off those monkey bars and my arm is like this. Easy to identify. It can result in short or even long-term disability. So we talked about, remember we covered these before, the muscles, right? There are three types of muscles in the body. There's the cardiac muscle, which is its own type of muscle. It has these intercalated discs that carry that signal. We have skeletal muscle, which is voluntary muscle. I can control that. It's part of my somatic nervous system, my arms, my legs, and all that good stuff. And then we have smooth muscle. Smooth muscle is controlled by my autonomic nervous system, like my cardiac muscle. It's the automatic nervous system. I don't control that. The movement of my blood vessels, the pupils of my eyes, my diaphragm, things like that, I don't control those things. They happen on their own. GI motility, peristaltic action of my intestines. We know that all muscle fiber has three inherent properties. It has excitability. It can get excited. It has contractility. Its excitement can cause it to contract when the sodium and potassium and calcium react. And then it also has conductivity. It can send that signal down to the next tissue, and the next tissue, throughout the syncytium of tissue. The heart has a fourth property. Remember, it's called automoticity, automatic movement. The heart can beat on its own. If I take a piece of my heart and put it on the table, it'll continue to beat. It has a time now. It has a time, a certain time that it beats. Yeah, once it runs out of fuel, it'll stop. But while it has fuel, it'll go. How long, usually? Because when they move a heart from hospital to hospital? That's different. When they remove a heart, when they do a heart transplant, you have about an hour. But what they do, if you ever see a heart transplant or any kind of organ transplant, you wouldn't recognize it. If I took my heart out right now, it'd be nice and pink and red and everything. When you see a heart for a transplant, it's completely blanched white. They remove all the blood from it and they cool it so that there's no cellular decay. So when you take a heart out, it's completely... If you see a movie where you've got a heart transplant and you've got a red heart that's beating, it's bullshit. Because it's blanched and it's cooled, and that's how they transport it. And once the blood goes through it, it'll pink up. So how does it change a life if it doesn't have any of that? It doesn't die, because the cells become dormant because they keep it cooled. If they kept it warm, if I took my heart out and left it on the table, it would die. But if I take the blood out and cool it, it would last for two hours. You could get two or three hours. As a matter of fact, you guys, if you wanted to, if you so choose, you could be part of the organ bank. And you could go to hospitals and you could harvest organs. As an EMT, you could qualify to harvest organs. They're like my removal. Yeah, they'll teach you how to do it. I've got a couple of friends that do that. And what happens is they're on call, and you get a car, and you're on call, and you can go anywhere in Massachusetts, or anywhere in New England, and you have to be there within an hour, and they tell you where to go, and you go to the hospital, and they bring you to the body, and you do your surgical procedures, you remove the organs, and then you bring them. How do you do the process? What's that? How do you do the process? You have to apply, and then you have to go through the training. You have to have a medical background. Being an EMT, I think you have to have more than a year's experience with an EMT. You can't do it with a brand new EMT. You have to have some experience. So, skeletal muscle is not just your bone. What was the four again? You just mentioned excitability. You've got excitability, contractility, conductivity, and then automaticity for the heart. So, skeletal muscle attaches to bone and usually crosses at least one joint. So, like my bicep brachii, my bicep brachii's point of origin is at the humeral head. It runs down the length of my humerus. Your uterus? My uterus. That's not right. And it's point of insertion is at the head of my radius. As a matter of fact, when I make a muscle, you can see that's the tendon right there. And when that muscle contracts, it pulls my arm up. So, skeletal muscle attaches to bone and usually crosses at least one joint. This is called voluntary muscle. It's part of my somatic nervous system. I control it. It makes up the largest portion of the body's muscle mass. And about 15% of the body's blood flow goes to the skeletal muscles at any given time. As a matter of fact, when you get sick, you get achy, right? All your muscles ache. Oh, this is terrible. One of the reasons you get achy is because infection is caught in the muscles. Because that's the most open area for your body to fight infection. So, you have a large blood flow. You fight infections and that's when you get achy. All skeletal muscles are supplied with arteries, veins, and nerves. And skeletal muscle tissue is directly attached to bone by tendons. Muscle is connected to bone by tendons. Bone to bone is connected by ligaments. Think of your ACL, PCL, and MCL. They keep your knees from doing all kinds of funky stuff, right? And your knees. Those are all ligaments. Whereas your Achilles tendon connects your calcaneus, which is the heel of your foot, to your gastrocnemius, which is your calf muscle. Can you say that again? Muscle to bone is what? Bone to bone is ligament. Think liga-liga-bone-bone. And then your tendon to bone, tendon to muscle, tendon connects muscle to muscle. So, this is what I was talking about here. This is the lumen. This is the lumen where the blood travels through. And this is that tunica media. And what happens is it contracts. It constricts like this. And that's what you get. That's that pulsation you get. Cardiac muscle is especially adapted to involuntary muscle with its own regulatory system. It has that fourth property, automaticity in self-stimulation. So, the skeleton gives us our recognizable form. When we're born, we have about 300 bones, mostly in our skull. By the time we reach like 5 or 6 years old, they've formed into about the 260 or so bones that you have as an adult. They give us our upright recognizable form, protects our vital organs, allows that movement, produces blood cells. Your bone marrow makes red blood cells and white blood cells. Immature. The white blood cells end up in your sleeve until they get released when they naturalize. Serves as a reservoir for minerals and electrolytes. We know calcium. We know calcium is stored in the cells, in the bone. So, this is our upright skeleton. We've done this already. The central skeleton is the skull and rib cage and spinal column. And then the peripheral skeleton is all of the appendages. Or the axial skeleton. The skull protects the brain. The thoracic cage protects the heart, the lungs, the great blood vessels, and the pectoral girdle. Two scapula and two clavicles. And we've seen this before, right? This is the sternum. This is the glycoid process. This right here, if you look at this, this is not really anatomically correct. So, if you run your fingers across, this is called the sternal notch. This is the manubrium. It's kind of ribbed right along here. And then you've got a little line here that's called the angle of Louis. And that's the body of the sternum. That's the xiphoid process. This is the sternoclavicular joint. It's the joint that the sternum meets the clavicle. Clavicle here, that's your acriomyan joint. Your acriomyan process is this right here. It kind of connects the clavicle to the shoulder blade. And it's part of your deltoid that allows you to do that movement, that greatest range of motion, the ball and socket joint. The humeral head sits inside the glenoid fossa. And it produces the glenohumeral joint. The humeral head sits in the glenoid fossa. And we call it the glenohumeral joint. And you can see how the muscles kind of run. This is the bicep brachii. Point of origin is at the humeral head. Point of insertion at the head of the radius. Whereas the tricep brachii, point of origin is actually on the scapula. And it runs down the back of the humerus. And it actually connects with the olecranon process of the elbow. This is your olecranon process right here. So your tricep brachii connects right here. Okay. You know what this is called? You mean it? You mean it. I told my son that. My son heard it one day. My son was in class one day. And because they used to bring him to class. My youngest probably goes through this whole course a couple times. And the first time he heard that, all the way driving home, this is my weakness and this is my weakness. Will you stop? So we talked about the hand and the foot and how closely they are together and how evolution kind of you can tell how they shape. So this is my radius and ulna. My radius is the thumb side. My ulna is the pinky side. From there, that goes into the carpals. The carpals consist of the bones of the lower hand to include the scapula right here, which is the most commonly broken bone in the hand. It's what separates the hand from the foot. And it allows me to have an opposable appendage. And then you have the metacarpals. These are your metacarpals. Your fingers don't end here. Your fingers really go all the way up into your palm. Right? You can feel it as you run across. You send in ligaments across there. And then you have your phalanges. Thumb, index, long, ring, and little finger. The pelvis supports the body weight and protects the structure within the pelvis, the bladder, the rectum, and the female reproductive organs. Remember, you have large blood vessels. Your iliac artery, your descending aorta, right underneath your umbilicus, branches off into your iliac artery. Once it hits the entire ligament, it becomes the femoral artery. And your femoral veins come back up. Your iliac veins. So there's large blood vessels in your pelvis. Fracture your pelvis. Not only does the pelvis blood bleed, but it could also lacerate those blood vessels and you can bleed out very quickly. A patient with an unstable pelvis and hemodynamically unstable, meaning dropping blood pressure, we consider that bleeding in the pelvis and it's high priority. The pelvis is formed by the ischium, the ilium, and the pubis. Right? So you've got the sacral vertebrae. You have the five sacral vertebrae all fused together. So you have the sacrum, the iliac sphincter, the iliac sphincter, and the iliac sphincter. The sacral vertebrae. You have the five sacral vertebrae all fused together. So you have the sacrum, the iliac spine, the iliac sphincter, you have the symphysis pubis, and you have the ischial tuberosity right here and that makes up that pelvis. Then the lower extremity, you go from, which is right here, this is the acetabulum, which is the pocket that the femoral head sits in, like this. So the acetabulum, you have the intertrochanteric region here. This is the greater trochanter, which is your hip. The lesser trochanter is inside right here. Then you have the intertrochanteric region. If a patient has a hip fracture, it's not a fracture of the hip itself, it's an intertrochanteric fracture or suprafemoral fracture. It's a fracture right in here. And what they do is they call it nailing, but they put a screw in that unless they have to do a complete knee arthroplasty, a hip arthroplasty and they replace the whole hip. And then you run down the shaft of the femur and then you go down to the knee. Remember the kneecap connects by a tendon to the quadricep and then it connects by a ligament to the tibia and that allows you to kick and walk. If you didn't have a knee, you could walk. And from there you go to the tibia and the fibula. The tibia is the big bone. That's your shin bone that you're always racking. On the lateral side is the fibula. Little white line is the fib. Little white bone is the fibula. And then from there you go down to the ankle. In the ankle, the inside ankle bone, this is your medial malleolus. This is the distal end of your tibia. The lateral malleolus is the distal end of your fibula. And then you go to the talus, the navicular, the medial, first, second, third cuneiform and then you have the metatarsals and the phalanges. Much like the hand. And there is the Achilles tendon which connects the calcaneus, which is the heel, up to the gastrocnemius. And then right in here you have what you call your plantar ligament. And you get plantar fasciitis. Do you ever watch those movies where they cut off that Achilles tendon? Like scary movies and they cut it off and the place is like a different kind of pain? That freaks me out in scary movies. I'm like, ah! I try not to watch movies where they cut the Achilles tendon. I don't even want to know what movies they do that in. And you just go, boom! If you can't stand, you have no flexibility or muscle control. That's what gives you muscle control. You can rupture that. Football players rupture that. Oh, yeah. It snaps and it cracks right in. You can't walk, you just go like that. You can't walk. You can't even do this. You can't do plantar or solar flexion. It just hangs there. I thought they break something down. Something, anything. Not good. I saw something in a medical procedure this week that they take the ligament and actually they scrape the blood off of it and they do something to it, like twist it and then they insert it back. Yeah, what you do is, there's a couple of things they can do. If you stretch, like the shoulder, we've kind of talked about it here, but if you have an injury to the shoulder where you stretch the ligaments, right? And that's what gives you that weak joint where you can dislocate the shoulder. Well, they do it in a sterile environment. But what they do is they remove it, they do one of two things. They can either cut it, they cut a portion out and they stretch it together and stitch it. Or they do like you do. They take it, they remove it, they twist it up, and then they put it back in so it can... In other words, what you want to do is get it contracted. And that gives the stability back to the joint. But the problem with ligament and appendage injuries is it takes about six months for them to heal. They don't heal like bone does. It takes a long time for those to heal. One of the most common injuries in the shoulder, the rotator cuff injury, is a labrum injury. And it's a ligament. And they have to replace that. Is that done? I dropped a bunch of 2x4s on my hand and it's still injured. Oh, like four months ago? Don't do that. Yeah, it's still suffering. Don't do that. Yeah, I was at the orthopedic this week. So the bones of a skeleton provide a framework to its muscles. Excuse me. And tendons are attached. A joint is formed anywhere two bones come in contact. So what happens is, in a joint, you have what they call a joint capsule. And this joint capsule separates this compartment from this compartment. In that joint capsule, the end of each bone has cartilaginous tissue. And then in between it, you have what they call a bursa sac. And every time you move that joint, it bursts. That's why they're termed bursa sac. And it releases a little amount of synovial fluid that bathes that joint and produces the closest to zero coefficient of friction in nature. The closest you get to zero coefficient of friction in nature is in the healthy joint. It has less friction than water on ice. Did you ever go on ice right after the Zamboni was on it? And you just have no grip whatsoever? The human joint actually is more lubricated than that. And what happens is, bones, as they grow, they don't grow from the middle out. They grow from the edges out. That cartilaginous tissue calcifies. And it kind of moves its way out. And that's the way the bone grows lengthwise. The edges of each bone, this is called the epithesial region. The epithesial region for you guys doesn't matter because you're not growing anything. For my 11-year-old son, that's very important. He has a fracture in the epithesial region. He's got to go to an orthopedic, pediatric orthopedic surgeon. Because if they don't fix that right, he can have lifelong deformity because that will grow deformed. Okay? So those guys are going to a pediatric trauma center. Significant force is generally required to cause fractures and dislocations. We've got direct flows, indirect flows, indirect forces, twisting, and high-energy forces. So a fracture. A fracture is a break in the continuity of a bone. It can be classified as open or closed. An open fracture, something opens the skin over the fracture. A closed fracture is closed. So it can either be, so a fracture is a break in the continuity of a bone. An open fracture is considered a break in the continuity of the skin over a break in the continuity of the bone. I can have a displaced or non-displaced fracture. A displaced fracture is when the bone ends come apart and you get deformity in the whole nine yards. It's broken in half. A non-displaced fracture is you get a crack in it. We used to call them airline fractures. You get a crack in the bone. It's non-displaced. I can get a non-displaced open fracture. How do I do that? If I hit you hard enough with a baseball bat in your arm, I crack the bone, but I break the skin over it. So the bone doesn't come through the skin, but the skin's still broken. Does that make sense? So if I have a break in the continuity of the bone, and a break in the continuity of the skin over it, I have an open fracture. So I can have an open fracture for a non-displaced fracture. That's important that you remember that because a lot of people think open fracture, oh the bones have to stick out. Oh the bones aren't sticking out it isn't an open fracture. What's the problem with an open fracture? What am I afraid of? Infection. Osteomyelitis. Infection in the bone. Remember the bone is part of your vascular system. If I get infection in the bone marrow, it travels into my vascular system. I develop bacteremia, septicemia, and can die from that. No bueno. So I want to make sure that I keep that in mind. So a break in the continuity of the bone with a break in the continuity of the skin over it is considered an open fracture. The bones don't even have to make the hole. Something makes the break in the skin over the break in the bone. That's important to remember that. You'll see that again. So determine whether the overlying skin is damaged. If it is, it's an open fracture. Fracture describes whether the bone has moved from its original position. Non-displaced is a simple crack. We used to call them hairline fractures. Whereas a displaced fracture is an actual deformity. The bone, the ends come apart. There are some different types of fractures that we're going to talk about. This is called a green stick fracture. Very common in children. Remember, children's bones aren't calcified like ours are. They're very flexible. So when they break, it's like taking a green stick and trying to break it. It doesn't snap like a dry stick. It kind of splinters. You know what I mean? It doesn't break completely. And that's a green stick fracture. Common in children, which is this one right here. This is what we call an oblique fracture. It doesn't go straight through the bone. It goes at an angle but through the bone. Very common in twisting fractures. There are what we call Smith's fractures. Common in child abuse. Where you take the arm and you twist it and you snap the bone. That's what you get. You get oblique fractures with Smith's fractures. This is a pathologic fracture. A pathologic fracture is a fracture of bone weakened by things like osteoporosis. It has a pathological reason for a fracture. And then this is an incomplete fracture right here. Also known as a hairline fracture or a crack. We also talk about a comminuted fracture. A comminuted fracture is a fracture in which two or more fragments exist. Almost like a shattering of the bone, right? Well, we're going to get to that. But a comminuted fracture is a fracture where the bones break in two or more pieces. Almost like a shattering. Very common in the elderly. And they get them from falling down the stairs or falling out of bed. Epithesial fracture is a fracture in the growth plate of the bone which is either proximal or distal to the bone itself. Greenstick is incomplete where the fracture it doesn't break cleanly. We talk about an incomplete it doesn't run through. That's also called a non-displaced. Oblique is a fracture at an angle. Pathologic is a fracture of weakened or diseased bone. Spiral is a fracture caused by twisting forces. That's another one you get. Spiral fracture, you get that as a... Spiral fractures can be oblique or Schmitt's fracture. Schmitt's fracture can be spiral or oblique fractures. And that's usually a twisting force. What is that one in the book? That's a complete and that looks like a transverse fracture. Which is a fracture that occurs straight across the bone. Because you can see the way it kind of curves. It looks like it's broken in one place. Suspected fracture in one or more of the following signs. Deformity, less than dead giveaway. If I see deformity, yeah it's broken. Tenderness, guarding or swelling. Now, it is possible to have an injury. You could have a really bad muscle strain, sprain, a dislocation or a fracture or all of them at once. So, sometimes we don't know. So what do we do? Immobilize. We immobilize and transport. So here, we can see, that's a pretty easy one, right? I've seen those, I've gone to a few of those where somebody either falls coming down a ladder or something and they land like this and this snaps this way and the bone comes right out. So the foot is like this and the bone is sticking straight down. So it pulls right away. Sometimes you get a fracture or an injury like this. Look at the swelling and displacement. What is that? Is that a knee, a patella fracture? Is that a dislocation? We don't know. So that's where you're not sure. Knees especially, if I saw that, I would not manipulate that in any way. I would use the long splint and I would splint it in the position found. You might see bruising, crepitus, that bone on bone grating, false motion. My wrist should move here. This should not move here. Right? If I get this movement here, that's called false motion. That's motion where you don't expect it. That's a classic tell-tale sign of a fracture. Exposed fragments, pain or a locked joint. Look at the swelling in that ankle. Now that could be a fracture in there. That could be a dislocation or a sprain. Probably a very severe sprain. So dislocation is the structure of a joint in which the bone ends are no longer intact. Sometimes the dislocation will spontaneously reduce. I know people, patients that do that, they have a very weak shoulder and it pops out and they pop it back in. The problem is each time you do that, you weaken that a little bit more. Eventually, one of those days, it's going to pop out and it's not going to come back. When the arm, the upper extremity, most commonly when it dislocates, it dislocates forward. Because of the shape of it, it won't dislocate back because that would actually, if you have a posterior dislocation of the arm, that's bad. If it's rolled up over the glenocumeral joint or fractured it, that's bad. Hips will dislocate to the rear, so you'll get a hip dislocation that will look like this. But an arm dislocation, forward.