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Okay, so I make it that half past s so we'll get started. Hello, Andre. Good evening. Welcome to the fourth session off are actually healthcare Siris. This evening is going to be introduction to anatomy and service and Atom talked, but the wonderful um, your E and David Nouri is Ah, believe the fourth year bars. I should have double check that with that before. And I think she's fourth year And David his final yet at Warrick. Both medics. Sleeping course. Really? Um, memory is going to go through the introduction to anatomy, and David will go through some surface. And now, to me, this is the fourth lecture in our series. So far, there are plans a foot, potentially more sessions toe happen, but there will be There will be a break between the end of this and the start of the next set. We will advertise appropriately in between, um, the sessions. The first three sessions, I sent out the links to everyone who wants to watch them again or hasn't seen them. The recording should be available. If you click on the link on, then next week we'll finish off this Siris with myself teaching diabetes that daily teaching medical emergencies. Any questions? Please do email me more than happy to see them and answer them. Uh, but with that in your area of a slow just slides. Yeah, sure. Uh, you want me to send in to your Should I just You can just If you just click share the top right next to the mute button, you should have an ability to share screen. Yeah. D thank you. Uh, give me one second again. This is more more child for me to use this slide. Okay? Is it okay? Do that minute. I'm just kind of let it share my where when it's samples. So if you share screen on here, it should appear in the content bit bottom, and I can send it live or or just appear live. Yeah, but I'm just gonna see if it will let me. Can you see my screen? Yes. Of the jump. You may want to write. Okay, So kick things off. Thank you for coming to this introduction to anatomy session. We'll do it. Sort of like not too detailed is very school, But just about enough, if detected, that possibly can really on in this one hour slots, so we'll kick things up fast with that. So firstly, high, as Freddie said friends, my area, I'm 1/4 year or about to go into for the medical student, but it's in the London the Queen Mary if if you are in touch. And I'm real extent I have been his age in ambulance now for just over five years, mostly working in love. That ends up being a lot of other things. And they got a little bit about me on this session, is I've tried to do is not just I really can really on the skull little signs of things just so that you can understand kind of what debt we kind of go into the medical school. Every medical school thing does. Every medical does do things a little bit differently. Some will ask you to learn more than others. Some would do different teaching styles, others dissection or pro section. So do buy that in mind. When you're watching this presentation, I've tried to go off similar to what we did in my first year with some bit removed, and I've kind of added a bit on the circulation system just to kind of touch into a little bit on there. Be some quick cash in seeds, kind of test your knowledge at the end. I know. Certainly about my enough to me like you're always includes a question it to start going, and by the end of this lecture, you should be able to answer this question and then she'll repeat the question at the end with new questions on. They're all kind of do a little bit like that where I just show you some questions at the end, and hopefully you can onto them or try to apply the knowledge will work out the answer yourself. Um, see if I've pretty much what we're going to do today. With that being said, Let's kick things off on with some ketose so and after me, some people will tell you that you need Latin juicy a C and a level to the rats, and you don't really the key kind of times that we're gonna talk through fast is the planes, and this is important because when you're looking at things like per sections, are you looking at a whole body? And then after the labs or whether you're looking at images like X ray, CT scans and so on is doing very quickly. Interrupt for a second last Waters pro section if you want to X ray section. So a pro section is essentially like a cut up portion of the whole body, so they will have your have your lecturers and your clinicians in the lab. What they'll do is they'll let's see someone you know to their body to science. They'll take like the chest part, peel off the skin or the muscles and everything, clear our fat and anything else and essentially allows you to rule. Usually see the anatomy of everything really well. There's a couple of pictures here and there, skulls and stuff, and I'll show you a picture of what protection won't look like any bit. So you understand it bit more, but essentially, that's what it is. Just some one of my like cleaning out the body for you and taking parts of it. You might get a limb. You might get half of a skull you might get, Um, yeah, part part of the I guess you might even get a whole liver out, and someone might ever called their bits of their liver cut off and you can kind of see or different part. But yet it is detailed as you can go, really, actually, probably see it. I hope that answers that question. I really I can't see the chapped ready. So if you keep doing that, I'll be great. So right back to this. So in terms of planes, there's, I guess this is how essentially you might've you the body in different ways and whether it's in your section or an imaging. So the first one you've got here is the sagittal view. How it is kind of like slicing the body down the middle of the midline is we like to call it when I'm really been like and we'll yes, go straight down the middle of the body in half on and you've got sort of like the horizontal plane, which is, if you're chopping up across and the body and then you've got this corona or frontal view on which they often uses well, there's again. This is how, like if you getting images going across someone's body, the horizontal is quite nice and easy. One if you have. If you've ever seen. Let's say, like a CT scan of the abdomen will slice that that image of the slice through the top of the tummy essentially will be likely to be like a heart. You have someone so that's one example, and we'll go into positioning as well in a minute. But that's just to give you an idea what kind of views you might see in different types of medical imaging and in terms of orientation, These this is really important. So orientation is essential for things like understanding the position of different body organs in relation to each other or in relation to the overall an anatomical position. So when we talk about and after me in general, the anatomical position have seen here on your left, let me get my legs. So this image here is the anatomical position. So if someone's standing up with their partners facing forward on on through, this is essentially the front part of the body here or in the in. The Orange Arrow depicts it really nice and easily here. That is your interior of your body's in the front, said the back is your posterior or dose ulcer side on the top of your body. Surprise, surprise is superior and the bottom is inferior on middle of the body or down the midline. Here is your medial aspect. And then the further away from the midline you go, it becomes lot of room on. Do you've got the proximal and system. So how that works is the closer. In some ways, it is to the center or the body. It becomes proximal both, but you can see my screen again. Can you see it Still? And then, uh, distal is further away from that midline or further out from the body, which is There you go. I'm don't worry about the cephalic and called or not. Everyone uses that. But those are the main things you might hear of X rays using things like anterior posterior or a piece of you. And it depends on how you are facing the X ray on different views of data to look at different things. But we went took a while too much. But you should understand that this is kind of how you apply a lot of things and then after me, so they might ask you questions about where things are in relation to each other. So, for example, you know where is the key here in relation to your suffer? Guess in or where is like the esophagus in relation to like the spinal column. So in that case, it's like the esophagus is interior in front of your spinal column. Oh, another thing might be like, wherever our you'll, we'll talk about some of the terms, but to keep it really simple for now and worry. Use your toes in relation to your knees and you would say, Oh oh, your toes a distal to your knees And that's just in the example. And as I said, we'll talk a little bit more about this with the applying terminal that once you understand that, we'll say so moving onto these government. And so this diagram on the right hand side. When my mouse is king, hold on. Second three Overall skeleton is here on the right on obviously not a lot of it lately. Well, it's very, very simple, but explicit out. Broadly speaking, your skeleton is divided into the axial portion, as you can see in white over here on, then the red bit is your Bendix, your skeleton was about everything else. Your axial skeleton is essentially got a call part of your body. It houses all the important stuff. So your vital organs have found in your thoracic cage your rib cage. Um, so your place, things like your heart and your lungs and so on and surprise. Surprise. Your brain is inside your skull. I don't need to tell you one more than that on in your spinal cord. You've got your your in your column you have or you weren't spray. You've got your spinal column over influence, and everything else is. Your prediction is, Gallatin is, I said, and that's mostly for movement. You have muscles and joints that help you move, Obviously, also kind of helps indirectly protect you from any other damage to your vital organs. On by kind of therefore, like, your axial skeleton is really important for protection on keeping those important body organs and nice and safe and secure on. Then, yeah, you are particular scans and helps you survive and do things that you need to do, whether it's eat, run away from danger. So on and so forth. Full pretty simple stuff, so we'll talk a bit about the axial skeleton. And so to split, the exact we'll start off with the skull first, you'll get in med school after me. All of these bones guaranteed. So you got eight cranial bones and the numbers in your brackets reflected the number of that specific bone because your body is technically, it's metrical may not look it, but the body part should hopefully roughly be the same on both sides in terms of the bones. And I'm not necessarily for everything else. So you've got to parietal bones, which is on the side of your skull. You got one big fronts of bone, which covers the front of your skull, which is here. You've got what, one f my purse, I wonder Year one f more bone, one sphenoid bone, which is inside the skull, which is shaped like a butterfly. Your temporal bone is basically by your ear on the occipital bone. Is it the base of your skull on this side? You about the facial bones, you got to nasal bandages off the top. You know, you have a feeling of yourself. The lack of burns a right inside, so on and so forth. So you got all of these different kind of bones, and then anatomy, particularly you learn about the searches of these of the lines that kind of connect different bones, and they help keep his bones stick together nice and secure. Make sure things okay, really, and doesn't move anywhere on. That's pretty much or you kind of need to know about skull bones, and then we'll talk a little bit now about the different holes in your skull. Bones. Well, um, so there are different holes. There are many years you conceive on. This is a new image from an anatomy textbook should just send the beginning. If there's any images that you see, there's not many gory pictures. Unfortunately, there are some pictures of things like from textbooks and from the Internet, pictures of skulls and pro sections like we prefer. Teo, Please don't screen shut this kind of stuff. But it's all that on the Internet, you can have a look at these textbooks and images online and on. So in terms of the skull, there are many, many holes for many, many different reasons. On Let's Take the one on the left. If you slice the brain in half or the head in half. I guess they're in crust, and you will find that this is the front of this sculpture, your anterior and that's posterior. You've got this form and Magnum, which is probably the largest whole you will ever find in the skull, and you could see a nice of picture here is well, and that is where the spinal cord enters into your very, really isn't doing connects to it that way on you've got another hole in which is the jugular Roman. That's where your veins are. And then the corrected canals where your internal carotid arteries on these arteries are important. They help supply the brain with blood. But that's just to give you some other examples of examples of holds that you might find in the skull. And as you can see, that's roughly one on each side. For that reason that you have 22 sets of arteries, two sets of veins, etcetera, etcetera or going into I/O of there, you also got nerves. Going through use holds a swell and especially your cranial nerves and cranial nerves of like your special nerves. They have innovated special senses on other important elements, I guess even the nervous system things like taste, smell, balance on site. It's a drug that is plenty more s o the's. You might find that some of these will travel in in and out the skull as well, not necessarily a love thumb. Hopefully, that gives you an idea into some of that them moving on now to the vertebrae on. So this is the spinal cord inside this, I guess. Burden structure here, which is your spinal column on. There are different different sections in this final column. Overall, we'll touch on each of them in a little detail to help you understand kind of what kind of stuff you might need a medical school s. So we will kick things off first with the collectible. So there are seven of them. As you can see over here on the overall structure looks something like this on the right hand side of the central hole. And as you can kind of gather that word for holding anatomy is foreman on in most part on? So this is the vertebra forming, and this is where your spinal cord travels through. And this happens this this has seemed pretty much in most if not all of them if the spinal vertebrae You've got these transvestite arm in, which is where your after you struggle through to enter your break on help supply the brain with blood. Simple as on then one. A key structure of help. You kind of differentiate the cervical broom is if it's spine. This process on what that means is the back spine. This process, which is posteriorly located a Z you concede in this bit here, splits into to hence the word if it that's all you need to know. But the as with everything you know in life, you get older. This is what everything should but like, except that sometimes where things don't look exactly the way you're expected to see them, I guess. Or, you know, every road needs to be broken on. In this case, this is where it happened. So, generally speaking, there are seven cervical vertebrae. See 12 c seven and that's case for everyone. But this structure you'll only really see and see three to see seven to see one and to see to a slightly different on if it's next site So So you want to see to really different. The reason being is they interconnect into a lot together or connect together to form a joint in your neck that allows you to move your head left and right up and down on that. Is that joint Essentially, which is why the structure is quite different. So you will be asked in and after me, Practicals or in like you're on exams where you get pictures, toe, identify C one and C two, and also even just generally identify that what? The general structure of this over converted rays, as you can see on the slide here. So that's why these two are really important for you tonight. To give you an idea, here is a little gift of how it works, and you can see the articulation point here. Um, really, really simple. You brought your need to know something like MS as well giants in your body. A really important because some of them, not all of them on, allow you to move. But there's three main types in the main type, and that you'll see here is the sign of your joint. So this sign of your joint is what is essentially giving you that opportunity to move your head and neck is really on. So I know your joints are really important. We a lot of what you might seems off when you're being talked about muscles and bones. Is joints really kind of conditions like you might have heard of, like arthritis and older individuals. Or any moment immunos suppress conditions like rheumatoid arthritis affect your joint on gets painful. It's very painful on it's a broad to give you 90 of what a joint structure is. This is a sign of you joint structure because they have sent your view. Fluid that helps lubricate the jokes, allows it to move kind of like putting oil and in, like, wheels and your cars or, you know, to help things move that liquid allows. Reduce the allows a reduction in friction, helping your bones move bones. Move nice and swiftly and smoothly, and everything goes nicely. But this is an overall structure that you might be alone. There are other types of joints, like I said, like fire procedure. It's a cartilaginous joints. Suitors are not an example of sign of your joints, but they are a different type of joint, but these are probably the most important one to be to know about anyway. There are plenty of other examples of different types of sign of your joints, so sign of your joints are broken down depending on the type of movement you can do with them. Essentially. So, for example, the one in your head and neck So the atlas and the access I'll see one and C two form of pivot joint that allows you to move up and down and left right on. You got your hands straight, which is your elbow. And if you just move that you can feel that joint meeting, you put your hand on your elbow. You can really feel that movement. There basically allows you to kind of move your arm up and down. As you already know, you gotta gliding joint in your shoulder. You've got other various types of joints and you can see ball and socket allows the largest range of movement. That's why you can move your whole arm running different circles up and down. Left arm, I said, Oh, partly because of your shoulder ball and socket joint in your shoulder But that's just to give you an example. So essentially you have three broad main types of joint. You sign of your joint allows the largest range of movement. But again, there are different types with sign of your joints, and they are very depending, all these different types, a lot of different ranges and types of movement to happen. And you'll be talkin medical school as well about the different types of movement, like flexion extension and so on. But we won't cover that today, So back to your battery on the next one we'll talk about is your thoracic vertebrae on these last 12 of them. As you can see on, unsurprisingly, they're kind of line up with your thoracic cage or your Remicade, which is why these cost, um, facets and the stemi fast. It's really important they are. They join or articulate is the one we like to use an anatomy with your ribs, um, allowing you to form that Kerry structure, which helps protect the vital organs in your body. The spinous profit process in this case is quite long and slender and quite thin, and it points downwards, and that's a nice, easy way to recognize the thoracic vertebrae, the whole inside. So the the vertical reform and allows the spinal cord to go through is a heart shape, and the way I remember that is because your thoracic cage has a heart in it. So got shake that spray. Hopefully that helps on. But as this as you imagine, this bit is the posterior better. This is the back of it, and that's the anterior bit. To help you see that for me, why we use the technology's and then you've got your love of that spray so your lung, but vertebrate the body is massive. The reason being is because as you go further down, you're going to break the weight and that you're bearing increases, right? It's not pining a load of, I guess, like you making this that cops. You have one cup of the top of the attitude, and you have three years, four years, five. So it's kind of like that in the sense of the weight that you're loading. You bet that the weight that the brace better increases as you go further down, which is why those vertebrae become huge on. So the words of your body on which is this round. But here is massive in the number of rhetoric in this case, I like to say Looks like a kidney that helps. We kind of remember where is you got a triangular hole in there as well, Which helps again helps you differentiate what the lumbar vertebrae looks like on. But that is the over just the love of it. And then lastly, you've got the sake room on the coccyx is usually five state go over to break and four for the coccyx. But again, don't worry about that too much. Now, a lot of remembering medicine is about you, Monix and that Ryan's and all that kind of stuff. So that's easiest way to remember how many road to bring her in. Each of the three sections that we talked about is breakfast at seven. Lunch 12, dinner at five. So there are 7 30 cervical vertebrae. There are 12 thoracic and five numbers Breakfast. First lunch second didn't lost. Hopefully that helps one of you remember that if that is really good for you in your medical career or urine just generally and then a quick little thing about your blood spray before we move on is that you're currying a spinal cord, which ends, which kind of goes to century from the top of your vertebral column. So see one right down to about L1, and then it kind of all ends in the structure called the quarter. Quite Know, which is still about the endings of your nerves on, But obviously your nerves have to go out to innovate structures in your body, like your internal organs to your muscles in your arms and your legs on information needs to come back in a swell on. So whether that's oh, I touch something hot in my hand and Eastern reflex or processing information that you're seeing outside on least eventually you'll come back inside. And this whole here's the Internet foreman, and this is where your nerves exit and enter, so that that's important. And then also, you've got a type of joint in your back in the vertebrae called the facet joints, and that, I guess, helped your black move a little bit like your spine does help with movement, too. Not just posture and keeping everything you know, upright and protected, and someone it does help you move and then you have an introverted disk and not obviously helps with things like preventing. I guess we've got brains from rubbing against each other and friction and causing damage. You may have heard of the condition called slipped disc, and that's what Good, Because if you break those discs and reduce the gap, your bones are likely to rubber gloves each other and then damage more so we don't want not as the ways that's the posterior aspect of your back is already in the posterior aspect of your body. But this is the back back of the spinal column in the front of the spinal column, so that helps you perfectly visualize how it might look in you on. You can also kind of feel if you touch the back of your neck, you can kind of feel this where C one and C two, and was constantly with him to see you, too, so you could fill C seven, which is that sort of back lumpy bit at the bottom of your neck. So hopefully you can feel that it is what you can feel the process sticking out a little bit. All right, so moving on. We're gonna talk a little bit now about the thoracic cage. So this is your first cage. You will need to there quite a probably a lot of this, to be honest. Maybe not so much the joke in our not gentle aviculare declination, but medical school, you probably be expected to learn the rest of all of this on there are 12 lbs and ropes, seven of them a troops. This means that they directly attach to your breast both. I also notice the sternum on fire. It's own piece of cost of cartilage or just the spitting. Great. Here, here, here, Here, Here. Yeah, there are. Yeah, is about seven pairs of drew ribs on. Then you've got your full strips on this image, like six a day. That'll all of these from 8 to 12 are your force rooms. But really, it's actually the three here. 89 and 10 because they join their piece of cartilage. Joins a true ribs piece of coffee. Rip eight piece companies during seven. So just ripped nines and sodas retention. So they indirectly attached to this third and virus in her own peace. And then someone else's piece guess if you have the ribs, Piece of cost of cartilage and then 11 and 12. Really simple. It doesn't have its own cartilage. It also it's called called a Fighting room. So hopefully that helps. And as you know, the thoracic cage is there to protect your lungs, your heart, any other organs and so on. Now you have your breast bones. The first one is also really important. Also noticed that, um, there are three main parts to it. Your manubrium, your body and yours. If I process and you can actually feel your sternal are ongoing, I think Same report. Touch up missing this in his lecture. But you cannot. If you feel going to go at the base of your neck and you go down a little bit in the middle of your body, that little dent, I guess you have to really feeling you practice it if you want, But you can feel this then, I guess, is what I like to call it. And that's this Dannell angle here. And they were on this a bit more later on in the next hour, so I won't go much further than that. So now I'm moving on to the rest of this. But which is the appendix? Your skeleton. So you've got your, uh, pollen really simple on it's the clavicle forms, I guess. The attachment to your axial skeleton. So it touches right to your better brain. Someone you've got, which is obviously the clavicles. Your shoulder bone. This joint here is the gun on human or joint. So it is where your scapula see your shoulder bone is because of the back of the scapular is your shoulder blade. You've got your shoulder joint here, which is we talked about earlier is the ball and socket joint that allows for that wide range of different movements you do on. You probably have met someone in your life. We're seeing someone in the TV show. A film is dislocated shoulder. Um, you've got the humerus here, which is the only bone annual upper arm, and then your forearm. You've got two bones, which is your radius and owner. They will join in the elbow joint, which is here, and then you've got a collection of bones of cheering. Rosa four called the couple bones goes down to your metacarpals, and then you're full and she's now. You're fine and use. There are three in every finger. See, kind of see whether if you look at your palm of your hand, there's two lines going through all of your fingers right again. All the thumb I have some of you might have. Technically, there's only two bones in your phone, so you have a distal fall in on a proximal phalanges Aires and all of these you have a little middle one here, which you can kind of see based on the lines on your fingers. Probably that's not too difficult to understand. As we said, this is all in the anatomical position, so your radius is in line with your thumb on your owners in line with your pinkie fingers. So usually your owner is medio. Usually in the anatomic position on your radius is laughter. So you might know again that this side here, but um, I touch one is in the surface and after me stuff about policies your pulses could be cutting the wrist, but on the radio side is your radio. After a while, I guess on the lateral side of on atomic speaking, if your palms are facing forward on, see? And that's why I surface and actively and anatomy is really important. Yes, you can then identify right. If someone has pain in their arm, you could be like, Oh, it's the nerves in their arm And the blood work maybe, is to do with that blood vessel compromises, making them having some pains or, you know, a fracture or wrists Spring. It's obviously really important than to know the bones and the structure of the arms and stuff like that. But especially when it comes to bones, you want to think about fractures and, um yeah, well, that kind of strange spring from the kind of injuries. What area is affected and bones could potentially be affected Course. The next one is the lower limb. We'll start off with the pelvis again. You might not necessarily to know all of this, but most of this you would do so you've got your ileum your issue, Um, which is here. And then your pubis is around here, and then you've got your pubic symphysis, which can't really seen this diagram very well. But you can see that little gray line here. It'll the two halves of this pelvic girdle, Meet the pubic Symphysis was another joint here again, Not a sign of your one. It's a cartoon. Imagine this one on which doesn't require any movement really helps Get that public Got a light and strong, which is really important. You got the sacred and coccyx is you could see which is part of the vertebrae on. But you don't need to know again. A lot of this after me is helpful to know later and perceptions and that'll be and understanding were different parts of the body. And what? Where the different vessels go where nerves enter and leave. All that kind of stuff is really important for that. But this is just to give you an over. Why do you have kind of a detail level of detail You need to know and you got off again. There's loads and I'm a little anatomy is great in terms of relapse attention, You're not just on the bones like chicken part, you know the holes as well. And so you've got example obturator form. And here you got nerves and blood vessels troubling through there is well again, another ball and socket joint over here. Nice and easy example, Um, on board anatomical landmarks in your public global of things like the anterior superior iliac spine. And as a result, already, the pubic symphysis and pubic tubercles really important too. So there's lots of different bits and pieces of anatomy. I'm not gonna go through every single bone, But just to give you an example, this is a really nice image to show you kind of the different bits off the pelvic girdle that you might need to know. As we go down now to the lake, you could see the femur is the single bone kind of the equivalent of the humerus. Except for the lower leg on the patella is you need by and you've got the fibula. And TBS of your fibula is more last rule than your tibia. And then you have tassels, metatarsals and phalanges again, the same kind of thing. Like we had only two a felon. Geez, if you're just yeah, as you can see here, you've got your full lung disease, which same sort of thing again. You should have the two phalanges in your big toe and then three and the others. You don't need to know every single tassel. You don't need to know every single couple when I was in biomedical with my first degree. We have to know every single one of them when you come to a medicine actually a really funny that liter, the ones that are more on atomic important because not all of them are going to be affected in healthcare. Is anyone on to the other ones that you need to know? But as you can see, the upper limit level and pretty much look the same, it's very similar structure, just like differences for obvious reasons. But the broad structure of it is pretty much the same to keep it lasts. It's important. Easy your A one question for you here. How does the whole area differ between men and women? Period Question. In times of the POTUS emptying of mine and women, I guess the the shape inside the actual pelvis, that hole in let me get my labor pointer. This this area here is a different shape. Women's pelvis is Why don't, um because you have to give birth. Those are kind of like the key differences. There's also differences, I believe, between men and women in terms of sort of. This girl is well respected. You remember? Uh, you see, I'll come back to that, but they're approved. This plenty of differences that is a good point in mail on females be at the main one is usually the shape of the pelvic area here on do Yeah, yeah, other differences. But not so much for you to necessarily worry about so much, really right now. But why does it? It's a white of pervious s. You? It's probably going to feed a females for that kind of reason on there's difference off shapes is, well, there's not just one type of ideal coverage, like three or four different types of purposes. Well, and one is more common than the other three. But you have will touch it from that. You have to. You'll see a bit later when you read up on it. Cool. So the next question next. But I said I'll go through now is about the circulatory system to kind of give you an idea how much you grew in about an organ system because the skeleton is quite different. It's very much fact. It's quite like this is this is where this is This is this is like like how many bones? The reason this is why they join. Where is circulation? The anatomy is very intelligent physiology. So hopefully you pick up a little bit of both on. Do you understand how the circulating system works? So, in terms of the basics is you might already know if you don't. That's okay, too. On arteries carry blood away from the heart. Veins carry blood towards the heart. I don't like to use the analogy that arteries carry oxygenated blood because it's not true pulmonary arteries and the only one of the in terms where you don't have that pulmonary arteries carry blood from the heart, but it's deoxygenated blood on pulmonary rains carry blood, and it was the heart. But it's usually, um yeah, oxygen into blood that they carry. But just remember that. So if anyone ask you what the main difference is, you should always say the arteries carry blood away from the heart main, carrying blood towards the heart. Um, in terms of your vessel structure, there are three key layers toe all vessels. You got Tunica INTIMA junior comedians. You know, Calvin Tisha on the amount of each layer varies between the different vessels. So you might find, for example, some of the larger vessels will not have as much of tuna comedian because they don't actually need that much muscle. So let's take the aorta, for example, is you may already know the aorta comes directly off the heart, blood in the highs. Traveling out of. It's such a high speed that actually you don't need that muscle toe to squeeze those vessels and get that blood out quicker on you don't need any help. It's all, in fact, really. So you actually find that it's probably less muscle in those larger blood vessels because the pressure which the blood is traveling is so high that it doesn't need that extra support. Do you will find that there's less? And perhaps as you go further down this off arterial tree, maybe you go down to some of the smaller arteries or arterials. They'll probably need some more, especially especially when you get kind of close to the organ itself. So maybe not Get close towards the kidney. Those arteries, that kind of supply the kidney will probably have more muscle help squeeze that got into the kidney and help refuse it and give it the oxygen and nutrients it needs. So the Tunica in tomorrow is the central layer. It's kind of lined here by an endothelin you get if you want. If you have heard of the white epithelium, every every organ, every every your skin, Hill has the lining to it. And there's different types of these linings on simple scrapers is just really simple on around shape, so you can google it. Really. There's different types of epithelium know about that because that whole on elector that you don't need to worry about, and we'll just be low from pictures of pink and purple that you will just get very confused by. But we won't talk about that too much. But essentially, it's a really basic one single layered loves, I guess, the layer of cells that lines the blood vessels. You don't want the barrier to be too thick, because then you won't be able to get the oxygen to defuse out on the nutrients to be exchanged, and nice and thin layer is enough. You've got again the Tunica Media, which, as we said, it's like that smooth muscle that helps squeeze those blood vessels or helps make the blood work first, larger or dilation. And that depends again on what the body requires if, for example, are actually were feeling a little too hot. Well, maybe the blood vessels need a surface of your skin condition late, and if that happens, it allows the heat, leave the skin quicker and allows you to call down. And my first, uh, if you actually, if you're feeling really cold, you're know looking as pink and you might give your heart. And that's and I guess, the other way to remember. You're usually a lot. A lot of time. You're paler, right when you are in cold weather is because your blood vessels are constricting to retain that heat. So that's again. Another way to think about it on your training graph and tissue is the extended layer that has all this lovely stuff on those different things, like last in in college in a connective tissue, which is what the CT means on. That helps essentially protect your blood vessels. If there's damage to it, you want the stroke in that layer to be a tough is it possibly can be without losing that elasticity in the ability to contract and dilate and allow that blood flow to change. You want that lady to be strong enough to kind of impaired as much damage is possible and can't repair quickly. Has a lot of factors it needs to repair and fix itself to carry on. It's like when you cut yourself, you know you want in that layer to essentially have a lot of things that you need to treat you with that process tomorrow. And that's where you'll find full that sort of stuff. When you were in medical school, you learn about so they're cutting process, and this is where that layer is really important. So right moving on. And we're going to talk now about the different types of blood vessels. So as we said, like these elastic arteries just kind of, I guess, you see to visualize it a little bit more. These large elastic arteries don't require as much muscle. And then if you go further down, the smaller they get, they might, yeah, they require more more vessel wall. So initially, when you get down to capillary beds, they're so thin there only pretty much one single layer. Then you've got this whole side here, which is the blue brick you have be in the system. So you know your blood is oxygenated. It carries your oxygen, goes into his completely regret supplies of the cells around it leaves. And it's carrying all this waste products. So your carbon dioxide, any toxins that produce any toxic material on it goes back up through these veins and into these larger range, which goes back into your heart and so on. And so, um, we'll talk about that and look more detail. But essentially, as you can see in this diagram, it kind of clearly shows you that the structure of these vessels really different, depending on location and what type of vessel they are and how you know what the demands are A swell and on anatomy is about being a adapt and be relevant to the function. So you know, there's no point having a really thick level of muscle in the computer really want a really thin layer of cells. And like that barrier to be really gentle, things can easily diffused I/O as required on here. You don't want, you know a lot of muscle here either, because actually, the blood you know, traveling is a fast. Why waste having more muscle in that area? It's all so that is to kind of give you an understanding about that. So in terms of veins, they carry blood back up. Yes. Let's talk about if you're thinking about blood and you got artery veins pretty much anywhere, right, you gotta have a blood supply to places. So if you're thinking about your legs, blood goes down into your legs, stocks it in your leg muscles, tissue, whatever. But if they would have come back up and you're working against gravity Onda, that's really important. So your how you gonna get that blood back up there without exerting too much energy all the time? So this is what your muscles come into play. Your veins are kind of strategically placed in your muscles so that as you move your legs, the muscles squeeze the veins, forcing that blood up against gravity to go back into the heart to then start the whole process again. So we'll apply that in the little minute. Explain this, or how little blood circulates around the body and stuff, but this is a really important mechanism. You also have the structures that you called vows on day. It's like a one way street. They have basically help blood flow in one direction. So that is your muscle squeeze, and the blood goes up right up your legs up this way and then is your muscles. Relax. You don't want a blood to go straight back there because that would defeat the purpose, right? You you know gravity will work, and that's it. You'll get blood pooling in your legs, and that's good. So the idea is that when your muscles relax, your blood don't go back down, and it just carries on going up that the whole cycle continue and restart again. So those are like the two really important mechanisms you need to know about faint. So your valves, which helps that one way flow and your muscles, which squeeze that blood so allows it to kind of go up against gravity. Those are the two main things you need today, so let's talk a little bit about blood flow around the bodies to help you understand plan into bits and pieces that I told you so imagine your blood cell in your left atrium. I'm really proud of this. Have a major way to help. Your job is it goes into your left ventricle in your heart, which is another chamber. So your chambers, I should really explain that. Imagine your heart. It split into to the left side has a nature of the vegetable. The right side has a small chamber called the agent under ventricle to just four chambers. That's what you really need to know about, um, but yes, sir. Blood vessels in blood cells in the left atrium goes down to your left ventricle. Thing goes up into the aorta to then disappearing. Get supply. The body supplies the through many different Bunches. Goes to your head to your arms, to your legs, to the your complaint, your stomach, your liver. You know, Aleve everywhere. That is, this blood needs to get everywhere, right? Needs to supply the kitchen that it's carrying. Used to supply the nutrients that it's carrying all through the different types investors that used to get. So when it comes back, it's deoxygenated. It will come back down by, uh, to to, um, to important vessels. You got your superior being a cover, which is up here in your in very Vienna covered in this case, this blood cell is decided. It's gonna come back up through those muscle pumps in your legs, on through those using those veins which also have valves in them, Right To make sure that the blood goes up, words enters your right atrium. It goes through your Vytorin, tickle on exits the heart again. And as we said, blood, you going away from the heart needs to be carried arteries of these, these blood vessels here of the to pulmonary arteries. So even though it's carrying deal oxygenated blood, their pulmonary arteries cause they're occurring blood away from the heart this then this deoxygenated blood needs to get oxygen again, right? It needs to get rid of the waste that it's goes that is, goes to the carbon dioxide and at the same time, any it's to make sure that it gets up the extreme ready for the next round. So it goes away into the lungs to go get that oxygen back again on get rid of the carbon dioxide, and then this oxygenated cub oxygenates blood comes back into the heart. Can you see that there's four vessels here? There's 1234. Blood is coming back into the heart, so it's no longer an answer. It's invades. These are the pulmonary veins. The blood re enter the heart rations of problem every brains into your left atrium, and the whole process just starts again. Get going and going. So hopefully that kind of gives you a little bit of a whistle. Stop tour of how blood travel through the body. As we said, there's different divisions in these capillaries. You got the arteries, the arterials, your capillaries and then go straight venues and variance back into your heart. So everything is kind of the same sort of thing on this process is quite easy to tell. And once you've got to do a lot of repetition with medicine and a levels and everything, the same thing applies in terms of your revision. So hopefully that gives you an idea of what sort of thing you need to know. Naturally speaking in medicine, you don't need to know just this anatomy in particular. This is an example of a pro section for the person the Astor you might see this and then the battery lab. You see lungs quite clearly seen here, or whatever left of it. You've got your heart here. You've got blood vessels, and you'll probably you'll need to know. You would definitely need to know the different branches to emergency on the next. Like you've got these different veins as well. You probably the branches. You get diarrhea from over here, and then the abdomen is underneath. But give you an idea. Here is your right atrium, right ventricle, left atrium Really simple there. And then you've got your little to hear as well. Which divides and Elise different branches. And you got your pulmonary trunk over here, which goes into your pulmonary veins. They're all really complicated stuff together. Know, understand. Kind of how it looks in, I guess, a dead person technically, but and you won't hopefully be seeing, um, look like this one. They're alive and healthy, but it helps you understand in surgery, if you ever get to see it roughly what you might be expecting to see. Um, as we said in medicine, things are more complicated. You need to know more detail. So the different branches of the aorta here and they split off recently even more. But that's just to give you some example of what kind of level you need to know, especially because, you know, I just learned this for the sake of learning it. This is an example of an image that was dated. Sorry about the not great quality, but you might be told to do an arteriogram and or visualize this picture of the coronary arteries of the heart. You need to know the different branches, so images like this will help you understand images like this. That's kind of be quick. Roundup. Hopefully a night. It's easier hate for you to kind of understand what kind of potential level of detail med singers into well enough to me how it links to physiology. Sorry, this is a really quick whistle. Top it'll, but hopefully that helps on give you a 90 day. With this in mind, I'll give you a couple of minutes talking to these questions on. We've got a couple of like, image based questions and maybe some true or false questions as well. So I'll give you a minute that it's 1918 on my cook toe. Answer these questions. Either you could put it in the chat, or, I mean, I can't really Freddie will have to read them. Or you could just answer them in your notes and see whether you can work it out. I hope you've answered those questions, so the ones in bold off the correct answer your eye is in front of your spinal column not directly in front, but it's the front, um, the at the axial skeleton consists of like the skull that's printed cage on your carpet. Bones are distinct. Your radius and owner. Your nasal bone is not located on top of your frontal bone in front of your knees on your forehead. You needs a Bernese below, it says, Inferior on. Do you? Do you find your oxygenated blood in pulmonary arteries? Um, expression is a little bit tougher. Um, might requires of image recall. You don't know that's fine, but you might get you might not even get half of these labels, and you might just be given 123 and four, and you have to work it out. Or you might just be given one option and given multiple choice questions, and you have to answer them again. It will really depends on what medical school you and the back on. How they quit. Series is an important what? Used to really look up a swell on that To give you the answers. Phillies, you have got the frontal bone. Ethmoid lack hormones are genetic. Bring. That's just a quick as I said. Whistle, stop. Talk. Often after meat on a lot of it that you do. Depends on really what? Medical school you go to, how they quiz you. And again, a lot of this that might be covered in a bit more detail, as you progress is all through medical school on. But that is to touch upon. So do you an insight into what kind of stuff you might be learning in there to me. How you might be talkin lectures on on so on and so forth. Do you have any other questions? Happy to answer what I can. Um, yeah, Hopefully that helps a lot of it. Oh, you got some people this aren't in the questions and make your name, which is nice. What's the best way? Okay. Yeah, I guess. Studying enough to me. I found flash cause really helpful. Uh, I don't my friend David, that I think that was the best thing I did. I bought like the pro for a year, which is like 12 lbs a year, and I take pictures from my online textbooks and Google images, and I literally just label them and quits myself on them about 100 billion times. Yeah, uh, nasty wise thing. I found that with the most useful that I ever had, I won't necessarily recommend it can be a little expensive. There's a website called Ken Hub and they have quizzes on there, and it's basically a bunch of Australians have put it together. So it's not exactly the same as how you'd learn in a British med school because of the fact that some of the names a little bit different or they've got slightly different ways of describing things. But, you know, Ken Hum was quite good question bank, and they got could like that's a good images and stuff there. I found that really useful. And that one is is the YouTube where I looked at the same Webster and he's the head of anatomy for swans, the university. Andi, he doesn't quite good. Short YouTube videos for anatomy. Um, yeah. David's Have you learned Not to me knowing you just knew it. I'm going to say with difficulty Uh, eso I am a big fan of things like Anky and kind of staged repetition techniques which you could Google if you don't come across them. I find that I can't see something once and retain it. When a consultant is questioning, May I have one cat? 5678 Many more times before I can truly retain something s so I go over things over and over and over, so that's my way of anything. So I'm a big fan of Anky and some laps, but I want to emphasize it's not for everyone. Some people think you have to do and you to do men school and you absolutely don't. So I'm just going to quickly mention what I've just put up as a slide. Just because some people have mentioned the quite like the anatomy stuff, we are putting together a just anatomy series for later on in the year. This one start the plan is probably October fruit like the end of October food and started in December. We were originally 12 sessions that started looking a bit insane s and now it's gonna probably to six session ones with a bit the gap in between Onda. So he's just sneak preview of what might be coming up. This might change a little bit between now and when we formally announce it. But what can we change it by spelling respiratory? Correct. Okay, let's poke fun of the dyslexic. Oh, I've never based. I spoke Astra testicle and urological correctly. You're about to tell me I didn't, but I gave it a good girl. No. Yeah, right. Um, but yeah, no going back to learning anatomy? Ultimately. Yeah. Datas. There was a repetition. And I want to find repetition in different ways. Sometimes helps. I don't know if the other guys will agree with that, but during things like the actual talk to lecture, you have it university following that up, maybe with flash cards or revision in your own time. Maybe from a text book or from like I did can have the question banks or that sort of stuff and then following it up with someone on YouTube, maybe, or following it up with I tended quite off extra anatomy lectures because I found electricity is quite like this that taught off the Natalie and so just doing it differently in different ways, I think Hoped, Yeah, improved my knowledge, but still hammering at me in different directions. Um, yeah. Other questions. If your e let's see what else you've got. Uh, just about to answer the one on, like, you know, a current tumor and all that kind of Yeah. So I guess it does that I should have asked me this clear because I didn't realize that you presented you Doesn't have a long Life. Street is really annoying that team since but essentially, yes, they're the amount of stuff that you have varies and you might not start, get told like there's a bigger tuna comedian or whatever here, there and everywhere. But actually the content tends to be different. So, like I think we got told that we had so you might have your largest arteries. They will have necessary like a tuna comedian, for example. But that necessarily isn't the biggest later, and it won't always be made up of a smooth muscle. So in the largest arteries that will have more last in to help it stretch more, rather than necessarily be contracting because you don't need it to contract. There's, like different little niche things like that again, some medical schools want you to know all those details. Some don't. So it does very on beer. Hopefully, that helps. But and the other thing to mention, there is also different universities want, you know, different things, but also different areas of whatever profession. You go into things example. If you want to go and become a nurse and working palliative care, probably completely useless knowledge to you. Meanwhile, if you want to go on become, I don't know, a vascular surgeon on your entire life becomes operating on these particular things. Probably quite useful knowledge to know how best is the wealth have struck, how vessels a structured. And then they think about the other way as well, you know, probably understanding more Nat to me about how patients eat and swallow. Probably quite useful if you're a palliative. Nous probably quite used to us if you're a vascular surgeon, so that that plays into it quite a lot of Well, yeah, it does. I think it lasted That's the thing with enough. Do it again. It's like some. And it also depends on your lecture. Like if they really like a certain topic, then they'll probably quiz you on that more so you end up being better at that topic because, you know, to expect it for exams. But they should really make their will. Examine you probably fairly on anyway. Yeah, as I said, like, it's better Teo learn and after me through seeing it. Anyway, I feel like it's the whole point is like you learn through different ways, and it helps you in those different ways. You know, lectures. A great is. Well, don't get me wrong, But seeing it in real life and learning like Okay, right, this pin structure Is this in this purse sectional, actually dissecting. Listen away from this. And this much underneath this muscle, you find this and someone does help you. Probably more than actually just reading off the page. Really good. Any last questions from your E and then we'll move on to a day. Not too compliments in here for you. That's nice. I didn't think it was a raising. Could tell a joke. It is Yeah, there's a problem. Oh, yeah, but I think just one thing is worth mentioning, I think probably can't bit more in David's session. Anatomy isn't exact for everyone. There are. There is a bit of variants and a bit of wiggle room. So obviously, where was where we've been saying that, you know. Example, Actually, comedian might be different. 10 different wits and consistencies in different parts of the body. It could also be different in different people. Uh, and you can cut one person open and they're set up one way, and you cut someone open and they're slightly different. Everyone is a You know, everyone is quite different on the inside. Um, that's really interesting when you see people that varied. Um, yes. Otherwise, I don't think this is for any more questions for you, kind. Sure. Your hand over to David. Hi. Ah, lovely. Right. I didn't want to start sharing my screen until it was definitely my turn. Oh, cool. Lovely. It's having a good old wine at me. Bear with me. I'm just going to waffle. Well, I did get on content from below. I'll go back to this slice. I think it will Oh, yeah. So Oh. Oh, that would just be trying to share my screen. I didn't even try to do anything exciting. Go is that Is there something I need to click that I can't see and they don't do that. And then I can send live, but it'll be just your face, right? Uh, that's very irritating. It seems to be your camera that's being shared rather than you'll. So there should be politics, folks. I wasn't anticipating this bit to be difficult, so I didn't even Brexit uh, it's just a little up. Interesting. Okay, I'll go back to my technical difficulty slide for the time being for disclosure. At this point, this is slightly embarrassing. As a former 90 million are all I see you, David is the one we go to the when we have I t problems, so I have absolutely no idea how to help him. So I believe the way this works is a sort of dragon drop. It doesn't want to drag and drop sharing your screen. It should appear in the little content box of the bottom and then it's Dragon Drop can isolate that way. This is very interesting. It's no problem with my second moderate because I have to find Well, would you accept that? Know? Yes. Very, very strange. I can't drag and drop that. I can't select it. Um, I think she liked me. Didn't come back and see the concern is working. The way I do it, normally up by the mute button at the top is just share screen. And then I clicked. It comes up with an option of different, like tabs. I've got open and I just click the one I want. Yeah, which is exactly what I got when I choose the option I want It won't actually select for some reason. Now, this laptop does have, ah, dodgy left click. But it will let me select everything else it leave, Let me drag and drop it. But just not actually not be selected. Very interesting. Just to check for a second. Can you stop sharing the slides just in case it doesn't want to replace somehow. Um, cause here everything I'm clicking should be fine. Okay, let's try a new plan. See if that works. Thank you. I'm gonna say Ryan, but I don't know if that's pronounced correctly. You're getting some minute we're being told it's okay. We're doing fine like this, positivity. I'm just really annoyed, like out of everyone. It should work for me, Damnit. I leave and come back. That's the only other thing I can think of it. If not ready, I'll have awkwardly email you my slides. Don't worry, right? I'll be back in a moment. Go back to my technical difficulties. One telling me not to worry. So if they want his questions, you're welcome to ask them. Well, David is rebooting. Otherwise, leave now. This is ridiculous. We're gonna mute David before he starts getting too aggressive with computer. Any one of the questions feel free to ask them. I'm happy to try and tackle anything in that meal, though should know most, if not all that familiar. Be amazed if I do, you normally catch me out on it much, read a couple of the earlier questions from the chat. The ones that we answered in the chat, someone asked, what is a pro section just to clarify? Basically, it's a very well pre prepared a model, so, you know, take a limb when you take a bit flesh from a cadaver ordinated body on, but it's very delicately and nicely put together so that it becomes a very good teaching model. Um, and they are very fiddly on there's old problems with them because ultimately there from living flesh, they normally have. But I don't quite a life expectancy, but they do wear out and then not have to make them all against. They can be very, very difficult to produce a difference between that and dissection dissection, normally is the active, uh, cutting something apart. So opening it up and see what's going on. Procession. Someone already done that for you and you just study it on my slide has just dropped because David left, which is very rude of him. Naughty David. There we go. No, eso it up is working. I actually believe had my slide displaying, but then Lexmark me get a back and include computer sound. Oh, no, I do have some computers and I do need to do that, so I believe it. Surely you know that looks like you are are policies. I'm going to blame that entirely on Microsoft teams. It wouldn't even let me leave correctly s so I had to just restart teams and everything appears to have moderately fixed itself. So I'm gonna put that one down. Is not my fault, Freddie. I was gonna Oh, I can't remember, But I have no one. I was going to set it up so that people could see me a Z Well, just for sunzee spend. Let's not try and hope it, complected. It's working. Let's run with it. Oh, you're no fun. Um, yeah. Okay, fine. Other theory that would work, but anyway, yeah, let's let's let's just cracking eso Apologies, folks. Normally, I would have a a second monitor and I'll be able to see the questions live as they come in. My second monitor has given up. I think Pastor is boiling away inside. I can hear making a very high pitch screech s so I can only apologize. Freddie will literally have to interject. Just tell me as we go along. I would be delighted to receive lots and lots of questions that would make me very, very happy. That said, I originally trained as an actual classroom teacher. I'm gonna ask lots of rhetorical questions as I go through on then provide answers to them. So don't worry too much about putting those answers in the queue and a for any questions that occur any point. Please do ask, and I'll be delighted to do my best to answer them as a finally a medical student. Lots of my answers to questions will be. I have no idea. But please feel free to ask anyone. I do my very best so you can see a lovely picture of me. They're out doing ambulance. He things s oh, I wa so qualified ambulates careers volunteer before coming to meniscal. So it was very I opening to see how much more detail I needed to learn everything in eso. You will see some of that detail tonight. I haven't tried to go as detailed is my worry. She has done a much better job in that respect. I felt I should also briefly mention my path into studying mental because it's an unconventional one, and, um so that may be of interest to some of you. So I did my Jesus. He's in a levels and I went off and did a degree in psychology. After that, I worked into better need schools as a learning support system for people with additional learning needs and things that I then went and trained as a teacher. I worked to the teacher in various schools in London for several years. I was also on I t manager during this time as well some of the schools I worked in, I then, uh, through my volunteering with some gel ambulance kind of fell in love with healthcare and started working the healthcare assisted first of the roll milestone on then at the role Brompton on, then from there, gained kind of the necessary experience to go to med school while I was health care system. Now, so the masters and cognitive neuroscience and you're a psychology Now, The reason I tell you that long winded and quite intricate story is not because I recommend this is a path into medicine, but just contrast with them mirror from earlier. The fact that you don't have to have a biomedical degree or go into medicine directly from at school. There are other options. You can take other routes. And although my route may have been significantly slower, I've had a lot of thumb getting here, But yeah, as it says on this, like now I'm now work medical school, and I'm just starting my final year, which means I have just over six months to my final exam, so I'm not terrified at all. But in the meantime, we're going to talk about some surface, and that may just the highlights. You've had those lectures said far, including now the introduction to and asked me. So I'm going to talk about surface of attorney on when I talk about surface. Um, estimate I'm using it is sort of an umbrella term. I'm talking about how we can apply anatomical knowledge to actually doing things with patients. But leave it or not, your patient is not particularly interested. What, for TB levels. They're spleen is out. Or how many rings of cartilage they have in their trachea. They're much more interest in. Why is this blood coming out of my eyes or police? Can you stop the pain I'm experiencing? So this is the session about how we can use anatomical knowledge that we learn in the classroom, in the clinic room in the ward with patients to actually achieve good health care outcomes. So it's going to be giving you some Amitiza Mikel knowledge and then showing you how we can apply that. Just give myself a little plug. I will be teaching medical emergencies the same time it next week. Please do come along and join me for that. Just give a little caveat that if we do have any hopeful ambulance clinicians, where the want to be a paramedic or a technician on associate ambulance practitioner and he see a or anything else that works on ambulance, we're not gonna be talking much from ambulance perspective. I'm gonna be talking about sort of in the hospital management of medical emergencies. If you're interested in at things like a kind of pre hospital management of medical emergencies on things like potentially want to become like a student, paramedic or similar police and Freddie polite but grumpy e mails on, Maybe we can persuade him to put together some sessions on things like that. I will reopen my partner, who is a student paramedic. Lovely. Anyway, before we start talking about anatomy, I want to see kind of what my legs you've got already. So this is gonna be rhetorical. Don't worry too much about putting answers to this in the queue and a section, But just have a think I want you to imagine right now that we asked you to go outside and dig up at some road somewhere on the want you to have a think about what might you want to know before you start going and digging up some road on what safety concerns might you have now? This probably all seems a little bit of off the wall, as it were. But actually, all the considerations we're gonna have for something like digging up the road outside your house or similar, actually applies to kind of how we work with patients and how we conduce invasive procedures and things like that. So really important to think about. What kind of things do you think you need to know before you start digging up the road somewhere on any kind of safety concerns that you might have any things that you might need to think about. So have a quick think about those. I'm going to give you a minute or two just to think about those. I'm gonna put up some kind of model answer things. I hope you had a think about on then as we go through the talk. We're going to make those a bit more relevant to actual patients and things like that. No, we don't operate on patients with pneumatic drills. No, we don't put a load of cones outside the operating theater, but there are actually some aspects that crosses across on are very relevant for us to think about. So, yeah, one last time that if you were thinking about kind of digging up the road outside your house or anywhere else, what kind of things might you need to know before you put the drill on the tarmac on what kind of safety concerns that you have and how might you overcome those safety concerns? So what kind of things would you do to make that operation say for how you're going to stop, for example, double decker buses driving into the hole you've made in the road so things I hope you might have thought about So things like stopping vehicles falling into the hole. So when we're doing things like invasive procedures, well, we're not more advanced cars or microorganisms falling into. So the whole we've made for surgical incision. We have got a thing to think about things getting through that incision. So things like a kind of personal protective equipment. Antiseptic solutions are potentially giving patients prophylactic antibiotics. So that's antibiotics before they haven't infection to, hopefully prevent them from getting one. Hopefully, you haven't thought about structures under the road that might get damaged gas pipes, water pipe, sewer lines, cables, all of these kinds of things. If you're digging into the road, there's probably things under there that might get damaged. So we've got to think about how can we locate these things? How come we avoid them? How can we avoid damaging them but also finding the right road to dig up? So it's really important when we do when we work with patients and pretty much any context, we need to make sure we have the right patient. Oh, uh, little bit. Lee Medicine has quite a high volume, quite high turnover. I don't think you'll find many doctors, nurses, paramedics, etcetera, who only see one patient a day. We've seen lots and lots of patients in lots of lots of different clinical context, so it's really important that we identify patients correctly. You hear news stories about patient having the wrong leg cut off or, you know, ah, procedure done. That wasn't supposed to be done on them. So in the same way we could identify the right road. We'd absolutely gotta make sure we identified the correct patient before we start doing anything else, like taking history or examining them, because that's gonna waste time. But also, it's not gonna be the right care of that patient so evil. Once we got the right road or in medical context, the right patient, we've got to find the right place in the road to dig. If we're digging in the wrong place, we're not gonna find what we're looking for. Whatever that may be. In the same way with patients, we've absolutely got to find the right the right place to make an incision or to insert cannula or whatever is we've got to do on a lot of this surface, not a beetle is going to be focused around finding the right places in the human body. So we're going to be talking about that quite a lot, but anything involving kind of patient care. We couldn't talk her talk about kind of procedures and examinations without talking about permission so consent. We need to get consent from patients to examine them toe, operate on them to do anything kind of invasive on. Indeed, we should be getting consent from patients to take histories from them and just kind of have a chat about their treatment and things like that on. It's really, really important. This is informed consent. So what we mean by this is patients need to understand what we're going to do before we do it, because otherwise they're not properly informed about what's gonna happen. So getting permission to dig up the road or getting permission to examine the patient is really, really important, because that's not the focus of this talk. I'm not gonna talk to much more about that. But please remember that any time we're talking to patients examining patients or doing any kind of procedures on patients, we must be getting informed consent first. So mirror my urine has done very, very good job of kind of giving a broad overview of kind of the human body is a hole and kind of different things that we can find in it. So my talk is gonna be less focused on kind of slides like this tonight. Just a highlighter again before we look at examining or kind of doing any procedure infections we need to be identifying him positively on. So you can see over here on the left if I get my laser point, because I'm going to need it later anyway. Did it really come on? Help If I knew what I was doing Ah, again. So, yeah, we get patients in the hospital often and given hospital wristband, we should be wherever possible, confirming verbally with the patient or writing it down if we need to. We've got additional communication needs confirming verbally with the patient, their name, date of birth, but also checking the hospital responders well, could be confused. Patient who's just going to agree with whatever we saying etcetera. So double check with the hospital respond. And like I said already about kind of getting informed consent, So now we need to find out where where things are on the body. So it's all very well having that text book knowledge of, you know, the spleen, the liver and all those kind of things. But we need to be able to find Thestrals so that we can popper eight so that we can examine on so that we can effectively care for patients to start with with basic surface and ask me. We can start thinking about arguably quite crude. Are markings and landmarks that will help us guide us to where? Structures. Maybe so we can see here with this topless person. We've got a kind of a mid sternal line, so they're not using necessarily any particular that kind of landmarks. Tell em out this in a lot of cases, for certain things, this'll may be done simply by I. We could have a landmark it with a few different kind of anatomical structures. So if you feel down the front of your neck until you get stopped by and bones coming across, uh, horizontally, which we will look at what they are later you may be able to find a little of you shaped dip, which is called your sternal notch. We could use this as a guidance for the mid sternal line, eh? So this this may give us some help equally, your anterior axillary fold at which we can see over here on the right is just again looking at that skin fold are a different of the axilla or the armpit, and again using that as a guidance on even more so with the midclavicular line toe. If you're not sure where your clavicle is, you could just about see it running on this gentleman here. He hasn't got particularly prominent clavicles up, but we can just amounts of the chemical that on the middle of regular line is just estimating by I where we think the midpoint of each clavicle is. So his other medical, uh, vehicle line will be roughly here. Now, these could be useful for giving some rough ideas off where different structures may fall. So you can see if we are mentally extend these lines down, we can go into the abdominal cavity, and we could start using these to guide where different structures. Maybe if we do that, it can start to look something like this. So here, just to give you some context, a win the abdominal region. So we got the chest above on the pelvic cavity below. On. You can see here we've got these vertical lines coming down. These represent these midclavicular lines so you can see here too, because we're always going to refer to as Mirror was talking about. We're going to talk about things in terms of the patient positioning so to the patients right off their right midclavicular line, we could expect to find kind of deliver the gold plan. Our right kidney, small intestine, D sorts of things are on things like that on. Then you can see to the left of their left middle of IC your line. Now I'm deliberately not talking about these horizontal lines just yet, just because I'm going to explain them better on another slide. But this is just to give you a vague idea off where different structures may sit where we may find different organs within the abdominal cavity. Now this has a number of different, useful applications. I think perhaps the one that might spring into everyone's mind, first of all is of course, kind of surgical applications. If we're going to remove kind of inflamed gallbladder or we're going to investigate, say something like on inflamed dependence, then starting an incision in the right area so a patient doesn't end up with an extra large incision is really important. So knowing where these structures are before we cut is going to be very, very important. But also what you may not appreciate is this is also useful for other are areas of mental is well. So, for example, physical examination off patient is very important. So when a patient comes in, we will start by taking their medical history. So asking about the event, asking about past medical history, those kind of things, asking about other things like social history on their ideas, concerns expectations. But then, pretty much irregardless of the complaint, we will normally do some kind of physical examination. So someone with abdominal pain or problems with digestion may well kind of receive an abdominal exam on. So as part of that, what we would routinely do is palpates so feel with our hands, different regions of the abdomen. And as you can see here, we normally divide them into what we call nine quadrants and how they're quadrants when they're nine of them. You can join me and being confused by that one, but we divide into these nine regions on there for when we're feeling these different areas. If we feel something unusual in one area, so let's say we're palpating over here in the left lung bar region on. Suddenly we find, you know, ah, hard lump or the patient has pain. When we press in that area, we can start to make some educated guesses about what might be the problem there. So maybe if they've got a hard lump in the left lumbar region, they got a tumor of that sending colon. Or maybe when we're palpating in that region and there's pain, it could be a problem with their left kidney. So really important for us to be aware of this knowledge. Now we can start going into things like this. So again you've got your nine abdominal quadrants and you can start talking about what pain in this area might suggest at this sort of problem, etcetera. However, in the same way as kind of mirror talked about anatomical variation, not everyone presents exactly the same with different conditions. If they did, medical degrees would be in a north a lot shorter. So it's really important to bear in mind that while tools that this could be a useful bit of guidance, especially kind of if you're starting out studying things like the abdominal cavity later on at things become a bit more nuanced. And just because, for example, someone doesn't have epigastric pain doesn't mean they can't have Gordon or good as the Americans call it and things like that, it could well be at that. They still do. But, for example, that pain is kind of a carried to somewhere else. Or there, perhaps not in pain, possibilities of medication they've taken. So things like this can be some kind of useful guidance, but it's really important to bear in mind as well. Then, actually, at there may there may be other things. So we tend to get a little bit more detailed and think a little bit more in depth about this just before I start with the next bit. Freddie. Any questions? At this point, any one is posed. No, that was very sad. Okay, know is I would be delighted to hear questions from people watching it from when they occur, But for the meantime, I will assume that means I'm explaining everything amazingly well. So what? We start to formalize things a little bit more on you may start to guess which of these kind of lines or planes were involved in a kind of abdominal cavity regions that we were talking about before. So we can start to use anatomical landmarks to help us identify different kind of theoretical lines going across the body. So in the same way, with our midclavicular lines, which would come down here and roughly here we can again look at different kind of imaginary lines. They don't exist for realize it worked, but this time we call them planes. So how about look at the different structures there and see if you can work out? What we're using is the land marks for different planes. I'm just going to start the top while you're thinking about that on. Just explain a few other structures that we've mentioned briefly. So here we've got a clavicle. Bones s. So this is what we're People kind of tend to break when they fallen outstretched arm and things are attempted. Fracture. Their clinical on here, as we talked about before, is our sternal notch at, So you can see it's going to prevent the U shaped. Normally, you can palpate that quite well on herself. Warm things I would really encourage you to do, especially while we're talking about. These structures are on this line is have ago a palpating them on yourself. So have a feel. See if you could find your clavicles. So start at the top of your shoulder. Come across the come towards the midline on, see if you could feel those bones almost sticking out of the skin that they kind of front of your shoulder area those your clinicals and then you should be able to find your sternal notch mirror. Also mentioned abysmal back. It's sternal angle. So you can see there. We've got parts of kind of the sternal construct on. Then we got a little line here on this is the sternal angle. So on some people you can find this very pronounced and the two bits of bone are our different angles, and you can really feel a change. I don't tend to talk quite as much about the sternal angle because I don't have a very prominent one on people who try and find on me struggle. So another thing we can do if we're trying to find structure in this area is we can feel for intercostal spaces. So we've got a rib here on. Then we've got a space which we call intercostal space, and then we've got the next rib. Now, you might be curious by these lines, these little shaded areas here. So we've also got kind of cartilage in this era's well as ribs s. Oh, yeah, we've got our ribs coming down and we've got our intercostal spaces. So hopefully by now, especially if you've been doing some counting, you might have noticed that the office turn or plain is just under that fifth rib. So in that fifth intercostal space on have a think about what organs, What structures you might find in the office turn or plain. So if we were to cut this person open along this line, going through their rib cage as well, what kind of structures will be find in this area? So hopefully you're thinking along the lines of the lungs, possibly part of the heart pericardial camellias. Well, now this may depend on our patient has much don't think so. Patient with things like heart failure will have a larger heart. And so it may well extend down this far. This's another way which will get anatomical variations moving down to come back shreds pyloric plain again. Hopefully have been kind of frantically counting on your own screen on you could see the, uh, transpyloric play is just tucked under that 10th rib as it were. So, therefore, we we would be able to do it by counting down are intercostal spaces and are ribs on finding that level. You'll also noticed with background here, we've got t nine t 10 to 11. T 12 L1 L2 L3 L4 or five. These are the names of the vertebrae were going to talk a little bit more about those in a minute because they can provide useful landmarks for us again. Mirror also did talk about that is a little bit in her talk on again. Haven't think about what structures we might expect to find on the transplant. Lauren Plain. Now, this one is a little bit trickier, depending on if you kind of started any anatomy before. But how about have a feel of that area on yourself on how I think about what organs you might find in that area. If you're having a little poke of you or almost your upper tummy area, there What? What kind of things do you think you're poking is you have a Prada around in that region. Hopefully apart from kind of the lumbar vertebrae, so you can see kind of L1. They're transferred air transaction across, but transpyloric plane, but also things like the end of your stomach. So the pylorus of your stomach, hence the transplant Lorik planes. That's the bottom part where food starts to move out into your duodenum. So you're gonna find kind of the bottom part of your stomach, and the start of your duodenum is going to start there. So your stuff your 10.3, the pylorus of your stomach would be kind of sitting roughly here on then, feeding into a duodenum on potentials where your pancreas, Your gall bladder as well. So we have your liver kind of arching up around here, going up to about T 10 Onda gall bladder somewhere roughly around kind of ninth, 10th, costal cartilage on then kind of kidneys, potentially the hilum of the kidneys so that it will the tubes go in an answer. Blood battles and the ureters are kind of tend to sit around kind of L1 kind of region as well on potentially spleen over on this side as well. Normally hiding just just above that costume march so you can start sequence quickly. Basic anatomy can actually, Really, guys is what we had attempted expect. So I told her I had your Denham starting L1. What it tends to do is curve around that distinctive C shape on, Come back about L3 and I say tends to because again, anatomical variations on again we can start thinking about what you might find our subcostal plain s 01 I wouldn't necessarily expect used to say that you're inferior mesenteric artery. So you have a that potentially in that region on the third part of your duodenum was we talked about. And, of course, more lumbar vertebrae. Well on what's the land marking here? Have you spotted it? So, yeah, it's underneath your last set of rib. So unlike the others, which are a bit more anterior, you might have to feel you should have to feel around a little bit more laterally to find your kind of Boston ribs. The 12th ribs on that line we're drawing from to make this sub costal plane on. Hopefully you can start to see where some of these names they're coming from. So we said the pylorus of the stomach. So that's where we get for L1 levels. That's why we're getting transpyloric plane on sub cost. Also, costal are being to do with the ribs subcostal underneath the ribs. What I didn't explain. It s so there's a cistern or plain, very bottom of your sternum. And we tend to call those if his sternum, your palpating or feeling that area don't press too hard, you can actually break off. It was, if it's journal, processing can be a little bit painful, so I don't push too hard. But that's why it's does it external plane on. Then we've got super crystal plane, which is the very top off your pelvic bones, as it were. So we've got to think about that. So it's the very top of those pelvic arches. So again, you should be able to feel out on yourself, and you should be able to draw across that kind of imaginary line that's really useful to be aware of as well on here. We've got kind of asked, Super crystal plane. I'm not gonna do about too much right structures in this region. It's something you can go and look up. I don't spend all night just kind of listing structures you confined on there is lying, so I'll crack on a little bit. Then, in terms of your trans tubercular plane, you are literally transit burkina. I should say you can find this by palpating your iliac tubercles. They're a bit more difficult to find, but the next one down this into spine, it's plain what this is to do with is your anterior superior iliac spines. So if you feel from the top, you're even get Crestor the top of those kind of always pelvic arches, and you feel down and forwards. So in theory, really anteriorly until you find to little points on your hip bones, and it almost feels like two fingers pointing forwards. This is your anterior superior iliac spines. Now this will be useful land marking for various surgical incisions, which will talk about a little bit, but also for land marking that into spine. It's plain, so you should now be able to buy, feel, draw a cross on yourself or another kind of consenting adults or similar these different vertebral planes on these different levels, simply by palpating the anatomical structures on knowing what goes where. So you can start to see hopefully quite rapidly how useful service Fatemi can be. Uh, so it's these knowing these anatomical levels on knowing about these planes could be useful for various things, not least because it could be useful for images as well. So here we've got a CT scanner also noticed the donor of truth on. If you're not aware, then this next bit will be a puzzle for you. But what type of imaging does a CT scan it use? So it looks at the the structures inside the human body or animals are sometimes used by vets, especially in juice and things like that. Where I, you know, your average dog or cat does not get a CT scan, but what type of imaging does it use? So hopefully you were thinking about X rays, but the X rays, the kind of come out of a CT scan, look a little bit different on the reason for that is, unlike this chest X ray we've got here of the CT scan was actually able to take lots and lots of X rays one after the other and layer them on top of one another. So when we tend to view CT imaging, it tends to look a little bit more complex because we've got a little bit more going on with all these different layers. So we've got a little gift here. Hopefully, that's going to play nicely. A found. They happen always on teams. Freddie, can I just check with you? Is that gift playing back nicely? It isn't, Thank you. I won't have to use my sneaky little YouTube link down here to get me out of trouble. So you can see here that what's happening is we're scrolling through a CT image on already, without even knowing that much about CT's or about anatomy. Necessarily. We can start to figure some things out very quickly. So just to give you a very quick bit Morientes in two CT imaging, what I want you to imagine is whether it's this person over here in the blue T shirt or someone else. I want you to imagine that we're looking at this person using their feet as binoculars, so that means that This is our left side and you consider helpful. They have put l here on. This is our right side because we're looking up through their feet is tempting. Think we're looking head down, But no, we're looking up through their feet so that's a useful bit of impatient. So we know what's going to appear Where on then The other thing to know is that on X ray, a rand gas appear very dark on more solid, such a metal and own peer whiter so very quickly we can start to figure out a few different things. In case you're wondering about a few different structures this year is the backboard of the CT scanner s. So don't worry too much of that matted. This person hasn't got a weird backpack on or something like that. That is the backboard and CT scan. Uh, that also tells me, Hey, this is their back on. This is their front. So in that case, we should be able to figure out some of these structures just by are kind of even very rudimentary anatomical knowledge. So we've got big black areas of gas that are bilateral on extend down several vertebral levels that we can see the vertebrae there, so these are going to be the lungs on. Then we've got a pocket of tissue on possibly some fluid as well in the middle, so that's going to be the heart on. Then we can also see some of the vessels coming off the heart. You could even start to see some of the blood vessels in the lungs as well. So these white lines appearing here just give you some more context. Well, so these white dots seem to migrate around the size that is, the ribs curving around. And, as you can see, they they're not straight. They change from kind of they can move from West One and a soma complain to another that explains why they appear to move his risk. Also, the CT image on this white dot here in the middle is part of the sternum, and so you can see the ribs and moving around and gradually joining up to the sternum. We've got some of it. Some of the bones of the arms here are not attempt to figure out which ones. It's not a great way for him itching the arms we want a bit more detail on a bit more focus on them on, we can see kind of soft tissues, so that's going to be kind of subcutaneous fat muscles, fascia, things like that. We want to see a bit more detail that we'd probably like a MRI, but you can stop. See, with some fairly basic knowledge, you could start to really understand some of the image in and start to know where we are as well. So those new with the bit more anatomical knowledge might be abstinent. Think about which vertebra levels were at. Have a look at the 30 brought body's. I'm going to talk about memory briefly, but in the mirror he did a swell so does not look like a kidney bean. Does it look like the vertebral bodies? A bit smaller, that will give you clues as well, as well as things like the ribs, which are articulating with those vertebrae so we can start to work out walking vertebral level. We might be operating it. However, that doesn't look on awful lot like a chest X ray up here. But just to make you aware, remember those kind of different planes of imaging. So Corona Sandra, it'll etcetera. That mirror was to have matched. This is a corona love you. So the CT because it's creating lots and lots of slices. And we saw those being scrotum before it can absolutely generate a Corona image as well. On so there, although not scrolling through quite a quickly, we could see in that Corona Lowrie ent a shin a zoo Well, so again, we can see ribs round here. The big black kind of gaseous areas, therefore, are going to be the lungs with the heart kind of hanging out in the middle on you can see how it changes from the sort of a more traditional heart shape into kind of the structures behind the heart as well. Those in there kind of fibrous pericardium and you can see, especially as we get to the back there, we can start to see some some of their kind of structures of the vertebrae even on we could start see our liver here as well, very distinctive shape because we got the diaphragm arching up and then the liver underneath. It s so being aware of all of those structures, a swell in this case you can see this patient has got their arms up for the scam. Where is this patient in the picture has their arms down. So even little variations like that can be picked up on. But again, knowing a little bit about anatomy and a little bit about where we would expect to find different things, we could start to make an awful lot of sense off different things. One last thing. I'm just going to point out just I'm just spotted. It is we can start to see They're right at the end. Off the stack of images, we can start seeing the abdominal aorta. There's a lot. So Mary already took a little bit about these. I'm not going to talk in quite the same way other than I want to recap. Um, reiterate what mirror was talking about the different shape of different vertebrae. So, just by glancing without worrying too much about the labels that have been put on them, you could see the upper this Vicodin end. We've got very different shape. Very small vertebral bodies on when we go through to thoracic and then toe lumber. We've got changes in shape on. We've got a kind of large of vertebral bodies because they're carrying more weight. More pressure on them, which again a bit like we were looking before, means that very, very quickly looking at again, this is a transversus ct abdomen. We can see that very quickly. We can start to identify. Haven't think about have a look at that vertebra knows the example. One is the other way up. But very quickly you can start to think about what vertebral level are we at even if you're just going for the region, which is absolutely fine. So do we think this is a survival slice, a thoracic slice or a lumbar or syncopal transfer slice? Hopefully, you're thinking it's a lumbar region because that large vertebral body, I'd say not quite a chunky vertebral body. And you can see at a kind of the lamina on the pedicles as well through this kind of CT imaging. So other things that might give us a clue Here are things like we can see kidneys on. We can see kind of the hilum of the kidneys where the tubes are going in naps. He can just start to see on that one on, we can see a few other structures as well. So we've got a structure here and remember again, we're looking up through this patient's feet, so this is going to be our right side, and this is going to be out of left side. So what is going to be? I said that wrong. So what's going to be a large structure in this area? I'm gonna stop saying left and right cause I'm confusing myself. That's what Ah, large structure in this area. So remember when the lumbar region So we come down below the rib cage on so underneath the rib cage nestling are just under there. What? What can we expect to find, especially that has this kind of distinctive arching shape on, then kind of a little addition as well. So here within the liver and then the gold plan as well, then we've got these kind of slightly more random shapes over here. This is likely to be and my CT imaging interpretations not brilliant, but looking at the shape of it, this is very likely to be the pancreas, but it could be like these other kind of slightly more random shapes. It could be small intestine. So I'm not gonna put my money one way or the other. I would want someone who knows more than me. But we can see our kind of kidneys there. And you can start to see some of the musculature as well. That kind of supports the vertebral column on helps with kind of flexion extension. So bending over and standing up right And think that and you can see again We've got very black area here, So this indicates Guess now we could think about Oh, this could be some gas in the bowel and things like that. And you can see little bubbles of gas And what I'm much for certain of being bowel over here. I think given this large area, guess I think it might be part of the pylorus of the stomach at. But again, I'm not I'm not gonna put my money on it. I need a good few years. Morphine, CT interpretation, for I start being more certain again. This is just the backboard of the CT. If that was puzzling anyone on this little dog over here? This isn't like a kidney stone. There's migrated out of the body or something, That that is the scroll bar from the image. I was looking at her. Please don't puzzle too long over that one. Given the information that I give you given you, then on the left hand side of the screen, No, only will we hopefully very fairly happy before with the fact that this is a lumbar vertebrae. But given the structures that we can see, we can even then narrow down which the tibial level were operating at. So I'm not expecting you see the number like a on CT, that would be impressive. But for example, can we see things like renal veins or thoracic duct? Can we see things like the fingers and half years, I guess veins, which are part of the drainage off the kind of normally off the the Treskavica. He said this would be the lowest point that we would kind of, uh, see them as it will. Uh, but I hope you would agree that given that we've almost got the hilum of the kidney, so one should be slightly above a one on one should be slightly below on things like the neck of the pancreas. The pylorus of the stomach on the funders of the gold vial. It's a part of the goal bladder there, the main kind of body of the gallbladder. Ah, hope you would agree that we're al one. So even just seeing a little snapshot like that knowing little bit about the anatomy in about a surface anatomy, we can start to tell exactly what we're looking at. Now, this is a bit of a cheat. I could have showed you an animation again on then. One thing you could if you wanted to, is for example, see when the ribs stop on that will tell you were into the lumbar region because they're know ribs in the lumbar region on you can even do things like count individual vertebra bodies. But even taking the information away from you even some rudimentary anatomical knowledge, we can gain an awful lot from even one c t slice. So anatomy knowledge and knowing kind of what level things that that could be incredibly useful in a wide variety of medical applications. So I said we talked briefly about surgical incisions, and this is going bit more back to true that surface anatomy here in the same way that we were able to identify planes. We can identify different areas to make incisions and things like that, say a few different ones to be aware of. So there is a medium or sometimes a midline incision. You'll see my line tracing to make it. But more colorful has not done very well. We should really be going around the umbilicus. We're not going to transect it. If we can, we're gonna put it on one side of the incision or the other. This one can be a bit problematic, and we'll come back to why in a minute. So paramedian, a slightly more commonly used, I believe. Although I am no surgeon, I will happily be corrected on that one. Then we got the subcostal surround. We talked about Subcostal Plain would be below all of the ribs, but a sub costly incision goes below kind of the edge of the rib cage on. Then, if we go away across the midline, a swell that's referred to as a rooftop incision on that these have different kind of applications there. For example, a rooftop procedure I believe is commonly used for Whipple's procedure, which is involved with kind of cancer in this sort of area. So involved things like pancreatic kind of cancer. And things are that on the Whipple's procedure is a huge operation, understating to try and kind of receptive is and things like that, um, slightly more classically, an operation you might be a little bit more familiar with is, uh, on a pen deck to me. So when the appendix is removed because it's become inflamed or sometimes preventatively, especially if people have recurrent episodes of appendicitis, so they keep getting kind of grumbling. Appendix on the landmark into this one, it may look like there's no structures that can be palpated here. How would we know to put a line just here? Well, actually, what we're doing is we're tracing line from the A cyst, um, breast of those finger pointing bits. If you feel down from the top of your iliac crest and you feel even be really anteriorly, you'll get to your basis your anterior superior iliac spines that's represented by this X here on. Then we're drawing an imaginary line again, but this time, from the ASIS to the underlying course on what we're saying is McBurney's point as this is no is roughly a third from the ASIS on two thirds from the under. Like us, this is one potential test for if we think someone has appendicitis. If we took the Burnley's point, the pain gets worse. We think it's more likely to be appendicitis. There are various other things we can do, like straight leg raises on depressing on the other side. All have various waiting's and evidence, but that shows you at least two different uses for that one anatomical landmark. So both for making incision for an appendectomy and for examining the patient as well. If we suspect abdominal pain. Just, uh, I like to not a surgical incision, but please, do you know on this diagram as well at the angle of the arms. A pleasure for two is the carrying angle. If I have time to talk a little bit more of our arms and things like that, so note that they angle away from the body. Then we got down here super pubic incision. I shouldn't think some of these also have people's names. Attach them as well. So this is a Pfannenstiel incision on this could be used to things like C section and things like that. But I said I'd come back until about the median incision, and why were problematic. The number one here is actually trying to go on a take something for Decent. This median incision is trying to agitate the anatomical structures that you can find this area, which is the linear Alba. It is the white line, because if we were to peel this patient's skin off, first of all, they probably be annoyed. But also what we see is a white line going down the anterior abdominal wall because there are no blood vessels in this one little area, and this is great in some ways on problematic another. So if we were to make a median surgical incision, that would be very little bleeding from this layer because there are no blood vessels down the linea Alba. However, this is also problematic if there are no blood vessels than there is impaired healing on. So actually, median decisions tend to be avoided because actually, it's quite difficult to get that incision to hear. I I should say, without work, blood flow, it's not. There is no healing, but it is severely severely compromised. This is just to show you on apologize is a very complicated dagger. What we are looking at is we are looking at the anterior abdominal wall. Your see, I linear Alba there again. But we look in it from the inside. So this is inside the abdominal cavity and down here as well on it's looking at the different layers so you can see where our paramedian incision is. We go through these muscles, the rectus abdominus muscles. So we have to be careful of that onder other structures that run in the area so you can see we got repossessed nation here in artery and vein. So we want to be careful with those as well. But also, we don't necessarily want to incise the Linea Alba because of the poor. Healing on it's just to show you is, well, even something as simple as a skin incision has a lot of other structures we need to be aware of. So some of these could be palpated. So when kind of people have low body fat percentage, you can you can see they're kind of pick muscles and things like that on record of Dominus forms a part of that on the reason they always have a neat dividing line down the middle is cause the Linea Alba, and there's no musculature in that specific area. You can also see various other things. Notice well that the abdominal cavity is lined with peritoneum s. So this is a coating that goes around the inside of the abdominal cavity on has various functions to do is kind of infection and lubrication and things that that really important to be aware off the peritoneal cavity, but not something I have enough time to talk about. Today I want to briefly talk about the heart as well. I am getting close to my time already, but I want to talk very briefly. Thankfully, Mary did some of this for me by naming the chambers of the heart for you. I'm going to go one step firm and talk about some of these variables because again there's important surface and after the considerations here, because one of things we need to be able to do is examine patient heart on Auscultate will listen to their heart sounds, and I've got some heart and lung and play for you in a second or that I will have to switch my cursor back. So have a quick think about what these different valves are, What they're doing, what they're connecting to. See if you can name any off. Um, so the first one he can see a little about here on it's going into this big red arch, essentially huge red art. And the red is a hint here that it's an artery. So this arch is the aorta, the main artery that carries blood away from your heart. And so this is the aortic valve. Very simply, it's the valve that control of blood going into the aorta. And the key point here is it stops blood flying back from the aorta back into the heart. Back flow is bad. Um, similarly, on the other side, we've got a valve here that's going into these blue, um, kind of structures here. However, although they're blue, they're not veins again. This is talking about the oxygenation of the blood, and as mirror was counseling you really not all arteries carry oxygenated blood, so these arteries are carrying deoxygenated blood to the lungs. So that's the pulmonary valve on these other pulmonary arteries. um similarly, we got the try custard valve, and the much about Now these ones are named for slightly different things that the tricuspid mom has three valve cusps. You can only see to here because of the nature of the diagram. But there is a third one. You have to trust me much about sometimes used to be referred to as the bicuspid valve. We now tend to call it the mitral valve off. Stop my head. I can't remember why that is. Please don't ask is I don't know lovely. I will change back to I will attempt. I don't want the laser pointer. Uh huh. So these vows make noises on the blood flowing through the heart makes noise. If I play you and hopefully this will work I have selected the correct options you should be able to hear. Well, you might be in case that affect your volume. Said those are normal hearts. And if you have to own a stethoscope and you can buy them for his little is 4 lbs, you can have a little listen to normal heart tones and their sound roughly like that. I'll be honest listening to these I think these have been digitally enhanced and so sound a bit more crunchy than normal. But you should be hearing roughly that for normal heart. So the key point, like I said of valves, is to stop back flow of blood. We only get those nice, normal heart sounds when all the blood is flowing at kind of in the same direction. None of it is kind of sloshing around in different directions or flowing back into blood. Coming the other way assumes that happens. We felt, um, things sound. Not quite right now, this is just one example of a murmur, and you can see how completely different that one cents now that I happen to know because they're recording told me already that is a much well, Valerie. Good. So basically, blood is coming down to the left ventricle. But when the left ventricle contracts, the mitral valve is working properly, and some blood is flowing back into the left atrium. And so you've got blood sloshing into blood coming the other way, and it makes a funny noise. Now, all of this is interesting to know, but it doesn't really have a service matter. Me bent so thank you. So if we start looking at where the structures sit are in relation to surface structures, we can see and palpate we can start to see. The heart should sit roughly here. And like I say, the size of your heart depends on your heart, health and things like that. So patients with heart failure will have larger hearts. But also you do get slight variations as well bring people main actually have a lot of large heart and things like that. So there were some structures were already aware of We've talked about before. So this is really one here we can see because it's it's small shape on how it relates to still not on the costal cartilage on. Then we can sit on seeing the rest of sternum coming in here. We got the sternal angle just here. I should change back to a laser point. Let Thestrals angle just here. So again we can start account into costume spaces. So we've got intercourse space here and intercostal space here so we can start to feel these on our patient. And this is really important because when we OSCAL take when we listen to our patient are We need to know what structures are actually underneath where we're listening, Teo. So when we start to auscultate, we're gonna find a second intercostal space on We're going to go, right. Paris turn a border family going to put our stethoscope there. Are we gonna listen? We're going to hear the eight autistic bowels now. It makes and, uh, now off course, you can see, um, presented here. The order is actually slightly more medial. The nasty escape placement. But remember, the structure that is here is in the way. We got asked. Turn him here on. That's gonna kind of ruin the acoustic effect. So we're listening as close to the aortic valve is we can get without putting asked Arthroscope direct. Yeah, that bone similarly on this side. So this is now second intercostal space left Paris Turn all border on here. We're listening to the pulmonary valve, and you can see we're very, very close to the pulmonary valve here. Down here, we're listening to at the tricuspid valve on again. The placement isn't perfect, but we've got that sternum sing in the way on. Then finally, we've got our mitral valve down here. now the much where I was actually up here up. But apparently the acoustics are better town here, and I will trust hundreds of years of doctors who came before me on that one. So you could see again how the surface structures are really important in informing our knowledge of what's underneath on how we can find these things and listen to the best few other tips. Or if your auscultated heart sounds, you want to ideally be feeling the patient's pulse as well, because you need to know if you hear a strange and is it's systolic when the heart is constructing and you can feel that problem of the pulse or is it diastolic when the heart is relaxing on, we can't feel the pulse on the other thing to be aware of a zoo. Well, with these kinds of things, a Z well, as's kind of things like informed consent and stuff like that is that you will gain more experience with time. So it's about where you here and abnormality best. We'll give you hints. So if I can hear a strange mood is best here, then it might be an aortic murmur if I can hear it best. It might be a tricuspid murmur, but actually there's lots of experience and hearing things again, again to get them perfect. So don't be afraid to ask kind of colleagues for assistance on Get people to tell you what you should be hearing, especially if you've got terrible hearing like may say very briefly, linking back then after what I was talking before about digging up the road and things like that. Sometimes we need to give patients. Medications may be outpatient has gotten abnormal heart rhythm. Or maybe they've got kind of, I don't know pain that we want to give them some medications now. Not all medications can be given orally, so we can always give tablets. And there are various reasons for that. Sometimes medications work so rapidly that actually they won't have reached the right place if we give them orally. Another reason might be that some medications were affected by stomach acid and things like that, so sometimes we have to give IV medications. Another benefit of giving IV or intravenous or intervened medications is that they are less effective. I think that stomach acid so you actually more of the medication available to use on. Also because it's going directly into your veins, it's much more rapidly available for use by the body, so we don't have to wait for that tablet. You wait to be digested because actually, we're not using a tablet or injecting medication directly into your veins, but also sometimes we need to do things like if LeWitt's hydration and again we can use oral hydration. And we should be giving a patient oral hydration where possible things like emergency situations or where there's some problem that's stopping. A patient taking oral fluids or sometimes in addition to or uploads want to give IV fluids. So for lots of reasons, we might need to put a cannula toe a little tube into the vein. So when we think of Cannulas, we often think of this image above, so you can see here a needle on the plastic at structure. What I want to emphasize is that the cannula is actually this bit, so it's just a plastic tube on a port. Coming at the end are all the plastic tube does. The cannula itself is supposed to hold the vein open and let us put kind of medication of fluid. Start what you can see. Here is the needle removed from the cannula on In this top picture, you can see the whole thing as it comes assembled. So the idea is the needle and the cannula both go into the vein together because the plastic tube is too floppy, it will just flop around. Otherwise it won't puncture a vein. So everything goes in together and then we hold the candida in place. We hold onto the wings on we withdraw the needles, just the tube is left in the vein. So sometimes you might hear people say, Oh, I had a cannula. I had a needle in my vein. The needle does go into a vein, but it comes out again. Just leaves the little achieve behind. So just like we were talking about with I rode working scenario earlier. Digging up the road we might go for the anti cubital fossa or just the cubital fossa. This could be a good place to find veins, especially if you're this patient here who has a fantastic veins on. Uh, please ignore the backwards numbers. I want to make this diagram the same way around this time around. But let's say we're going to put a cannula into one of those veins. How I think about what structures We might need to be aware off what potential damage we could cause if we go in the wrong place and anything we can do to help us avoid the wrong place. So I won't give you too much thinking time on that one, cause I am now slightly over running, and this is the last thing I definitely want to talk about. I deliberately put too much in my talk because I didn't want to under under. So hopefully you were thinking about things like nerves, which we concede here on things like the artery. If we're putting drugs into a vein, we normally want to avoid the artery. There are sometimes when we take blood from arteries instead. But normally we're aiming for veins like we can see labeled in the left most diagram. So the the key structures for us to normally avoid are nerves arteries. As you can see, there are some muscles and some ligaments as well, which we also want to avoid on just like Mirror was talking about this could be an exam question that I could be asked about. So we have a little pneumonic for remembering what is in the cubital fossa. You'll find that lots of medical school acronym seems related to alcohol and things like that. I'll let you draw your own conclusions, but to help me remember what's in the cubital fossa lateral to media. Or so from the outside of the arm to the sort of the inside of the arm, we've got kind of the radial nerve, the brake. You're tender in the brachial artery and the median. Remember, this is really need beer to be at my nicest. So yet another example of medical students using new Monix to help remember long lists of things. Okay, I had lots of other slides. But on Friday, unless Freddie desperately wants me to over around, I think now might be a very good time to stop. Yeah, Yeah, it sounds. That s Oh, yes. I did have lots and lots and lots of other slides. If people want a copy of the slides, they're welcome to them. But I always over plan because I never like to run out of things, never run out of things and we talk it. But it's gonna happen one day fairly to repair. It is Predator is preparing to fail. Okay, that doesn't something. Any questions yet? No, wait. We got one. Come on in. Poke it. I would I would love to receive some questions. David is is good with questions poking Test him, Make him struggle. I need to slide up a little book. Yeah, Apologize. I just don't know. You know that. Oh, did I know? Explain for on hydration. Thank you. Thank believing in yes, oral hydration number like us. A whole. The two most straightforward wants to explain that. I see in the trap we've got aspiring cardiac surgeon. I have my greatest respect. It's definitely know if you if I could do in it very civilly believe, you know, Thank you. And hardest thing to understand for you in anatomy. I understand. I think it's probably nearer. Which is why on Freddy Slide about other services, that kind of systems no one has put their name down for anatomy because there are lots of lots of structures you need to understand. But also in your Oh, you need to understand what they do and where they linked to on there, for example, you can start kind of looking different bits of the spinal cord on. There are different groups of nerves, and they do different things on it all gets very confusing. Another one on I'm starting approach. You've got someone signed up for that one already. Lots of people don't like Ent kind of head neck because there's a little space on, so it gets confusing to some people. I think I like the ent and Josh was on the anti placement when he agreed to do that section. So I think it was a bit like how your E, I think, has now volunteered herself to be neuro because she seems to understand the foramen of the skull. Yep. Well, thank you very much. Anonymous person for your questions out of if anyone else hasn't. If there's no other questions, I might just tell one last anecdote, which sort of relates back to see you did it. You should. A CT scan on the mirror is talking a bit about angles and looking at where you're looking at the plains of view on a CT scan or an X ray in one of my in my end of first year exam, the med school, we had a question where we were given a slice. It was, ah, Transversus likes of the human on DTA old like picture of one from a CT and asked, What is this structure? What is wrong with it on Make a vague treatment plan for it being first years, you don't have to make an exact treatment plan. We got to make some and I got the thing the wrong way around and decided this horrible large lump was clearly a massive kidney tumor and wrote about referring to oncology for excision and chemotherapy. And also, it turns out, is the liver. And I just completely got it upside down and it was the liver. Thankfully, I got the treatment plan right, because it turned out it was met. You're meant to pick up that it was liver cancer, but I got right diagnosis, wrong organ, having the right knowing what you're looking at his various I I was never forget kind of lots of times in anatomy lab, both looking at kind of actually, almost if you slice a human being so thinly that you can get slide content of what was inside them on things like memory and CT scans on just basically students hyperventilating over computer monsters. Guy, I don't know what anything is on patient anatomy demonstrators talking through know. Come on. You know some of these structures you can get this. This is skin, you know, skin. Yeah, if you looked at any of my diagrams or anything, so I'm never gonna understand all this as medical students, we have definitely been there on. There are no guarantees that we understand it now, to be honest, As for the what is the hardest thing to understand That yeah, euro ent is also No, not that, Um, but the one I was found. Why? For some reason, we spent three weeks of unit going about going on about fashion. That's about it. On the pressure, basically, is the connective tissue between your skin and your muscles, So it sort of irritates the facts. You got the fatty layers and things like this in there, and I don't understand why we spent three weeks going on about it. So just a little question that's popped up there about why would you do an MRI instead of CT on what differences do you see? An image is between the two. If I was being treated, I would say You do what the consultant tells you on the bus, Emory, that we tend to see more detail. So first of all, they tend to have higher resolution at because of how they work, so without getting too technical. Basically, with X ray machines, you're firing X rays through the patient on. They respond in different ways to different things at magnetic ranchers, and that's imaging that you get in. An MRI is actually making hoping atoms spin. So rather than firing things through and watching them come out the other side and seeing how they're deformed, etcetera were actually making on a on a microscopic level, We're making bits of the patients spins, and nothing's moving on so you can get slightly better resolution because of it. They're just spinning on the spot after MRI tend to be very high resolution images on More. More importantly, they're very, very good imaging soft tissue. So you saw on the CT scan, for example, most things that weren't kind of bone or a rescue up a kind of gray mush. Now we with as CT technology advances, we get more, more detail. If you go and look at, say, the history of things like CT scanners, you'll see that to start with, they were almost unreadable on. Rather than being these high resolution images is, imagine if you had very few picks sores, so colored lights, squares in your monitor that made up so you could literacy the chunks of image on the word smooth lines between them. And I'm pretty sure the people who are interpreted, the more more witches and wizards and they were doctors. But things that come on and they have improved but still for looking is different. Soft tissues. They tend to be a bit grain bush on. It's difficult to tell one bit of gray mush from the next. So when you're looking at as Freddie was proven that things like fascia on kind of muscles and tendons and ligaments, it's difficult to tell where one stops and the next one stance MRI are a lot more detailed on wall pick up at soft tissues. Really, really well, so one of the PD, one of the groups of people that really love. MRI imaging are orthopedic surgeons. Sometimes they're fixing broken bones and X ray or CT is absolutely fine to go yet, but bones broken. But when they're looking at more nuanced things like a we think someone has damaged ligament in their knee. They're going to be reaching for the Emory request form, which is probably still paying. Uh uh, because that will give them more information about the kind of the soft tissue that you wouldn't pick up on the CT. Other considerations is, Well, if they've got something magnetic in their body, they may not be able to have an MRI. And I say may not because you are getting things like memory safe peacemakers now and things like that that apparently do not come flying out of their chest. The first sign of a magnetic wave, which is good on things like CT is Well, one thing I didn't talk about with CT versus X ray is that CT tends to have a least 20 times the dose of a normal X ray, so we don't tend to put people through CT scans unless they need them. MRI does not give an X ray dose so we can We can send people for millions of memorize happy days. But we need to think about how many CT scans that it can have. Yeah, that's the pretty comprehensive on. So there there's also sometimes it's what's available. Yes, way in the MRI scanner, please do not. Well. There is a massive Q for the MRI scanner, please. You CT or the other one. That tends to be that CT scanners don't seem to be operational night in most hospitals seem to leave the MRI going on X ray. So you get those, too, if it's the middle of the night. Ah, you take this map now? Yeah. It's also like CT scan is a far less scary. That MRI scan is if you're gonna get through one a CT scan. It looks like a giant white donut. So you sort of go through it and you're out. The outside and MRI scanner is sort of a big tunnel. And so you're stuck inside it when you're getting scanned. Uh, yeah. So if we have no more questions, I'll get people about 30 more seconds, and then I will end well, If nothing else do come and join friends and I next week for diabetes on medical emergencies. I'm going to see how many times I can use the word tube in 11. Our talk thinking about her all the place of bet. I don't think I will like a good chewed on medicine. True, Jube? Yes? Start with C H double O P E Shoob. Cool. I don't think anyone else is coming, so we will end. Thank you. What do you see? Or next week?