Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

all right, I make that half past, so let's get started. So hello, Andre. Welcome to the age to healthcare, Siris and not a me Siris. The final entry in the serious for this. Let's go around. So my name's Freddie Cuba. I'm going to be manning the check this evening. We have the wonderful Josh here to teach the session tonight. He's a final year. Imperial Medical school. Uh, as the tweak, I don't share this making the most of session. If you want to please to take notes, please ask questions. Questions are really great way for you to sort of reinforce what you're learning. Clarify bits you don't necessary Know about on a great way to help enforcing since your brain on there. But if you do enjoy anything, please do let us know and we can help give you more resources and help shape future sessions towards what you're into queries. There's my email address. Please. Do you feel free to email me also? You can follow us on such a media a treat healthcare on instagram or Facebook? Um, upcoming. So this office is the last lecture in our Sirisanont to me upcoming. We still have our once month Siris. The next session is dying of palliative care that will be on the 14. December should be really interesting session, so pleased to come along. Other than that, I'll introduce these bit later on. But this is what we have coming up in the new year. Um, the other than that I will hand over to the wonderful Josh. Just you want to share your screen? I can definitely try and do that. Um, okay, how's that? That's good. And never this's there You go. Cool. Should be good to get it. All right. Of Josh. Excellent. Yep. So how many's Josh? I'm finally at Imperial. I'm going to do sort of a whistle stop tour off had and neck anatomy, which actually is more just neck and after me that we'll go through it because ahead is kind of boring about the neck. This, um, in Florida. Um so, yeah, one reason why I kind of like the idea of talking about neck anatomy is that everyone really panics about the neck because there's a lot of really important structures in there. But there's also a lot of rubbish that can get down there but it's not really a problem. So put in this photo from TV show called Ghosts with lovely arrow through the neck on back early. If you look at where it is, this may, you may know cause an amount of damage. But realistically, you know how much damage this is gonna cause until you either put minute CT scan or if you know you're not to me. Um, secrets off, figure out. If you have been stabbed in the neck, you can figure out what is actually gonna be damaged based on you're just you're not be. And I, um, then hurt the CT. Box it up so we'll do kind of a whistle. Stop on. There's a lot more info on the slides that you can kind of take notes from the stuff you want to. So putting it really simply what's in the neck, You got some bony, that sense of rushing, that's that's the most simple I could possibly make it, um, on does kind of two sections of the bone and that's you got Boniva. It's a front. So there is. This is things like you're, um, your voice box track. Yet the bottom which is, uh, basically the top part of your airways. You've got your various bits of cartilage that quickly cartilage get fiery cartilage and the hyoid bone the top. So this it's right the front of the neck. This little bit here is your Adam's apple. If you're doing an emergency away, you go just below that into this membrane. Um, yeah, And then at the back, you got the spine. So the cervical spine, cervix just meaning neck. So you obviously could school were at the top. You kind of rested your skeleton at the bottom, and then seven vertebrae in between. Right in the top. You've got what they like to call the atlas, which joins in with the scope near the access, which has, like, a little peg that kind of joins in with the at this and kind of allows most of the movements the'yre Really, it means that you can kind of move it in all different directions on, then, lots of different vertebrae going down to see seven. Um, which is the first only thing you can feel you can fill at the back of your neck roughly in my with your shoulders. They're being nice little bony that that will be your C seven. Because spinous process just that the first you can feel and then you go into the thoracic ones. But it's had the neck surgery care of those on both fleshy. That's there's a lot more flushing bets than Boniva. It's so you split this down. Quite grossly. Into blood vessels are arteries and veins. You then also got your nerves. You got a little system, Got your endocrine system. This is stuff in the neck for that. You got loads of muscles on, then your esophagus. Um, just sort of categories that will go through that, Or mostly so obviously means arteries. Take your, um, basically, you're oxygenated blood away from the heart, essentially or all of the part of the pulmonary ones that Yeah. So you got your oxygenated blood comes, it's down here somewhere. Goes through the aorta, which is this thing on. Then you've got your, um, kind of carotid that come off that on duration is our one of the biggest arteries in the body. Other than kind of maybe the aorta and your femoral, because they're the arteries that supply all of the blood to your head on your brain. Generally, your brain is considered quite important. Organ on so kind of in the middle of the neck. We have what's called the corrupted by vacation, where the common carotid just splits into the internal on the external, the internal going up on the inside them into the school, the external kind of going out and supplying the outside of the skull and bits the face as well. On the internal one there is essentially the thing is supplying your entire brain with blood. And then you got veins. And so that's gonna bring the oxygenated blood back down to the body stuck in the top. You got loads of kind of Venus Sinuses. They call them in the brain, basically just giant pockets of blood for it's off, pull them, and it then drains down into little variants. You got a jerk your list Thean, turn on the X donna again. Internal drains, the inside of this girl, the external drain to the outside of the skull and then different parts of different ones. So the internal little to do this, the faces well on that will drain into the, uh, Clay Vienne. Very It's a play in being called that because it's just under the clavicle, all the color. But they're not draining into the superior vena cava, which then drains into the right atrium and they get pumps all around the body again. Um, that's Cliff. And then, to make it kind of even more simple, the bits that we've really care about we've got the cover cross is which then splits into the extent of the internal arteries. You think of the in terms the veins, you got your X, don't drink, you know, and your internal jugular, which both plugged into the PSA plane. Ian, which then plums into SBC to make it kind of as simple as possible. These the really important wants to know about, because if any of these a cup, they'll bleed a lot. Um, and the nerves are a lot more complicated than veins and arteries, unfortunately, with loads of them and it all looks and absolutely chaotic nets. But realistically, there's not too much here that you need to focus about. They're all. There's lots of different nerves doing lots of different things. Generally, most of the nerves come off where the diagram, Mister nerves will come off from in between the's vertebrae. So there isn't actually that come off. See you on. But you got just about C, too. C three C four C seven, and then this one underneath C seven that comes off that we call c eight. Um, no fruit. Even though there isn't actually see eight vertebrae, it comes off down there, and analogue often supply lots of different things, including most of the neck, A lot of the chest and actually good proportion of the arms Well, comes off somewhere in between on D if you kind of thinking another one of the most important muscles in the body being the diaphragm, you got a nice little off Brian to remember which nerves that comes from. So C three c four c five keeps a diaphragm alive. So the diet from itself, which is the big muscle that helps you breathe. It's supplied by C three c four c five. So if you get a spinal injury anywhere kind of above 55 definitely busty three, you're not gonna be able to breathe. Um on, do they? Is that you come off around the side on each side there, then split off into lots of different pathways and do lots of different things. And this is an example of one of the plexus plexuses plaques I in the body. This is the cervical plexus. You've also got a break your plexus in a sacred plexus. I think the lumber plexuses well on this line for them on, they're basically just big junctions of nerves so that you get a different kind of areas are supplied by different nerve roots. So if there is damage, then it isn't. You means that it's not the biggest deal in the world, and it means you could damage kind of morbid out having such a functional loss. Um, say, for example, the trapezius. Now, although nerve to the trapezius muscle, which is the two big kind of muscles that come in most your back and also in your neck and let you shoot your shoulders. That comes off from the accessory nerve, which is cranial nerve 11 that actually comes off from Let's Go then it's also got this little rate from see, too, and it's also got this little work from C three, and that sort of sits just down here is this little yellow into changed on her, and then you can just about see the break your placed under. But it's this one here that's one of the important things to look up. The other important, that sort of nerves are the recurrent laryngeal nerves, which is a great thing for them to test this on. These nerves come down with the comes on with the vagus away from doing things go on. It's got a nice long path for some reason, and then for some weird embryologically reason that I don't understand it, then decides to go underneath the aorta and the back up again to supply the voice box. And this could be a common nerve that's kind of damaged in fibroid surgery or any head and neck surgery, because it's got such a long, weird, tortuous calf that doesn't really make any sense. But then, if it does get damage that essentially comparative eyes one of your vocal cords so you've got to vocal cords going next to each other. If one of them is paralyzed, you will have a classically a horse voice, somebody croquet. If they're both paralyzed, you can't talk. It'll so They're really important to be aware of when you're doing surgery in the neck. But otherwise it's lots of different nerves that are lots of different things. Do lots of different other things. For example, a nerve to the 10 o'clock and mastoid, which is a muscle on the side of your neck, will come to you later. You got supraclavicular nerves, which will help sort of supply some of the muscles in the shoulder front of nervous. Well, loads of them on there all important in the wrong way. But at this age, you really don't need to know about them. I don't got lymph nodes, another fleshy that classically people will kind of say, Oh, my glands are upon. My nodes were up. What they mean is they got an inflamed or enlarged lymph nodes, and these are either kind of split up into two different rays. So one way is by kind of anatomical location. So whereabouts are they? So you got a group of nodes called the submental nodes, which just underneath the chin, um, which this isn't she just means below the teeth. You think about just kind of to the side of that you've got the submarine debutante nodes, which are just underneath the mandible or the jaw. You've got the porotic nodes because they're over the parotid gland. Pre auricular nerves because that nodes because that just in front of the ear postauricular just behind the ear occipital because they're near the occipital bone of the scope on Do you got there kind of survival nerves because they're in the neck. Cervical, meaning neck deep ones are deeper, superficial ones that close to this guy. And then you've got the super clavicular nodes, which are just underneath just above. Sorry, super just above the clavicle or the collar bone. That's one way to kind of classify where they are, but another floating or helpful way intensive sort of the physiology of things is to look at the number of groups in the neck and this, uh, thing in the ent surgery on House counsel's broads. Is that the nodes in the neck? If you let's say you have a head and neck cancer, let's say in the mouth it will spread. It's going to spread somewhere. Eventually, it will spread to a lower number first, and then it'll start spreading to a higher number, it will never go the other way around. So, for example, you've got one here just under the chin. Does that feel like it's a bunch of mandibular? You think your to just under head a 34 year five on this side on six over here. So your classic pattern is to get kind of a one that it won't be. There may be two and a three and a four, maybe about a five, but you will never get a five and then three, and they're one, and you're definitely never get a five and then a one unless they're from two different disease pathways. This could give you an idea of where the cancer might be and also where it might spread to you next over. It definitely wouldn't spread to on, then endocrine. There's well five technically endocrine organs in the neck. That's one thyroid gland, which sets just over the voice box here at the front of the neck. I think you can appreciate here. This has gotten enlarged thyroid. This is her chin just down the middle of her neck, and then I got these kind of swellings that I'm outlining here. That's where her enlarged thyroid gland is. There's just the bottom. The neck be very grand. Uh, yeah, just basically just sits over the truck here, but then behind the thyroid got face of that. I don't behind the thyroid. There are the parathyroid glands power up, meaning kind of next to or near the fire, it being thyroid. So there's four glands that can set in the four corners of the thyroid and the power of Florida are responsible for releasing cynical PT age or parathyroid releasing hormone. Uh, yeah releases a PT hate, which know parathyroid hormone, which then it's and he lets you regulate calcium in the body so it will do things like help. You either absorbed more. Counseling will get rid of it. It'll help you kind of take more of the kidneys, will get rid of it and kidneys and also break and lay down. Bonus Well on down. The father of itself does is essentially the metabolic regulator of the body. So the hypothalamus which part the brain well release I think we'll tr thank your for retreat from releasing hormone, which I think is the security three, which is just underneath that which will stimulate the pituitary to make TSH for firewood stimulating hormone. So the TSH will then go to the thyroid, which will release T three and t four, the fire road hormones that essentially controls your metabolism. So when you're thinking about disease pathways, if someone has a low or underactive thyroid, you can think of everything is being really, really slow and not really working, so they'll be really cold on. But they will hate the cold outside. They'll be dressed in lots and lots of layers. They'll, um, be putting on weight because they can't break it down. But it will be very hungry, because again, that's sort of not breaking down the food. Uh, they can also get constipation because they got slowed down on and you get swelling a swell, um, lots of different areas. So, for example, the extremities on the face you can get kind of puffy as well on do also, as it's slowing everything down the heart, we go slower as well. On down also, interestingly, you get a loss of the out of thirds of the, um, I brought, you know, whether do that and then, conversely, in hyper thyroid, so That's something that's making the thyroid kick out too much thyroid hormone. You get the complete officer. So if you think of the basically got too much thyroid hormone, so their body is going way too quickly. So they have a really, really high heart rate. They might go into an arrhythmia and, like atrial fibrilation, they're gonna have never could be nice of war. They might have a tremor like a shake. They will be quite irritable. Hum, have lots of energy there be losing weight because their body is trying to break down everything on that. But there were really hungry on. That's how you kind of tell them apart and then go out the muscles. There's a party, many of thumb in the neck. I make a lot of very similar things, just sort of going through a couple of important ones. Nice, big kind of flat muscle over the edge. The first when you get to the platysma, just a big sheet of muscle. You then got your trapezius, which I mentioned earlier that nerve, which helps you shrug your shoulders and you get a sternal cleidomastoideus. And it's called that because it goes from your sternum, uh, took another clavicle and then to your mastoid bone, which is just a little kind of bony lump behind your air, and that helps you turn your head. There's loads of the muscles involved that will help you do lots of different things generally involved in neck movement, because if you think you can move your neck in so many different ways, you can break a tip left and right. You can kind of bend it on flex forward, or you can extend it back, and you can also tilted to the side as well. So there's low that if we kind of fluid motions that this will help with, and then this other muscles as well that more intrinsic that help control off the jaw, which is off up here. But then also control off. Kind of keeping things in one place, um, in the neck on. Then finally, the esophagus. I'm not include the track here because we put it in the bone mets, but the esophagus is just a cube. Um, that's it's the back of the throat. It goes down into the stomach. It's usually just flat, but then, when you swallow food or something goes down. It kind of opens up to that down. But that's also in the neck. Be, uh, here. So if you look at this diagram, this is kind of a cross section of the neck. You got the truck here front just behind that. You've got the, um it's a fungus at each side and kind of around the front as well. You have the thyroid. You've been got your, um, big kind of vertebrae. And inside the vertebrae, you've got your spinal cord and then lose muscles or fat on stuff on each side and your vessels that run on the sides. Oh, there's is a well and good kind of knowing about this stuff in the neck that it's a liquid complicated on day. To think of it in separate systems is a little bit too much eso. What we do is separated into triangles earlier on, you said very into two triangles. Later on, you can separate it into a lots of different triangles, but I'll keep it simple for now because, as you can appreciate, this is quite tricky diagram. There's loads of kind of blood vessels going everywhere, knows going everywhere. That's this big muscle that this'll muscle. Um, loves the stuff going on over here, and it's really complicated to start figure out what is actually going on of what is where. So we can is that you just overlay some triangles. So the anterior triangle is more of an upside down triangle and the borders of that Ah, the kind of jaw itself, the midline on the anterior border or the front border of the sternal cleidomastoideus, which is they're kind of strap muscle on the side of your neck. The last time your house on that sits there, you've been got the posterior border, um, of the prostate triangle. So the front of that is the posterior border of stand. Quite a master. It the back of it is the anterior border off the therapies es, which is that muscle that helps you shook your shoulders and then you've got the clavicle or the the collar bone underneath. And those the two triangles that So what? Actually, in them you've got this is the anterior triangle so that you can appreciate. This is the midline you got, the sternal cleidomastoideus that's just start being cut away involved here and then the drawer here. You got some teeth up here? The drawer here on. But this is what it would look like if you cut open. Obviously would be nice fancy colors like that. But you can appreciate that. This is going to be the just in our knowledge. Now, this is the internal jugular. One of the important buses we talked about earlier then actually splits off to give the facial vein, which then kind of drains part, the faces well tucked away behind that. Because obviously, arteries are more important than veins because they get blood to places. You've got the corrosive it, which you can sort of appreciate that it's one here and then it splits often to you here. And they got low that if they nsm what we got on a Listen if nerve Sorry, we've got the vagus trends on here, which is the main nerve that controls the parasympathetic nervous system, which is the nervous system. That surgery, if you think of the, uh, thing sympathetic parasympathetic is the fight or flight or the resting digest nervous systems to the vagus nerve for essentially controlling your rest and digest, Um, that while we go the hyoid bone. You've got the kind of some plans under here. Yeah, The two things need to be aware of ready other internal jugular on the cross. It's so if you get stop say in the anterior triangle, you're gonna be a lot of trouble because you got some big vessels there on. Suddenly your brain's not gonna have any oxygen on. That's generally quite a bad thing. Compared to this to the posterior triangle, there's not any No, but my genetic, Um, so you've got the external jerking is probably the most important thing in it, which runs kind of from the so plaguing should say, And then goes three of the possible trial and then over the standard kind of lost, um And then you have lots of other small ish kind of arteries, right? The bottom got subclavian artery, which is one of the ones that then we'll go on from the aorta to then go and supply the arm. You got the occipital, which can be seen here on the super scapular, which you can't be seen here, but they're both small ones anyway. But you do have this vicryl plexus that kind of forgetting junction of lots of different loves. Um, so if you get kind of stopped in the posterior triangle, Yes, you might hit a blood vessel, but your main issue is gonna be nerve damage, and it's kind of a little bit more simple. Diagram down. So that was a very, very, very, very, very quick whistles. Not off the kind of neck. Not to me. Um, the head isn't much. The head is very simple compared to that. So you got lots of different bones brain, But I believe we've had a neuro lecture. Hopefully, um, on lots of different complicated muscles that control the face that no one really ever needs to know about unless you're operating on them. But in summary, you have only that. So you got better from that. But the back you've got your flesh. Yvette's so but vessels, including arteries and veins and nerves got a little system and nodes. And then your endocrine system, as well as lower lip muscles and the esophagus. I think that was it. Unless quit coffee now injury swole no. Is that, um, see if he has any questions about Josh session. Obviously, we'll put the, uh, the Uh, plus, the recording will be available afterwards, and it will be uploaded on a medal for anyone who wants to have a little bit there. Let me find the feedback for me. As always, we do really appreciate feedback. It's, ah, brilliant way for us to, like develop ourselves teachers in a different way. For us is Siris to figure out what you guys want to see and how you want to see it. Please do get feedback because it is very, very useful. Other than that quickly, if they if they have questions, please, do you put them in the thing of wise? Absolutely. Introduce what we've got coming up in the next couple of months, and we'll leave it there with her and the sort of brief the evening. Um, please ask questions while I go through this, but basically, these are the sessions we have planned in the email. With joining like this week, I mentioned that we are going to move to a slightly different format or least trial. A different format on that is, rather than doing sort of six consecutive weeks, because, I mean, as you can probably tell, imagine most of your energy is flagging. But this point, though, is you have been told successions. Um, but six consecutive weeks could be quite a lot. It's quite difficult people to show up each week. So instead, what we're gonna go to is just twice a month that go every month like that, rather than six weeks on and then a break and then six more weeks than a break, we're just gonna consistently have two sessions a month of the general view that one session would be sort of general interests. All the things that are a relevant all areas healthcare, relevant people, even professionals in healthcare as actually hear things like nutrition, for example, the clinical case discussions and mental health lower on on the other ones. Convicts like more academic. So the next, um, in the endocrine system on bones here in the next three months. And that's sort of the former We're gonna try for a bit if it doesn't work. If it turns out we need more sessions. If you got say that there's not enough material here, if attendance isn't great, these other things will try something else. We'll give this a go and see how it is for the time being, so that in mind, our next session coming up is are dying a part of care session. That's our last session for 2021. It feels really weird. This year is finally coming to an end, but terrifying. But it is coming to an end to die in a part of care. They'll be on Tuesday, the 14th on. That should be quite interesting session. Think that, hoping I'll be very good session that's pleased to come along. After that, It will be in January again with nutrition session talked by our wonderful dietician. Um, very good questions. Please put with chat. Otherwise email them to me. And if no one has anything to say and massive thank you to Josh for a very, very detailed session, I'm quite glad ended up being a bit shorter because there was a lot of information in there. I'm sure everyone else probably feel similar, but thank you very much. Everyone. Thank you, Josh. I'll give you guys, let's say 40 seconds to ask some questions. You have any If know, obviously you've got my email or you could. Messages on social media is little questions. Give us A 20 seconds. Good guesses. No means any questions. Just your laptop taking off? Yes, I got my laptop has the most ridiculous ability to overheat. So sorry about that. Everyone has been completely death. And by my helicopter travel laptop. Uh huh. I've seen no questions, so I think we'll end it. There's a massive thank you to Josh Month. Drink with you. Everyone who showed up tonight. Hopefully good time. And we should see those next time. Thank you.