Sympathetic 20 20Parasympathetic 20Lecture 20Outline by A6524fjQ

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									Life in the Fast Lane:
The “Easy Way” to understand the sympathetic and parasympathetic system.
Jeffrey R. Grunow, MSN, NREMT-P
Chair, Emergency Care & Rescue
Weber State University


Lecture Outline
   Introduction.
   BASIC Anatomy of the Nervous System.
   Sympathetic responses.
   Parasympathetic responses
   Relationship to the “new” EMT-B.
   Review of selected medications.
   Conclusion.

Lecture Disclaimer
    This lecture has a political correctness rating of PC-13.
    The use of humor (at times risqué) is meant to facilitate the
    process of learning. No offense to any sex or party is
    implied or intended.

Introduction
   Sympathetic/Parasympathetic concepts used to be EMT-P / RN
    related.
        Revised EMT-B curriculum allows select sympathetic medication administration.
        Basic understanding will aid in “cross-referencing” the patient’s meds with the
         PMx.
        Basic understanding can help in determining drug OD.
        Highlight why sympathetic meds have specific uses


                                                Nervous System
   Central Nervous System
        Brain
        Spinal Cord
   Peripheral Nervous System
        Cranial Nerves
        Spinal Nerves
        Autonomic Nervous System
              Regulates the involuntary vital functions of the body.
                                Nerve Cell Anatomy
   Dendrite
   Cell Body
   Axon
   Synapse

Nerve Cell Anatomy
   Dendrite
       Incoming (impulses) flights.
   Cell Body
       Metabolic “hub”.
   Axon
       Outgoing (impulses) flights.
   Synapse
       In-flight (space between axon and dendrite or nueromotor junction).


                                            Dendrite
   . . .the “fingerlike” extension of a nerve cell that collects electric
    impulses and conducts them towards the cell body.

                                               Axon
   . . .the “cylinder like” extension of a nerve cell that conducts
    electric impulses away from the cell body.

                                           Cell Body
   . . .the main portion of a cell that contains the nucleus,
    cytoplasm, and mitochondria.
       working part of the cell

                                            Synapse
   . . .point where one nerve signal “jumps” from one nerve cell to
    the other.
       Normally, nerve signals travel in one direction.
       Dendrite>Cell Body>Axon
Basic Synapse Anatomy
   A synapse is a space.
       Think of the synapse as a “river.”
   The axon and dendrites send and receive nerve impulses.
       Think of these as “ferry boat docks.”


Basic Synapse Anatomy
   Neurotransmitters assist nerve impulses across the synapse.
       These are the “ferry boats!”.
   Sympathetic system:
       Norepinephrine is the nuero-transmitteritter.
   Parasympathetic system:
       Acetylcholine is the neurotransmitter.
       (Affected by chemical warfare agents)


Sympathetic Synapses
   Sympathetic synapses have special receptors (docks)
       Think of this as a special dock for each ferry company.
       These include:
          Alpha 1 & 2
          Beta 1 & 2
          Dopaminergic



Autonomic Nervous System
   Sympathetic:
       Involuntary part of the nervous system that “speeds up” vital functions
        of the body.
       AKA “fright or fight”.
       AKA adrenergic system.


Autonomic Nervous System
   Parasympathetic:
       Involuntary part of the nervous system that “slows down” or inhibits vital
        functions of the body.
       Often said to activate the “vegetative” functions.
       AKA cholinergic system.
Sympathetic / Parasympathetic
   “Head to toe” review of physiologic responses.
       Eyes
       Mouth
       S k in
       Respiratory
       Cardiovascular
       Urinary
       Digestive
       Reproductive

Sympathetic / Parasympathetic Reactions
   Tongue in cheek approach
   “Making out” framework:
       Drive-in movie expectations.
       “Baseball” analogies.
       Testosterone agenda:
          Dinner only vs.
          Dessert included



Eyes - Sympathetic
   Dilated pupils
   Dry (no lacrimation)

Eyes - Parasympathetic
   Constricted pupils
   Increased lacrimation

Nose - Sympathetic
   D ry
       Decreased secretions


Nose - Parasympathetic
   Very moist
       Increased secretion
Mouth - Sympathetic
   D ry
       Decreased secretions


Mouth - Parasympathetic
   Very moist
       Profuse salivation


Skin - Sympathetic
   Moist
       Increased perspiration
   Piloerection
       “Goosebumps”


Skin - Parasympathetic
   No real change

Heart - Sympathetic
   Rate increased
       Increased cardiac output.
            (CO = HR X SV)
   Contractility increased

Heart - Parasympathetic
   Decreased rate
       Decreased cardiac output
   Some decreased contractility
       Decreased cardiac output


Heart - Sympathetic
   Coronary arteries
       Dilate
   Strong pulse
       Hypertension
Heart - Parasympathetic
   Coronary arteries
       Constrict
   Weaker pulse

Lungs - Sympathetic
   Bronchial dilation
   Decreased mucous secretion

Lungs - Parasympathetic
   Increased mucous secretion
   Bronchial constriction
       Wheezing


Parasympathetic Recap
   Constricted pupils
   Tears
   Runny nose
   Drooling
   Normal skin
   Decreased cardiac output
   Bronchoconstriction
   Increased mucous secretion


Parasympathetic Recap
   “The agenda”

Sympathetic Recap
   Dilated pupils
   No tears
   Dry nose
   Dry mouth
   Moist skin (“goosebumps” OK)
   Increased cardiac output
   Bronchodilation
   Decreased bronchial secretions
Sympathetic Recap
   “The Agenda”

Peripheral Perfusion - Sympathetic
   Significant cutaneous blood vessel constriction.

Peripheral Perfusion - Parasympathetic
   Some cutaneous blood vessel dilation.

Urinary System - Sympathetic
   Kidney output decreased
       Preserves fluids
   Urinary sphincter tightened

Urinary System - Parasympathetic
   Kidney-no effect
   Urinary sphincter relaxed

Stomach - Sympathetic
   Decreased secretions
       Preserve fluids
   Decreased motility

Stomach - Parasympathetic
   Increased secretions
   Increased motility

Intestines - Sympathetic
   Decreased secretions
       Preserve fluids
   Decreased motility

Intestines - Parasympathetic
   Increased secretions
   Increased motility
Parasympathetic - Recap
   Increased stomach secretions
   Increased stomach motility
   Increased intestinal secretions
   Increased intestinal motility
     Symptom         = HUNGER!

Sympathetic - Recap
   Decreased urinary output
   Decreased stomach secretions
   Decreased stomach motility
   Decreased intestinal secretions
   Decreased intestinal motility
       No real interest in eating


Male Sexual Response
   Parasympathetic
       Erection
   Sympathetic
       Ejaculation


Female Sexual Response
   Sympathetic
       Excitement
   Parasympathetic
       Orgasm
       Crying
                   Let’s pause to catch our breath…
   Parasympathetic
     Hunger / vegetative oriented
     “Slow down system”


   Sympathetic
     Loss of hunger
     “Fight or flight”
     Deals with organ excitement (stimulation)
EMT-B’s and Pharmacology
   EMT-Basics are now able to assist a patient with physician
    prescribed nitroglycerin, auto injectors and inhalers. The
    pharmacology of these medications will be reviewed for
    indications, contraindications, dosages, side effects, etc... The
    EMT-Basic will establish either on-line medical direction or
    follow off-line medical direction prior to administering select
    medications.

Sympathetic Receptors
   Five basic types of receptors.
       Alpha 1       Blood vessel constriction
       Alpha 2       Slight bronchoconstriction (Little EMS Usage)
       Beta 1        Rate and “squeeze” related
       Beta 2        Bronchodilation
       Dopaminergic
          Possesses alpha and beta properties
          Dose related



TABLES

Sympathetic “Overdrive”
   Tachycardia
   Hypertension
   Tachypnea
   “Ricochet Rabbit Syndrome”
       Commonly found in stimulant OD
       Overuse of bronchodilators (MDI’S)
       Overuse of decongestants
       Use of some diet supplements
       Cocaine OD
Parasympathetic “Overdrive”
   Often called S-L-U-D-G-E
   Increased:
       Salivation
       Lacrimation
       Urination
       Defecation
       Gastric response
       Emesis (expiration)
   Symptoms common with organophosphate poisoning (Chemical terrorism!)

What about Atropine?
   Atropine is a parasympathetic blocker.
   Heart rate increases due to limited or no parasympathetic
    inhibition.
   Examples may include:
       A car with a stuck accelerator speeds up because the brakes are
        inhibited.

What about the Alpha-Beta blockers?
   Alpha blockers are used for hypertension treatment
       Prevents arterioles from constricting
   Inderal (propranolol) was the classic beta blocker.
       Heart rate slows down because of beta blockade
       Prevents bronchodilation
       Prevent perspiration (sweating)
   Alpha-Beta blockers can be both helpful and harmful depending
    upon the situation!

Conclusion
   Sympathetic reactions affect everyday life.
   They don’t have to be difficult to remember!
Conclusion
   The parasympathetic system generally slows the body.
       Works like the brakes on an automobile.
   Sympathetic (reactions) or medications generally “arouse” the organs of
    the body.
       Works like the accelerator of an automobile.
   Knowledge of the various effects are imperative for the EMT-P and the
    new EMT-Basic.

Thank You!
   Questions?

   Download handout and e-mail.
       Faculty.weber.edu/jgrunow
       jgrunow@weber.edu

								
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