Anatomy, Physiology and Pathophysiology of the Climber

Anatomy:  The structure of the body. 

Physiology: The healthy function of the body. 

Pathophysiology:  The effects of disease on physiology. 

Prone: Lying face down

Supine: Lying face up

The brain enables core life functions.  The remaining anatomy works to maintain proper brain function. 

The brain is the computer of human function and is protected by layers which can be remembered with the mnemonic PADSH.  These layers of padding (PADS) protect the brain from damage.

P:  Pia Mater

A: Arachnoid

D: Dura Mater

S: Skull/Scalp

H: Hair/Hat/Helmet- While the hat and helmet are not parts of the head they should be added as appropriate for brain protection.

Click the image below to see the layers protecting the brain. 

The mouth and nose are the entrances for air from the atmosphere to begin the path to the lungs.  They are also the exit for carbon dioxide during exhalation.  In order for the climbers airway to be clear and functional (patent) the lips and tongue must be intact, free of swelling, positioned properly and without obstruction.  

The neck is the group of anatomical parts that connect the torso to the head.  While its absence would allow for the climber to sustain a much greater mechanism of injury (MOI) from falls the fact that our head does not sit directly on our torso allows us to look up at our route and down at our foot holds. 

 The structures most important for climbers related to emergency care are: 

• Carotid arteries
• Jugular Veins
• Trachea
• Cervical Spine

The Carotid arteries are on either side of the neck between the trachea and the sternoclydomastoid muscles. They allow blood to be pumped from the heart and aorta into the head.   These arteries are the most frequent location of pulse palpation for patients suffering from life threatening illness and injury. 

The Jugular Veins are located closer to the skin than the carotid arteries.  They allow blood to be drained from the head into the superior vena cava and into the heart.  Jugular veins are typically full while supine, flat while sitting and distended during certain significant illness and injury.  

The trachea (windpipe) facilitates the passage of air between the head and the lungs.  It should be centered in the neck.  Tracheal deviation is a late and ominous sign of tension pneumothorax (collapsed lung).  A disruption in the trachea can result in a crackling sensation beneath the surface of the neck called subcutaneous emphysema.  

The cervical spine is located in the back of the neck and consist of the first seven vertebrae. (C1-C7) C1, the atlas and C2, the axis form the platform and attachment between skull and rest of the spine.  The cervical spine is a key point of assessment for pain and deformities related to spinal injury and help guide our spinal motion restriction efforts.  

The chest (thorax) contains the fundamental organs providing life sustainment to the brain and the climbers existence.  

• Chest wall (sternum and ribs)
• Heart
• Lungs
• Diaphragm

The sternum  and ribs work to protect the vital organs listed above.  Damage to this protective shell is not inherently dangerous but a key sign of damaged organs beneath the external pain and tenderness.  This is an example of using topographical anatomy which is locating inner (deep) areas based on their reference to more outer (superficial) anatomy.  There is cartilage connecting the ribs to the sternum. It is this cartilage that causes most of the unpleasant noise of trauma during chest compressions.  

Knowing the location between the top of the sternum (manubrium) and the bottom of the sternum (xiphoid process)  assists with locating the proper location to perform check compressions.

Topographical anatomy helps locate body parts.  Topographical maps help locate climbs.  

Don't get GPS dependant while in the mountains and don't guess when helping the sick and injured!

The heart is the pump that moves blood around the body.  It is about the size of a clenched fist and can be described as hand sized but not "off hands"  The heart is made up of three primary parts.  The myocardium (muscle), the electrical conductions system and the vasculature (vessels).  The heart muscle provides the contractile power that becomes the "push" the pumps blood around the body. Damage to the myocardium can result in lowered amounts of blood being pumped and is called heart failure or cariogenic shock.   The electrical conduction system is the hearts power source and starts with an impulse from a special group of cells that act as the hearts pacemaker. Problems with the electrical conductions system can cause slow heart rates (bradycardia) and fast heart rates (tachycardia).   The coronary arteries are the most important part of the hearts  vasculature and allow blood from the aorta to nourish the muscle and electrical conduction system.  A blockage in a coronary artery is the cause of heart attack.  The inferior and superior vena cavae bring blood from the body and return it to the right atrium.  The aorta allows the blood pumped by the left ventricle to move to the body.  

The Lungs facilitate the exchange of gasses necessary for life.  Within the alveoli oxygen is picked up by the blood and delivered to the cells of the body.  Carbon dioxide is delivered to the alveoli and exhaled.  The path between the trachea and the alveoli moves through  a point of bifurcation called the carina down the left and right mainstream bronchi into bronchioles.   Problems within these parts result in many of the respiratory problems such as asthma and bronchitis.  The gas exchange at the cellular level is respiration.  Respiration is commonly used synonymously with breathing and ventilation but they have differences.  Breathing is the negative pressure process that occurs when the diaphragm drops and the chest wall expands resulting in lesser pressure in the chest (thorax) compared to the atmosphere.  This negative pressure difference causes air to rush into the lungs.   The movement of air between the atmosphere and the lungs is ventilation.  Ventilation is most often used to describe positive pressure ventilation most often provided as rescue breaths when the patients breathing is ineffective or absent.  

The diaphragm divides the chest from the abdomen and is a dome shaped muscle that with the intercostal muscles (between ribs) facilitate the movement of air by expanding and contracting.  A fall onto the back can cause a temporary diaphragmatic paralysis commonly refered to having the wind knocked out of you.  

The abdomen is divided into four quadrants by the umbilicus.  Within these quadrants lie both hollow and solid organs.  The hollow organs can rupture and spill their contents into the abdominal cavity causing inflammation, pain and infection.  The solid organs can rupture and bleed significantly.  

The stomach is the main organ of digestion and is the blame of many causes of pain.  

Intestines continue the digestive process by absorbing nutrients and water turning food into waste and passing it to the rectum.  

The pancreas produces insulin and glucagon which regulate glucose (sugar levels) within the body.  Problems with the pancreas cause high (hyperglycemia) and low (hypoglycemia) blood sugar.  

The Liver takes up much of the upper abdominal cavity and is a frequently injured organ from blunt abdominal trauma.  

The kidneys primarily perform a blood filtration function to rid the body of toxins. As part of the filtration process the kidneys manage fluid levels and acid base balance.  The primary filtration units within the kidneys are the nephrons. 

Sitting above each kidney is an adrenal gland that produces adrenaline (epinephrine). Epinephrine is the primary neurotransmitter for the sympathetic (fight or flight) nervous system.  

Shock

Shock is the end stage of all pathophysiology.  While it is very common for accident reports to state "and the patient was going into shock" it is defined as inadequate tissue perfusion at the cellular level.  

Shock can be classified as four types:

• Hypovolemic
• Cardiogenic
• Obstructive
• Distributive

Hypovolemic shock is due to low fluid volume and is often caused by bleeding and dehydration. 

Cardiogenic shock is pump failure due to examples such as heart attack, rate problems and heart muscle diseases. 

Obstructive shock is due to obstructions of blood flow for causes including collapsed lung and cardiac tamponade. 

Distributive shock is due to container (vessel) dilation and includes anaphylaxis and  neurogenic forms of shock.  

The Pelvis facilitates the transition between the legs and spine.  Climbers can experience this connection by moving the pelvic girdle close to the wall and feeling the force reduction on the hands and arms as weight is shifted to the legs.  The pelvis also protects major vessels that move blood between the upper and lower body.  The uppermost part of the pelvis are the iliac crests above which a properly positioned climbing harness is positioned.  In the case of pelvic fracture the harness can be moved to the acetabulus  of the pelvis which are the sockets into which the femur (upper leg) fits.  

Lower extremities

Our legs carry us to the base of the climb and push us up the route.  We transition our weight from leg to leg during this process.  

The upper leg (femur) is the largest bone in the body and hardest to break. An isolated mid shaft femur fracture is the only indication for a traction splint.  

The lower leg consists of two bones (the tibia and fibia).  Tib/Fib fractures are common at the end of ground falls and are either open (skin broken) and closed (skin intact).  

At the bottom (distal) end of the legs are some of the most frequently broken bones, the phalanges of the feet.  They would likely be broken more often if it wasn't for our approach shoes.  

The ankle is a hinge joint that allows proper French climbing technique on snow and ice.  An injury of the movement of the bone between the calcaneus (heel) and the tibia is named after a popular pop music star and is called Talar Shift.  

Ankle twists are painful and are unlikely to generate sympathy from a friend named Ron after a long day of teaching  climbing at Rumbling Bald Mountain when an after work climb has been scheduled.  

Upper extremeties

Our arms provide balance on slabs, dangling in the steep and facilitate the vast majority of our interaction with the climbing environment. 

Hand scrapes during jamming and stopper removal are common.  The muscles of the arm like all skeletal muscle facilitate movement so we can pull, place protection and bundle ropes.  Additionally they help maintain homeostasis (healthy body function) by generating heat through movement, sometimes in the form of shivering.  Excessive minutes without warmth and blood flow to the phalanges of the hands may result in the screaming barfees.  

Both the upper (hands) and lower (feet) should be assessed for circulatory, sensory and motor (CSM) function before and after splinting as well as during a neuromuscular assessment related to head trauma. 

The posterior (back) is less frequently the area of life threatening illness and injury.  It makes up a large portion of the body surface area.  The body is covered by skin which is the largest organ of the body and is a part of the integumentary system.  The rule of nines is used to determine body surface area for burns but could be helpful in assessing body surface abrasions for a patient who took a long slab slide.  The rule of nines divides the body into eleven areas of nine percent each leaving genitalia to be one percent.  

The skin facilitates sweating for purpose of cooling.  Heat stroke should not be ruled our in the case of ongoing sweating.

 The back contains the thoracic and lumbar vertebrae.  An assessment of the posterior should include palpation of the spine in order to determine pain and resulting tingling or numbness.