In history, it is estimated that an arrow has killed more people than any other weapon. With time, the usage of arrows has declined due to the trauma they would cause. This study explored a patient who was brought into the Emergency Department with two arrow wounds; one between the 7th and 8th rib and the other in the posterior cervical triangle. We will be discussing the effects the injury caused on the cardiovascular system, the autonomic nervous system as well as the neuromuscular effects. We will also be discussing how the injuries affect the tissues in the patient’s trachea.
A patient that was brought into the Emergency Department by ambulance had two arrow wounds, one being between the seventh and eighth rib and the other in the posterior cervical triangle. The ribs are a part of the Thoracic Cavity in the Axial Skeleton. The thoracic cage protects the heart, the thymus, lungs and other structures within the Thoracic Cavity. The Thoracic Cavity itself serves as a point for muscles that are involved with breathing, movements of the pectoral girdle, and maintaining the position of the vertebral column. It also includes the Pleural Cavity, which includes the lungs. Serous membranes line and enclose the lungs and several other body cavities where they secrete lubrication that reduces friction in muscle movement. Serous membranes are made up of a mesothelium supported by a thin layer of areolar connective tissue. There are three types of serous membranes that are rich in blood and lymphatic vessels. The first is the pleura, which lines the pleural cavities and lungs. Second is the peritoneum, which lines the peritoneal cavity. Last is the pericardium, which covers the heart. The purpose of the serous membrane is that they line body cavities that lack openings to the exterior, such as the rib cage and minimize friction between other surfaces.
The Autonomic Nervous system (ANS) consists of the Parasympathetic Nervous system and the Sympathetic Nervous system. The ANS is the involuntary division of the Nervous system and is in charge of our “flight or fight” feeling or “rest and digest” feeling. The efferent sympathetic neurons originate from thoracic nerves and synapse with the peripheral nervous system. The ANS is in charge of regulating body temperature and coordinates cardiovascular, excretory, respiratory, digestive, and reproductive functions. Once the arrow penetrated the 7th an 8th rib, the patient’s vital signs can increase due to pain and adrenaline kicking in. If the patient begins to lose too much blood, his vital signs can decrease drastically, which can send him into an asystole rhythm.
The trajectory of the first arrow is posterior superiorly of the axial plane. Injury to this area can cause serious damage to other organs and structures such as the diaphragm, muscles, nerves, and the posterior peritoneal membrane. Serious injury can be inflicted to the heart and lungs especially because the ribs serve as an attachment to muscles for breathing. Where the arrow penetrated, it also went into his abdominal cavity where the arrow could have hit the abdominal organs including the spleen, part of the kidneys, stomach, and liver.
The cardiovascular system is the transport system of the body. It consists of the heart, a network of blood vessels, and blood itself. The network of blood vessels can be divided into a pulmonary circuit and a systemic circuit. The heart has four muscular chambers that work together pumping blood through blood vessels that connect the heart to peripheral tissues. The pulmonary circuit carries blood filled with carbon dioxide from the heart to the lungs and returns blood filled with oxygen back to the heart. The systemic system transports blood filled with oxygen from the heart to the rest of the body’s cells and returns blood filled with carbon dioxide back to the heart (Martini, et al., 2018). As a result of the arrow wound, both systems can be compromised because the patient would not be receiving the oxygen he needs, and they would therefore not be able to breathe properly because oxygen depends on the blood from the right atrium of the heart. Contraction of the right ventricle of the heart sends blood to the lungs via the pulmonary artery. Both systems work together pumping blood to each of the circuits. The blood circulates to the rest of the body as well as to the arteries. As a result of the injury, the patient’s hemoglobin values would be low because there would not be enough oxygen to be transported. Hemoglobin is responsible for the cell’s ability to transport carbon dioxide and oxygen. The patient’s hematocrit values would also be low because the Hemoglobin depends on transporting oxygen and carbon dioxide, which forms the red blood cells. The percentage of whole blood is the hematocrit level. If the patient lost a sufficient amount of blood, both values would decrease.
The possible neuromuscular effects of the second arrow can be injury to the suprascapular nerve and infraspinatus, which is responsible for some of the muscles of the scapula. Injuring the posterior cervical triangle, can lead to muscle damage assisting in rotating the humerus, abduction of the arm and rotation of the head. The neuromuscular junction is responsible for chemical communication between a neuron and a skeletal muscle fiber. Each muscle fiber has one neuromuscular junction. Muscle fibers, like other cells in the body are enclosed by a plasma membrane and contain a large number of organelles. Each neuromuscular junction consists of the axon terminal of a motor neuron. Other key components include the synaptic knob, synaptic cleft synaptic vesicle and acetylcholine (ACh).
The types of tissue found in the tracheal slide include hyaline cartilage, psueudostratified columnar ciliated epithelium and submucosa. Damage to the hyaline cartilage of the tracheal wall will cause it to collapse and cause serious tracheal injury. Hyaline cartilage is the main component of the trachea. The submucosa supports the mucosa; therefore damage can lead to allowing toxins to be inhaled to the body and cause infection. If there is damage to the tracheal wall, it can affect the epithelium, which is helpful for passing oxygen. If the tracheal wall is damaged, breathing will be compromised.
To conclude, with the way the arrow penetrated the 7th and 8th rib along with the posterior cervical triangle, the patient could live with assistance in breathing. The patient would more than likely have nerve and muscle damage due to the arrow penetration in the posterior cervical triangle. The arrow entered the ribs at a 15-degree angle, which means the arrow could have penetrated a lung or another major organ superficially. If the patient was rushed to the Emergency Department in efficient time, then they should recover from their injuries with some damage. The alternative is, if the patient was not brought in immediately, they could have lost too much blood and could have coded from not being able to breathe. The arrows could have also penetrated an organ that could not be repaired.