AP 4

• SPECIFICITY
• AMONUT OF PAIN IS RELATED TO AMOUNT OF TISSUS DAMAGE
• DOES NOT ACOUNT FOR PSYCHOLOGICAL PART OF PAIN

• GATE CONTROL
• DEVELOPED TO EXPLAIN THE COMPLEXITIES OF THE PAIN PHENOMENON
• GATES IN THE SPINE AND THALALMUS

• BARE NERVE ENDINGS IN BODY THAT RESPOND TO CHEMICAL, MECHANICAL , AND TEMP
• THIS NERVES ARE NOT DISTRIBUTED EQUALY IN BODY
• DEPENDS ON HOMUNCULUS

• ALPHA
• LIGHTLY MYELINATED (FAST AND RAPID)
• MED SIZED
• CARRY WELL LOCALIZED PAIN INFO

• C FIBERS
• UNMYELINATED
• BURNING ACHING
• SLOW TO RESPONED
• HARD TO BLOCK

• ARE LEVELS OF THE DORAL ROOT
• THERE ARE 10 AREAS
• THE MOST IMPORTANT FOR PAIN IS LAMINA 2 (PAIN GATE IN SPINE)

• HAS THRESS CLASS
• 1. PROJECTION CELLS- CARRY INFO TO BRAIN VIA SPINOTHALAMIC TRACT

• 2. EXCITATORY INTERNEURONS
• THEY RELAY INFO TO
• - PROJECTION CELLS
• - MOTOR CELLS (TO PULLWAY)
• - OTHER INTERNEURONS

• INHIBITORY INTERNEURONS
• WITH WHAT TO HIT THIS IN OR

• SPIN- BLOCKS ROOT AND LAMINA
• EPIDURAL- JUST ROOTS

• GLUTAMATE
• NMDA
• AMDA

• GABA (BLOCK SUB P)
• SEROTONIN
• ENDORPHINS, ENDROMORHINS

POINT TO WHICH STIMULUS IS PERCEIVED PAIN

• PAIN AT ONE LOCATION MAY CAUSE AN INCREASE IN THE THRESHOLD IN LOCATION
• AFTER ABD SURG THE PT JUST THINKS ABOUT PAIN OF NG

• ALL PSYCHO
• TIME OR LIMIT OF PAIN THAT A PERSON WILL ENDURE BEFORE INITIATION OF PAIN RESPONSES

• FROM THE NERVE SYSTEM (CUTTING, STRECHING, HITTING OF NERVE)
• PERIPHRAL NERVES
• CENTERAL (IN BRAIN HARD TO TREAT)

• ALERT US THAT SOMETHINGS IS IMMEDIATELY HURTING THE BODY
• SIGNS OF SNS

• FROM SKIN CONNECTIVE TISSUE MUSCLE BONE
• HAS A AND C PAIN FIBERS

• PAIN OF INTERNAL ORGANS AND ABDOMEN
• POORLY LOCALIZED TO THE LESS NUMBER OF NOCIEPTORS

• PAIN THAT IS PRESENT IN AREA REMOVED OR DISTANT FROMTHE ITS POINT OF ORIGIN
• LIKE MI HAVE BACK AND SHOULDER PAIN

• STATE OF EXISTENCE
• SUDDEN INSIDIOUSLY
• LASTING AT LEAST 3 MONTHS
• CHANGE IN BEHAVOIR AND PSYCHOLOGICAL (PAIN REWIRE PT)

• PERIPH AND CENTRAL MORE SENSITIVE
• NEUROPATHIC PAIN
• ALTERATIONS IN DORSAL ROOT
• LOSS OF PAIN INHIBITION IN SPINAL CORD

• MOST COMMON LOWER BACK PAIN
• MYOFASCIAL MUSCLE (NEED DEEP MASSAGE OR MARCAINE TO KILL MUSCLE TO REFORM IT RIGHT)
• PORT OP CHRONIC PAIN CUTING NERVES, AMPUTATION
• CANCER PAIN

• FROM TRAUMA OR DISEASE OF NERVE
• CHRONIC
• S/S SHOOTING, BURNING, PARETHESIA, STABBING PAIN.

CAUSES DIABETIC NEUROPATHY, DEAFFERENTATION (CUT NERVE), SYPATHICTICALLY (LOSE BLOOD FLOW AND REPERFUSTION, CENTRAL PAIN, PHANTOM LIMB PAIN)

• BABYS HAVE PAIN
• EXPRESSION OF PAIN; FACIAL, CRYING, BODY LANG
• KEEP RR > 20

• PERIPHERAL THERMORECEPTORS
• SKIN
• SPINE
• EAR

• HYPOTHALAMIC CONTROL
• RELEASE TSH-RE -TSH- T4-EPI TO INCREASE META THAT INCREASE HEAT PRODUCTION

• MAKE HEAT
• META
• CONTRACTIONS (SHIVERING)
• CHEM THERMOGENESIS (BROWN FAT)
• CONSERVE
• VASOCONTR
• FETAL POSTIONS

PEOPLE ARE SHORTER IN COLD AREAS AND TALLER IN HOT AREAS

• MOST COMMON
• TRANEFER OF HEAT FROM AN OBJECT THROUGH SPACE (LOST TO AIR) TILL ABSORBED BY OTHER OBJECT
• LOSES 80% OF HEAT VIA HEAD

TRANSFER OF HEAT FORM SOLID TO SOLID

TRANSFER OF HEAT BY CIRCULATION OR MOVEMENT OF LIQ (VASODIL)

LOSS OF HEAT BY EVAPORATION OF WATER

• KILLS MANY ORGANISMS
• DECREASE SERUM IRON, COPPER, ZINC
• DEPRIVES BAC OF FOOD
• PROMOTES LYSOSOMAL BREAKDOWN AND AUTODESTRUCTION OF CELL
• INCREASE LYMPHOCYTIC TRANSFORMATION AND PHAGOCYTE MOTILITY

• 41C NERVE DAMAGE
• 43C DEATH
• FORMS HEAT CRAMPS, EXHAUSTION, STROKE
• MALE HOTTER THAN FEMALES

• HEAT CRAMPS ABD AND EXTREMITIES
• PROLONG SWEATING AND LOSS OF NA
• PEOPLE NOT USE TO HEAT
• INCREASE HR BP AND FEVER
• TX WITH FLUIDS AND COOL DOWN SLOWY

• COLLAPSE DT LONG HIGH CORE OR EXTERNAL TEMP
• PROLONG VASODIL LED TO DEHYDRATION, LOW PLASMA VOL, LOW BP AND CO AND UP HR
• S/S DIZZINESS, WEAK , NV

• TEMP OF >40.5
• CAN'T SWEAT
• GET CEREBRAL EDEMA, DEGENERATION OF THE CNS, SWOLLEN DENDRITES, AND RENAL TUBE NECROSIS
• DON'T COOL SKIN TO RAPIDLY SINCE IT WILL CAUSE VASOCON LIMITING CORE COOLING

• GENETIC (BLONDE HAIR BLUE EYES)
• PERCIPITATED BY VOLATILE GAS
• UP CA RELEASE OR LOW CA UP TAKE WITH CAUSE UP IN MUSCLE CONTRACTIONS
• LEADING TO UP META= CO2, AND LACTIC ACID
• TREAT WITH DANDROLIN 2.5 MG, (INHIBIT CA, HAS BICARB IN IT, AND MANNITOL) VENT, AND VENT

• TEMP BELOW 35C
• PRODUCE VASOCON, COAGULATION, TISSUE DAMAGE, ICE IN CELL, INCREASE BLOOD VISCOSITY,
• ACCIDENTAL HYPO- FALL IN COLD WATER
• THERAPEUTIC- FOR SURGERY TO LOW META

• 75-80% OF SLEEP TIME
• HAVE 4 STAGES

• 20-25% OF SLEEP TIME
• PARADOXIC SLEEP
• OCCURS Q 90 MINS AFTER 1-2 HOURS OF SLEEP

INSOMINIA

• BREATHING
• UPPER AIRWAY
• OBSTRUCTIVE SLEEP APNEA
• OBESITY HYPOVENT SYNDROME

• SLEEP/WAKE
• PARASOMNIAS- SLEEP WALKING
• SOMINAMBULISM
• NIGHT TERRORS
• ENURESIS

INFECTION OF EYELIDS

• STYE
• INFECTIONS OF SEBACEOUS GLAND OF EYELID

INFECTION OF OIL SECRETING GLAND

• INFECTION OF CORNEA
• NOT WEAR CONTACTS IN OR

• INFECTION OF CONJUNCTIVA
• PINKEYE

• PAPILLEDEMA (UP ICP) NO NO FOR SPINAL AND EPIDURALS
• GLAUCOMA
• MACULAR DEGENERATION
• STRABISMUS (FIX EARLY)
• COLORBLINDNESS (X LINKED TRAIT)

NEARSIGHTED

FARSIGHTED

• INFECTION OF OUTTER EAR
• SWIMMERS EAR

PRESSURE OF MEMBRANE THAT CAN CAUSE SCARING

• CN 1 AND 5
• MOST OF TASTE (SOUR, SWEET, SALTY, BITTER)

• WHERE BODY IS AT DEPENDS ON INNER EAR, VISION, RECEPTORS OF JOINTS AND LIGAMENT
• CAUSE VESTIBULAR NYSTAGMUS. VETIGO, MENIERE DISEASE