The first arrow had hit the patient in between the area of the 7th and the 8th rib of the rib cage. This part comprises of the intercostal space and the intra-thoracic cavity which in turn is enveloped by the serosal membrane. The serosal membrane cavities which make up this space are the pleura and the pericardium. The pleura are two pleural cavities which are found in the thoracic cavity and the pericardium is the pericardial cavity that is placed within the mediastinum of the thoracic cavity (Mutsaers, 2013).
The serous membrane is a tissue membrane which is responsible for secretion of serous fluid. This covers the wall of the organs like the thoracic and abdominopelvic cavities. This is further divided into visceral and parietal layers, where the mesothelium is composed of avascular flat nucleated cells or simple squamous epithelium, whereas the connective tissue comprises of nerves and blood vessels. By enclosing the body cavities or called the serosal cavities, these secrete lubricating fluid which is able to reduce friction for the movement of muscles (Paramhans et al., 2014).
The part of the nervous system which is responsible for supplying to the internal organs of the body which includes the blood vessels, liver, intestine, kidneys and others is known as the autonomic nervous system. This is mainly divided in two parts, the sympathetic and the parasympathetic nervous system. When the arrow penetrates the 7th and 8th rib area, the axon might be affected of the visceral motor neuron of the CNS. This is in turn connected to the internal organs to the brain via the spinal nerves. This in turn can have an effect on the vital signs of the patient in terms that this might increase the heart rate of the patient, followed by an elevated blood pressure. This happens because the human body is known to be connected with the sympathetic chain ganglia which also targets the thoracic, visceral, head, body walls and the limbs (Florea & Cohn, 2014).
In terms of the direction and the anatomical planes, it can be out forward that the abdominal cavity extends in a superior way in to the osseocartilaginous thoracic cage and this goes into the fourth of the intercostal space. As a result of this, the respective organs are known to be far more superior to the abdominal organs like the spleen, the stomach, the liver and the part of the kidneys, each of which are guarded by the thoracic cage (Ganguly et al., 2014).
The cardiovascular system represents a network of organs along with vessels which play a role in the flow of the blood along with the nutrients, hormones, oxygen. Additionally the several organs work together to continue the flow. According to the case presented here, the pulmonary system of the patient is unable to take part in the circulation occurring between the heart and the lungs respectively. In case both of these systems stops working, the patient will not be able to breathe properly, which in turn will not allow the blood to return. This is because the oxygen of the body is dependent on the blood that is coming from the right atrium of the heart (Lavie et al., 2015). Therefore because of this, the blood present in the right atrium is pumped into the right ventricle. When it is present on the other side of systemic circuit, which in turn takes place in the interaction of the heart circulation and the rest of the body however the lungs are excluded. The haemoglobin of the patient as a result is low at this condition since there is no enough oxygen present which can be transported to all over the body, however the level of the haemoglobin needs to be maintained. It is reported that both the haemoglobin and the haematocrit are based on the whole blood. Hence this is dependent on the amount of the plasma present. In case the patient is extremely dehydrated, there is a chance that the haematocrit and the haemoglobin appears together in case the patient is normovolemic. In case the patient is overloaded with fluids, there is a chance that it is lower than the normal level (Paramhans 2014).
The neuromuscular effect that can be present for the patient is pain and also there might be a rise in the respiratory failure which might be a result of the easy muscle fatigue, along with the recurring infections of the lower respiratory tract. For the muscle to contract, there are signals which originate from the nervous sytem, which are transmitted to the muscle present at the neuromuscular junction. This place presents an area that is a for the communication occurring between the schwann cells, motor neurons and the muscle fibers. There might be presence of the chronic neuromuscular disease like the conditions of amytotropic lateral sclerosis, spinal cord injury or the muscular dystrophies that might result in the respiratory complications. There might be a several number of other complications present which affects the pathways connecting the voluntary centres of respiration which creates problem for the patient to breathe which might happen to the patient presented here (Pratt et al., 2013).
- The innermost layer is the mucosa, which consists of the columnar epithelium that is ciliated having goblet cells. These epithelial cells envelops the body and the body cavity, which is found in the air sac, the lungs and the digestive tract.
- This is the subcutaneous layer that is the deep mucosa made up of the connective tissue having the nervous tissue and the blood vessels. This is further subcategorized for provision of support, elasticity and strength.
- This area surrounding the submucosa is the hyaline cartilage. This forms the rings of support for the trachea. By providing a flexible and strong structure, it keeps the airway open. Injury can affect the two airways of bronchi. There might be shortness of breath, which makes haemoglobin less (Brand-Saberi & Schäfer, 2014).
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Florea, V. G., & Cohn, J. N. (2014). The autonomic nervous system and heart failure. Circulation research, 114(11), 1815-1826.
Ganguly, T., Kar, S. K., Dasgupta, C. S., Goswami, A., & Mandal, A. (2014). Penetrating Arrow Wound of the Chest-A Case Report. J Case Rep Stud, 2(2), 206.
Lavie, C. J., Arena, R., Swift, D. L., Johannsen, N. M., Sui, X., Lee, D. C., ... & Blair, S. N. (2015). Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circulation research, 117(2), 207-219.
Mutsaers, S. E. (2013). Mesothelial cells: their structure, function and role in serosal repair. Respirology, 7(3), 171-191.
Paramhans, D., Shukla, S., Batra, A., & Mathur, R. K. (2014). Successful removal of an impacted metallic arrowhead penetrating up to the brainstem. Journal of Emergencies, Trauma and Shock, 3(3), 303.
Pratt, S. J., Shah, S. B., Ward, C. W., Inacio, M. P., Stains, J. P., & Lovering, R. M. (2013). Effects of in vivo injury on the neuromuscular junction in healthy and dystrophic muscles. The Journal of physiology, 591(2), 559-570.