7 Elements – Keeping it simple with higher level thinking

Homeostatis

Medical emergencies can be tricky at the best of times even for the most experienced clinicians and practitioners. If you don’t deal with sick patients on a daily basis, feeling overwhelmed is common, and anxiety can build quickly. When this happens, take a step back and try to simplify things with a few easy tricks.

To maintain homeostasis (a happy body) we balance what I like to call “The 7 Elements”. If a patient presents with a medical or traumatic emergency, odds are they have a problem with one or more of these:

1. OXYGEN – We need oxygen to stay alive. Without access to oxygen for more than a few min we become hypoxic / hypoxemic (low oxygen in the tissues and blood). Take away any part of our body’s access to oxygen and it quickly starts to die. Our brain is the most susceptible to lack of oxygen, but if you tie a cord around your wrist and prevent oxygenated blood from flowing to your hand, eventually that hand will become blue (ischemic) and then necrotic (black). Same for the heart – if you occlude one of the coronary arteries that feed a portion of the heart, that part of the heart will also start to suffer the same effects as the hand. As you can see, oxygen is a key player in maintaining our homeostatic balance.

2. GLUCOSE – A sugar, glucose is the only food our brain can eat, and our big brains have a huge appetite for it. Same goes for every cell in our body. Lucky for us, everything we eat can be converted to glucose, and even when we fast, our body is great at creating glucose from all sorts of things in our body (like metabolizing our fat, accessing glycogen in the liver in conjunction with the pancreatic hormone glucagon to create glucose, etc.). But just because we consume glucose doesn’t mean our cells can process it properly. Certain diabetics, for example, lack the ability to bring glucose from the extracellular space (the blood plasma) and into the intracellular space (the actual cells) either because their body has stopped producing insulin or their cells have stopped recognizing it. High blood glucose can lead to a myriad of health problems. Equally, low blood sugar can lead to complications including seizure, coma, and death.

3. PH – The acid / alkaline balance in our body is essential to maintaining homeostatic stability. Our body operates in a very narrow PH range, slightly on the acidic side between 7.35 and 7.45. If you throw our PH balance off one way or another, things start to go south quickly. People with respiratory problems can often retain C02 and therefore retain carbonic acid in their body (we modulate our carbonic acid levels with our respirations). Hypoventilation can cause acid to build-up causing respiratory acidosis while hyperventilation can cause a person to blow-off too much C02 causing respiratory alkalosis. Metabolic conditions can cause our acid / base balance to be thrown off, such as hypothermia, overdoses (like ASA and TCA overdoses), and DKA (Diabetic Ketoacidosis).

4. H20 (WATER) – We need water to stay alive. After all, our bodies are approximately 80% water. We consume water through drinking, eating, or through putting fluids directly into our vascular system as in the case of IV therapy. We loose water through respirations, urinating, defecating, vomiting, bleeding, and sweating. We need water to remove toxins, to digest, and to maintain adequate blood volume. We can only live without water intake for a few short days before dying from dehydration. It’s easy to see how someone with a water problem can deteriorate quickly.

5. PRESSURE – Much like the cooling system in a car, our body requires adequate pressure to maintain an adequate homeostatic balance. We do this with our vascular system (the pipes) which have the unique ability to constrict and expand, with our water volume (note point 4), and with our heart (the pump). If we don’t have adequate blood pressure, we cannot get oxygen and glucose (see points 1 and 2) to our brain and other tissues in our body. Blood pressure is a key player in keeping us alive, which is why our body is always trying to keep it in an acceptable range.

6. ELECTROLYTES – We loose electrolytes when we loose water. These comprise mainly of Sodium, Potassium, and Calcium. We need electrolytes for our heart to properly function and for every cell in our body to be able to produce energy. We don’t need a lot, but when we are low, we can suffer major consequences.

7. TEMPERATURE – Our body can stay alive within a very narrow temperature range, within a few degrees of 37C. Turn it up a notch to only 39C and you have a major fever. Go the other way to 34C and you are seriously hypothermic. Our core temperature (meaning our torso and our brain) has to stay the temperature of a hot summer day in order for us to remain alive. Lucky for us, our bodies are excellent at compensating. Ever notice when you go outside in the winter you sometimes have to pee but you didn’t need to pee before going outside? That’s because when you get cold your body turns off the heat to the extremities (like your hands and feet and ears) in order to keep the core warm. It cannot afford to keep all the rooms heated so it just heats the essential ones. That’s why your hands and feet get cold first. Your body turns off the heat by constricting your vasculature (narrowing the pipes) and bringing all the blood into your core. Since you can’t fit all that blood into your core, your body makes urine and you pee out the excess fluid (water).

So, next time you are faced with a complex medical problem, keep it simple with some higher level thinking. Look at the 7 elements and odds are you will find your patient has problems with at least one of them, often multiple ones. With the 7 elements it’s also easy to see more complex relationships like why a hypothermic patient may have a problem with temperature, but also be dehydrated (a problem with water), have a problem with glucose, and possibly electrolytes.

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