This chapter presents the anatomy review of the human heart. The human heart is a hollow four-chambered muscle that is responsible for pumping blood throughout the body. The heart lies in the mediastinum in the thorax, pointing toward the left of the midline. The heart consists of four main layers: the pericardium, epicardium, myocardium, and endocardium. The epicardium is the outermost layer of the heart muscle. The middle layer of the heart is called the myocardium. The innermost layer of the heart is the endocardium. The heart is divided into right and the left side. The right side of the heart contains the right atrium and right ventricle. The left side of the heart contains the left atrium and left ventricle. The heart has four valves: tricuspid valve, mitral valve, aortic valve, pulmonary valve; acting as tiny doors that keep the blood moving in one direction.
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The chapter explores how to measure the electrical direction for the P wave, the QRS complex, and the T wave, as well as for other forces. It provides a method for determining the direction of the electrical force for any of these waves, or complexes, on the electrocardiograph (EKG). The heart produces electrical and mechanical energy on a continuous basis. Both forms of energy come from specialized cardiac muscle fibers. These fibers provide electrical signals and mechanical energy that physically pumps the blood. Although the EKG does not show that mechanical energy, it can be used to measure a variety of electrical events. When a force is abnormal in size or direction, it may indicate that the specific part of the heart producing the force is abnormal. Therefore, learning the normal electrical direction of forces in the heart provides a simple and scientific way of understanding and interpreting an EKG.
This chapter explains various types of heart blocks such as premature atrial contraction, sinus arrest and asystole. It explains various types of pacemakers such as ventricular pacemaker and artrial pacemakers. Junctional rhythm is a regular rhythm. A P wave is frequently not seen because the rhythm originates in the AV junctional node. Junctional rhythm may be a manifestation of digitalis toxicity, sick sinus syndrome, and acute inferior wall infarction. Pauses are most commonly caused by premature atrial contractions (PACs) that do not conduct down to the ventricle and generate a QRS complex. These are called nonconducted PACs (NCPACs). Asystole is a prolonged period of no electrical activity. Cessation of function of the sinus node is called sinus arrest. Normally, when sinus arrest occurs, another pacemaker must take over, such as the junction or the ventricles. Ventricular pacemaker rhythm demonstrates a vertical electrical artifact (EA) at the beginning of the QRS.
This chapter presents the case examples of pressure and volume overload on the left ventricle and provides list of criteria for the diagnosis of Left Ventricular Hypertrophy (LVH) on the electrocardiogram (EKG). It also describes and explains how to identify ST changes in LVH and LVH simulating anterior wall infarction on the EKG. LVH refers to an increase in the wall thickness or dilation of the left ventricle. LVH is often the result of increased pressure, or volume, within the left ventricular chamber. Mitral regurgitation (MR) occurs when the mitral valve allows the backflow of blood from the left ventricle into the left atrium. The most common cause of pressure overload is hypertension (HTN). Hypertrophy of the left ventricle increases the amplitude of the left ventricular forces, because more mass generates more electricity. In LVH, the frontal plane, the horizontal plane, or both may show increased QRS amplitude.
- Go to chapter: Stabilization Phase of Trauma Treatment: Introducing and Accessing the Ego State System
This chapter aims to help clinicians learn stabilization interventions for use in the Preparation Phase of eye movement desensitization and reprocessing (EMDR) treatment. Using these interventions will aid clients in developing readiness for processing trauma, learning how to manage symptoms of dissociation, dealing with affect regulation, and developing the necessary internal cohesion and resources to utilize the EMDR trauma-processing phase. Earlier negative experiences stored dysfunctionally increase vulnerability to anxiety disorders, depression, and other diagnoses. When assessing a client with a complex trauma history, clinicians need to view current symptoms of post-traumatic stress disorder (PTSD) or depression as reflections of the earlier traumas. The chapter outlines the strategies dealing with dissociative symptoms, ego state work, and internal stability that help clinicians to develop an individualized treatment plan to successfully guide the client through the EMDR phases of treatment.
- Go to chapter: ACT-AS-IF and ARCHITECTS Approaches to EMDR Treatment of Dissociative Identity Disorder (DID)
This chapter describes key steps, with scripts, for the phases of therapy with a dissociative identity disorder (DID) client, and for an eye movement desensitization and reprocessing (EMDR) session with a DID client. In brief, the method employs the artful use of EMDR and ego state therapy for association and acceleration, and of hypnosis, imagery, and ego state therapy for distancing and deceleration within the context of a trusting therapeutic relationship. It is also endeavoring to stay close to the treatment guidelines as promulgated by the International Society for the Study of Trauma and Dissociation. The acronym ACT-AS-IF describes the phases of therapy; the acronym ARCHITECTS describes the steps in an EMDR intervention. Dual attention awareness is key in part because it keeps the ventral vagal nervous system engaged sufficiently to empower the client to sustain the painful processing of dorsal vagal states and sympathetic arousal states.
One way of thinking about procrastination is to regard it as a form of addiction; an addiction to putting things off. As with other addictive patterns, the client will choose a short-term gratification instead of going for a long-term result that might, in the end, be more satisfying or empowering. As with other addictions, a procrastinating client often suffers ongoing erosion of her self-esteem. Quite often, procrastination may function as a defense as a way to avoid other life issues that are disturbing. With this type of problem, we can use a variation of Popky’s addiction protocol, and the level of urge to avoid (LoUA) procedure. It is also important to use resource installation procedures to help the client develop an image of the benefits that would come with being free of this problem.
The important elements of the Eye Movement Desensitization and Reprocessing (EMDR) and Phantom Pain Research Protocol are client history taking and relationship building, targeting the trauma of the experience, and targeting the pain. This protocol is set up to follow the eight phases of the 11-Step Standard Procedure. This chapter presents a case series with phantom limb patients obtained a few before and after EMDR magnetoencephalograms (MEGs) at the University of Tübingen, Germany on arm amputees that show the presence of phantom limb pain (PLP) in the brain images before EMDR and the absence of it after EMDR. In these case series, it is found that PLP in leg amputations is much easier to treat than arm amputations, likely due to the much more extensive and complex arm and hand representation in the sensory-motor cortex compared to the leg and foot representation.
This book presents theoretical underpinnings of perinatal and pediatric bereavement, chapters on dimensions of perinatal and pediatric loss that have been of interest recently, and clinical interventions derived from research. It is divided into two sections. The first section has 10 chapters focusing on aspects of perinatal loss. It presents background content on various grief theories developed in the past five decades. These theories have expanded our understanding of the processes of death, dying, and bereavement. Grief after pregnancy loss can be more complicated for certain groups. The book provides a comprehensive overview of perinatal grief among lesbian couples and an overview of perinatal loss in adolescents, discussing normal adolescent growth and development, and using Sanders’s integrated theory of bereavement to discuss the common physical, emotional, social, and cognitive reactions to loss. The second section has eight chapters focusing on various aspects of caring for families whose children are dying or who have died, and caring for children who are grieving. Sometimes, the death of a child can occur under traumatic circumstances, setting the stage for very intense psychological responses. The book focuses on the impact of the cause of the death on posttraumatic stress responses and overall parental health after the traumatic loss of a child and describes supportive interventions for bereaved parents. Suicide is one of the most traumatic losses a family can experience. Finally, the book presents the importance of creating and capturing meaningful moments in the time leading up to and after the death of a child, focusing on the importance of relationships among families and professionals as they prepare for the child’s death.