Anatomical Plane and axis - general anatomy

planes and axis

1. Anatomical planes and axis Yashu Bhardwaj 03-06-2024 anatomical planes and axis 1

2. Contents Introduction Positions of body Anatomical planes Anatomical axis Movements Summary MCQs Refernces 03-06-2024 anatomical planes and axis 2

3. Introduction Anatomy – science deals with structure of body, from macroscopic to microscopic level Anatome ( G reek word) = to cut up 03-06-2024 anatomical planes and axis 3

4. Anatomical position To avoid ambiguity, all anatomical descriptions assume that the body is in the conventional ‘anatomical position’ standing erect, facing forwards, upper limbs by the side with the palms facing forwards, lower limbs together with the toes facing forwards 03-06-2024 anatomical planes and axis 4

5. Fundamental position 03-06-2024 anatomical planes and axis 5 It is same as anatomical position except the palms of hand face the side of body This position is used in discussing rotation of upper limb i.e. supination pronation

6. Patient positioning Proper  patient positioning  is an important part of ensuring that a surgical procedure is safe and effective. Determining a patient's position for a procedure is determined from a preoperative assessment and is based on factors like: type of procedure, length of procedure , patient’s ability to tolerate the procedure, exposure required by the surgical team, anesthesia access, among others. 03-06-2024 anatomical planes and axis 6

7. Supine position ( Dorsal Decubitus) 03-06-2024 anatomical planes and axis 7 In supine position, the patient is face up with their head resting on a pad positioner or pillow and their neck in a neutral position. The patient’s arms,  maintained in a neutral thumb up or supinated position, may be tucked at their sides or abducted to less than 90 degrees. USES : for intracranial procedures as well as procedures on the anterior surface of the body: Cardiac Colorectal Thoracic Abdominal Laparoscopic surgeries Upper extremity surgeries Lower extremity surgeries Procedures on the neck and face, as plastic surgeries and general surgeries.

8. Prone position 03-06-2024 anatomical planes and axis 8 person lies flat with the chest down and the back up. USES: Posterior compartment access and visualization are improved, Conversion to an open procedure, if necessary, is facilitated by the prone position, especially for open procedures through a posterior midline approach

9. Proning IMPORTANCE : Proning is required only when the patient feels difficulty in breathing and the SpO2 decreases to 94 (less than 94 ). Regular monitoring of SpO2, along with other signs like temperature, blood pressure and blood sugar, is important during home isolation. Missing out on hypoxia (compromised Oxygen circulation) may lead to worsening of complications 03-06-2024 anatomical planes and axis 9

10. Proning Pillow placement : One pillow below the neck One or two pillows below the chest through upper thighs Two pillows below the shins P roning team typically consists of six highly trained experts including: Registered nurses (with either critical care or operating room expertise) Respiratory therapists Physical therapists Anesthesia physicians 03-06-2024 anatomical planes and axis 10

11. Proning How Does Proning Help Proning allow for better expansion of the dorsal (back) lung regions, resulting in improved oxygenation. In the prone position, lung compression is decreased, secretions drain better, and collapsed alveoli reopen . Several scientific studies state that proning is pivotal for some patients who experience mild respiratory distress and do not need a ventilator I t actively prevents progressing the condition to severe respiratory distress and shows improved signs of oxygenation . 03-06-2024 anatomical planes and axis 11

12. R isks of proning Airway obstruction Dislodgement of endotracheal tube Pressure-related skin injuries Hypotension (low blood pressure) Arrhythmias (irregular heartbeat/rate ) P atient may be unqualified for proning if they have: Spinal instability Unstable fractures Open wounds Burns Tracheal surgery A baby in utero (over 24+ weeks pregnant) 03-06-2024 anatomical planes and axis 12

13. For Self- Proning : It’s a synchronized pattern. This includes: Step 1:  Turn the patient in the prone position (i.e., lying on the belly). Step 2:  Next turn the patient laterally (i.e., sideways) on the right side. Step 3:  Then make the patient sit up with the spine straight. Step 4:  Next turn the patient laterally (i.e., sideways) on the left side. Step 5:  Finally, turn the patient to the initial prone position. Step 6:  Alternate the position every 30 minutes. Step 7:  Each position requires the patient’s heart rate, blood pressure and pulse oximetry (oxygenation level) to remain stable during each move. Step 8:  It is advisable not to spend more than 30 minutes in each position . You will need 4-5 Pillows. 03-06-2024 anatomical planes and axis 13

14. Lateral recumbent position( lateral decubitus position) 03-06-2024 anatomical planes and axis 14 In medical parlance, the recovery position is called the lateral recumbent position The idea is to prevent getting emesis (stomach contents) into the lungs, which is a condition known as aspiration. In the right lateral recumbent position, the individual is lying on their right side. This position makes it easier to access a patient's left side.

15. Lateral recumbent position 03-06-2024 anatomical planes and axis 15 In this position, the individual is lying on their left side.  This position makes it easier to access a patient's right side .

16. Lithotomy position 03-06-2024 anatomical planes and axis 16 It involves: lying on your back 90 degrees flexion at your hips Your knees will be bent at 70 to 90 degrees padded foot rests attached to the table will support your legs . In addition to childbirth, the lithotomy position is also used for many urological and gynecological surgeries, including: urethra surgery colon surgery removal of bladder rectal or prostate tumors

17. Trendelenburg position 03-06-2024 anatomical planes and axis 17 A variation of the supine position patient’s head is tilted down so that the patient’s abdominal organs are moved towards the head I mproving surgical access to the pelvic organs . used for : lower abdominal surgeries including colorectal, gynecological , genitourinary procedures

18. Reverse Trendelenburg position 03-06-2024 anatomical planes and axis 18 A variation of the supine position P atient’s head is tilted upward so that their feet are positioned down. used for stomach, gallbladder, and biliary tract surgeries

19. Fowler’s position(beach chair position) 03-06-2024 anatomical planes and axis 19 P osition for patient resting comfortably, whether in-patient or in the emergency department. Patient's knees are either straight or slightly bent and the head of the bed is angled between 45 and 60 degrees. Respiratory changes result in increased oxygenation by maximizing chest expansion, minimizing abdominal muscular tension, and minimizing the effects of gravity on the chest wall It is also recommended during feeding to reduce the risk of regurgitation and aspiration.

20. Fowler’s position(upright   position) Head of the bed between 60 and 90 degrees, is useful during the placement of nasogastric tubes as it decreases the risk of aspiration. P atient sitting with their hips and knees slightly flexed. used for: feeding the patient, improved breathing, for radiology, grooming, other circumstances that require an upright posture. 03-06-2024 anatomical planes and axis 20

21. Sim’s position 03-06-2024 anatomical planes and axis 21 The Sims' position is a variation of the left lateral position. The patient is usually awake and helps with the positioning. The patient will roll to his or her left side . Keeping the left leg straight, the patient will slide the left hip back and bend the right leg. This position allows access to the anus for rectal examination

22. Cranial cavity Formed by the cranial bones and holds the brain Vertebral canal Formed by the vertebrae and contains the spinal cord Thoracic cavity Formed by the thoracic cage, muscles of the chest, sternum, and the thoracic vertebrae; contains trachea, bronchi, lungs, heart, aorta, superior and inferior vena cava, thymus, thoracic duct, oesophagus . Pleural cavity Fluid-filled spaces that surround both lungs 03-06-2024 anatomical planes and axis 22 Cavities

23. Cavities 03-06-2024 anatomical planes and axis 23 Pericardial cavity it contains a small amount of serous fluid that acts to reduce surface tension and lubricate. Therefore, the cavity facilitates the free movement of the heart. Abdominal cavity Contains liver, gall bladder, bile duct, pancreas, kidney, adrenal gland, stomach , spleen, small intestine, most of large intestine; the serous membrane of the abdominal cavity is the peritoneum Pelvic cavity Contains bladder, terminal part of the large intestine, and reproductive organs (internal)

24. Anatomical planes Plane – Imaginary plane used to transect body to locate structures or direction of movement and sectioning Axis – an imaginary line about which a body rotates 4 anatomical plane: 1) Median plane 2) Sagittal plane 3) Coronal plane 4) H orizontal plane 03-06-2024 anatomical planes and axis 24

25. Median plane M edian plane passes longitudinally through the body and divides it into right and left equal halves 03-06-2024 anatomical planes and axis 25

26. Sagittal plane 03-06-2024 anatomical planes and axis 26 The sagittal plane is any vertical plane parallel with the median plane

27. Coronal plane 03-06-2024 anatomical planes and axis 27 The coronal (frontal) plane is orthogonal to the median plane and divides the body into anterior (front) and posterior (back)

28. Transverse plane 03-06-2024 anatomical planes and axis 28 The horizontal (transverse) plane is orthogonal to both median and sagittal planes. Radiologists refer to transverse planes as ( trans)axial

29. Oblique plane 03-06-2024 anatomical planes and axis 29

30. Comparison of upper and lower limb 03-06-2024 anatomical planes and axis 30 B order of the upper limb that includes the thumb, and the border of the lower limb that includes the great toe are the pre-axial borders, whilst the opposite borders are the post-axial borders .

31. Anatomical axis 3 axis : 1) Sagittal axis also known as antero posterior axis 2) Frontal axis also known as transverse axis 3) Vertical axis or longitudinal axis 03-06-2024 anatomical planes and axis 31

32. Sagittal axis 03-06-2024 anatomical planes and axis 32 Sagittal axis or anterior-posterior axis is the axis perpendicular to the coronal plane, i.e., the one formed by the intersection of the sagittal and the transversal planes.

33. Frontal axis 03-06-2024 anatomical planes and axis 33 P asses horizontally from left to right and is formed by the intersection of the frontal and transverse planes.

34. Vertical axis 03-06-2024 anatomical planes and axis 34 Vertical axis - passes vertically from inferior to superior and is formed by the intersection of the sagittal and frontal planes.

35. Movement in the sagittal plane about the frontal axis 03-06-2024 anatomical planes and axis 35

36. Movement in the frontal plane about the sagittal axis 03-06-2024 anatomical planes and axis 36

37. Movement in the transverse (horizontal) plane about the vertical axis 03-06-2024 anatomical planes and axis 37

38. Movements at shoulder joint 03-06-2024 anatomical planes and axis 38

39. Movements at elbow joint 03-06-2024 anatomical planes and axis 39

40. Movements of thumb and fingers 03-06-2024 anatomical planes and axis 40

41. Movements at hip and knee joint 03-06-2024 anatomical planes and axis 41

42. Movements at knee joint 03-06-2024 anatomical planes and axis 42 t

43. Movements at foot 03-06-2024 anatomical planes and axis 43

44. MCQs Q1. Coronal plane divides the body into : Right & left B) U pper and lower C) A nterior & posterior D) Equal right & left halves Ans. C 03-06-2024 anatomical planes and axis 44

45. MCQs Q.3) Movement , which occur at thumb to lifting a tea cup by its handle? a) Ulnar deviation b) Opposition c) Extension d) Adduction Ans. C 03-06-2024 anatomical planes and axis 45

46. Clinical vignette Q. A person while walking barefoot in his field got his sole of foot bruised by stones present on field, he sat down to check bruised area and remove the stone. Which movement is occurring at foot. Dorsiflexion Plantar flexion Eversion Inversion Ans. D 03-06-2024 anatomical planes and axis 46

47. Clinical vignette Q.A 25 year old person tested covid positive and is at home isolation checked his SpO 2 level and it reads 94 so he decides to start self proning and he lie on his belly, which is the next position he should take minimum after how many minutes ? Supine lying 30 minutes Side lying 120 minutes Semi fowler’s positon 120 minutes Side lying 30 minutes Ans. D 03-06-2024 anatomical planes and axis 47

48. Clinical vignette Q . A patient came to the clinic with a chief complain of chest pain , he is 52. he came with his arm on his chest, this movement at elbow joint is occuring in which plane? Coronal Sagittal Median Transverse Ans . B 03-06-2024 anatomical planes and axis 48

49. References Gray’s Anatomy 1 st Edition Vishram Singh Textbook of Anatomy 03-06-2024 anatomical planes and axis 49

50. THANK YOU 03-06-2024 anatomical planes and axis 50