Biologically Important Macromolecules

So, let’s get back to the basics of things, starting at the molecular level (I can see a certain expression of disgust on your faces).

There are 4 biologically important macromolecules, these being carbohydrates, lipids, proteins and nucleic acids. They all have in common that they are constructed from simple organic (i.e. coming from organisms) molecules. They are bound together by condensation (dehydration synthesis), and broken up (digested) by hydrolysis.

Condensation (or dehydration synthesis): when two molecules bind together, and a molecule of water is produced as a by-product:

(thanks to http://faculty.clintoncc.suny.edu/faculty/michael.gregory/files/bio%20101/bio%20101%20lectures/biochemistry/bioche1.gif for the picture)

In this case, if a glucose and a fructose molecule bind together, one water molecule (H2O, circled), will be produced.

Hydrolysis is the exact opposite. a compund molecule is split apart; in order for this to happen, a water molecule needs to be present and divided among the two now split molecules (Hydrolysis: Hydro=water, lysis=breakdown in to components).

 

Carbohydrates

Function: Primary Source of energy, as they are easily broken down. Some structural use.

Identification: A relatively simple molecules made up of Carbon (C), Hydrogen (H) and Oxygen (O). Monomer (building block) is a carbon ring (a monosaccharide)

Synthesis: Condensation

Location of Synthesis: in the smooth Endoplasmic Reticulum (ER)

- Examples of monosacccharides are: Fructose, Glucose, Galactose, Deoxyribose, Ribose

- Monosaccharides are the only form of carbohydrate that can be absorbed by the body.

 

Lipids

Function:  Secondary source of energy (molecular structure is more complex than a carbohydrate, therefore the break down requires more energy). Some structural (phospholipids are used in the cell membrane), and some functional (hormones). Also acts as a buffer to balance pH levels in blood.

Identification: Complex molecules made up of C, H and O

Synthesis: Condensation

Location of Synthesis: in the smooth Endoplasmic Reticulum (ER)

- All lipids are insoluble in water.

- There are four categoris of lipids:

• Triglycerides are the most abundant in the body, found in fat tissue. Their purpose is to cushion (mechanical), protect (mechanical/chemical) and insulate (thermal).
• Steroids are classed as lipids; examples are cholesterol, bile salts, vitamin D, hormones. They are only included in the lipid group because they are also insoluble in water
• Phospholipids
• Others

 

Proteins

Function: Structural or Functional

Identification: Always contains Nitrogen (N)

Synthesis: Condensation between two amino acids yields a dipeptide and water. The bond is called a peptide bond.

Location of Synthesis: In ribosomes, that are found in rough Endoplasmic Reticulum, or in the Cytosol.

- Monomers of Proteins are Amino Acids. The monomers are held together by peptide bonds. Many Amino Acids that are bonded together are called polypeptides. Polypeptids that have over 100 bonds are called Proteins.

- The only difference between different Proteins is the R (Residue). There are over 20 known residues à over 20 different Amino Acids.

 

- Two types of Proteins exist:

 

 

 

 

 

 

 

 

• fibrous: structural (think of hair-fibre)

• globular: functional (think of a glob, blob of jelly. Not  structural!)

- The type of protein depends on three things:

• The number of Amino acids
• The type of Amino Acids
• The sequence of Amino Acids

- The four structures of proteins:

1. The Primary Structure is the linear chain of Amino Acids
2. The Secondary Structure is the twisting that occurs due to the attraction between the individual Amino Acids
3. the Tertiary Structure is the folding of the Protein due to the attraction and repulsion between prtein sections
4. Structure is two or more chains of Amino Acids stuck together (like magnets), e.g. hemoglobin. Proteins do not always necessarily have a quaternary structure. 

    http://upload.wikimedia.org/wikipedia/commons/a/a6/Protein-structure.png

    - Denaturing a protein changes its tertiary or quaternary structure, it is generally irreversible. Denaturisation can occur mechanically, electrically or thermally. Think of eggwhite. It is clear, but if you fry it, it will turn white. Same thing if you chuck it agains a wall. I haven’t tried electrocuting an egg yet, but I believe it would denature the proteins - if anyone has ever tried it, let me know!

    

   Nucleic Acids

   Function: Regulatory and hereditary

   Identification: Contains Phosphate (P)

   Synthesis: Nucleic Acids form chains through condensation between the sugars and the phosphate groups. The polynucleotides have backbones of sugar/phosphate molecules, with nitrogenous bases radiating out.

   Location of Synthesis:

   • DNA (Deoxyribose nucleic acid): in the Nucleus
   • mRNA (messenger Ribose nucleic acid): Nucleus
   • tRNA (transport RNA): cytoplasm

   - Nucleotides are the monomers. These are made up of:

   • A five carbon sugar
   • Phosphate group attached to one end of the sugar
   • A nitrogenous base attached to the other end of the sugar

    

    

   - If the nitrogenous base has one ring, it is a pyrimidine. Two rings, a purine.

   - Nitrogenous base binding:

   • DNA: Thymine with Adenine (AT&T)
   • DNA & RNA: Cytosine with Guanine (or thing that the letters C and G are surrounded by the letter A and T in the alphabet)
   • RNA: Uracil with Adenine (AU for AUstralia)

   Comparison between DNA and RNA

   DNA	RNA
   Nitrogenous bases are Adenine, Thymine, Guanine, Cytosine	Adenine, Uracil, Guanine, Cytosine
   Double Helix	Single Strand
   Deoxyribose (H)	Ribose (OH)
   Mostly Nuclear	Throughout the cell
   More stable	Less stable
   Permanent	Temporary
   Insoluble	Soluble
   One basic type	Three types: messenger, transfer, ribosomal
   Concentration constant	Varies, according to cell type
   Adenine, thymine/cytosine, guanine ratio about equal	Adenine, uracil/cytosine, guanine ration more variable
   Very large molecular mass (100 000 - 120 000 000)	Much smaller molecular mass (20 000 - 2 000 000)

   

   http://www.bact.wisc.edu/Microtextbook/images/book_4/chapter_2/2-5.gif

Mental Health - The Basics

In Mental Health, one has a duty of care towards the patient (or towards the consumer, as they are called in Australia these days). As nurses and paramedics, we are not looking for a cure, but are aiming more for an improvement in functioning, enjoymebnt, health or at least “more able to be“.

“Man does not live by bread alone“

In other words, the goal is that the consumer feels OK, their subjective wellbeing is allright; they are the best they can be. Additionally, they should be able to make use of their Mental Abilities:

• cognitive: capacity to understand, reason and remember
• affective: capability of appropriately feeling and experiencing emotion
• relational: ability to get along with others

 

What is a Mental Illness? The Western Australian Mental Health Act of 1996 states the following:

 

 

If the person suffers from a disturbance of thought, mood, volition,

perception, orientation or memory that impairs judgment or behaviour to a significant extent.

 

A few definitions regarding Mental Illness and what to look out for/what may be an indication:

• Thought: what and how consumers think
• Mood: how they feel emotionally
• Volition: the energy or will to do things
• Perception: False senses, hearing seeing things (hallucinations…)
• Orientation: knowing time, place, person
• Memory: ability to recall, both short and long term memory
• Judgement: reasoning affecting behaviour & decision-making

 

 

Quick’n’short Guidelines when dealing with patients (not only Mental Health consumers!)

 

 

Listen, don’t label. Explain/interpret rather than try to understand the story.

Eye Contact: amount depends on the circumstances & culture

Language: Do not talk as if the individual is not present. Avoid technical words or jargon. Don’t talk down or patronise people. Give them space to speak (pauses). Make sure and ask the person if they have clearly understood what you have been telling them.

Watch and listen, body language and the way people speak can reveal a lot

Reassure people that they won’t be judged or laughed at.

Anger from the patient should be acknowledged, and time should be given for them to calm down.  Esure your own safety, record, identify the anger and the motives behind it

Seductive behaviour is a no-go. Do not return it, try to ignore it. Explain the boundaries of the professional relationship.

Demanding behaviour should be counteracted with a statement what you will or will not do. Try to be empathetic, and provide choices and alternatives for the person.

If the person is inquisitive, it is likely that they need reassurance. They may want to undermine your ability, or they maybe dissatisfied from a previous experience.

 —

In an attempt to compare the physical and the mental world (is there a difference? who knows!) our lecturer introduced mental health with this slideshow, I highly recommend it.

This pretty much traces the physical world. The mind remains a mystery…

Homeostasis

What?

Homeostasis is all about balance. Looking at my unit outline, there is not much time spent specifically on this subject - but it reaches out is to many other fields, and the effects can be enormous.

Keeping balance is easy, you do it all the time. Stand up, and you will not fall down. You can balance on your two feet. No balance, you fall down, you hurt yourself. Same with pretty much every system in your body. 

Take, for example, your body temperature. This should be 36.8 °C. If it drops below that point, your body will start shivering in order to produce heat, additionally goosebumps will appear on your skin to retain heat. If you get too hot, your blood vessels near your skin dilate to let of more heat.

 

“Keeping the internal body constant is called Homeostasis. It is a state of Dynamic Equilibrium.“

(Dynamic equilibrium: always being adjusted and tweaked to be in balance)

Other systems that are regulated by homeostasis include levels of salt, carbondioxide water and oxygen in your body.

 

A basic look at how this is achieved shows that there are three components required for a control system

1. Receptors: Gather the required information, e.g. what is the current body temperature?
2. Integrators: These decide what needs to be done, whether everything is fine or a correction is needed.
3. Effectors: Enforcement of any necessary corrections

 

 

How?

There are two ways that homeostasis is regulated: Threough the nervous system (short term)and through the endocrine system (long term). Imagine yourself in minor car accident. The initial shock come from your nervous system, it acts quickly and does not last long. But does the feeling wear off half an hour later? Nope. Your endocrine system has kicked in and taken over that part for the nervous system.

Clever aye?

 

More How.

The body has two mechanisms:

Negative feedback - decreases the likelihood that the action would happen again

•  Real World example: Telling a child off for bad behaviour: you don’t want that happening again.

• The mechanisms that is used in most regulatory systems in the body

An example would be the regulation of blood sugar levels in the bloodstream. The brain insists on blood sugar levels being at exactly 90mg of glucose per 100ml of blood. (to quote Dr Richard Brightwell: “The brain is lazy, selfish and tells you lies”).

In case your glucose levels rise above that, your pancreas releases insulin (making cells more permeable to glucose to help absorbtion) until an appropriate level is reached.

Same story if your glucose levels drop below the 90mg/100ml, your pancreas releases glucagon in to the blood stream

 

Positive feedback - increases the probability that the action will happen again

• Real world example: Praising a child for good behaviour: You want to encourage this to happen again.
• Not found very often in the body.

Childbirth is a great example: The soon-to-be born baby, just by being in the uterus, exerts pressure against the wall of the uterus, which acts as a trigger to release Oxytocin (which is a hormone that makes smooth/involuntary muscles contract. Females have more smooth muscles than males: in their uterus). Relesing oxytocin contracts the uterus, the baby exerts more pressure upon the uterus, more oxytocins is released - a cycle. These contractions are called – you guessed it – contractions, and stop after the stimulant (baby) has been removed (born). No need for the uterus to contract anymore!

Actually, that is not true. Apparently the mammary glands are another area of the body where one can stimulate the release of oxytocin. After childbirth, the uterus is not quite the size it used to be, still pretty stretched. More oxytocins equals more contraction equals a uterus that more represents it’s original state. An interesting fact that goes with this is the rising number of hysterectomies that occurred during the 1970’s, following the introduction of artificial mothers milk, so mums in the 1950’s did not have to breast feed (and apparently weren’t encouraged to do so). They did not receive enough oxytocins. Their uterus were left in a semi-stretched state, thinner and bigger that natural, an ideal breeding ground for bacteria.

Morale: Everything happens for a reason.

 

 

Mental Health & Drugs

Last Monday, the 21st of April we had a great talk from Gerard G. Cleveland, a Solicitor and Trainer from the Mental Health Law Centre in Western Australia. He has had extensive exposure to the drug scene as a police officer in the drug squad in Toronto/Canada.

Once again: Thanks Gerry!

 

The talk was mainly about Ice (methamphetamines). Here is a brief summary:

Meth Labs (where the drugs are manufactured) are Dangerous - both because of the toxicity of the involved chemicals, and the fact that more often than not the people who run them are armed. It can take 100 000$ for them to get cleaned up, due to the hazardous chemical waste involved. There is always the potential for a fire or an explosion.

Meth Labs can be found practically anywhere, one should not assume that they are only situated in lower social class areas. Evidence for a meth lab can be many things, for example

• The smell: This stuff will burn your airways, such is its potency. Similar smell to a very burnt clutch, stings in your airway.
• Rubbish: If you have a hunch, check the rubbish bins! You my find a lot of strange chemicals, e.g. AntiFreeze. Especially dodgy if the time of year doesn’t fit in (it’s warm and sunny) or you live in a location where the temperature never really drops below freezing point.
• You arrive to a patient with (chemical) burns, but there is no apparent fire.
• Massive ventilation (lots of fans to get rid of the smell) and a high electricity usage. Alternatively no electricity because it has been switched f by the electricity company or a generator out the back to hide the excess electricity use.

We were also made aware of “Boot Labs”, Meth Labs that have been installed in the boot of cars. The reasoning is simple: It’s a mobile solution, harder to be tracked down by police and easily disposable.

Also to be aware of using someone else’s kitchen to do some cooking, i.e. the grandson using the grandparents house.

So why do people use meth at all? A small comparison, courtesy of the MHLC:

 

event	feelgood factor
good meal	10
orgasm	100
meth high	1500

The pleasure, the kick you get from meth can be comparable by multiplying a good meal by 150.

Consider the background that people come from. Quote Gerard Cleveland: “If you are a 16 year old male prostitute, not gay but forced in to homosexual activities, living on the streets it’s worth asking why 

shouldn’t they use meth?”

And fair enough, I can understand that argument - if you are way down low and don’t have much perspective in life, these drugs are the only light in an otherwise dark and lonely tunnel.

How meth is taken: Usually it is smoked, but can also be taken intranasally (snorted as a poweder), taken orally or injected in to the veins. Some cases of rectal insertion of meth chunks have been reported in the USA. (MedicCast, Episode 51)

 

For smoking, some time the glass of a lightbulb is used - another sign that you may have entered a meth lab!

 

Something to consider when treating a potential meth user: After their probable aggressive behaviour, they may become very drawn back and quiet. - Alert! - Following such great physical exertion, the body tends to overheat, temperature management is essential!

 

 

 

To round up the talk, he gave us a few hints for dealing with difficult patients: 

• Treat our patients like adults. None of the Parent-Child talk (Do It Now!) or Child-Parent talk (Pleeeeeeaaaase do it, please?).
• Give them options (but only the options you want them to have): “How about you come to Hospital with us, or would you like to call your doctor and make an appointment?”
• Be assertive! Don’t let the patient take control of the situation.

Gerry also recommended to have a peek at NLP, or Neuro Linguistic Programming. That would be something for a later post though

 

Last, but not least, I would like to link to an episode of the MedicCast, Episode 51. About halfway there is some great information about Meth and Meth Labs, here are some tidbits:

 

• Methamphetamines encourage high production of Dopamin, the neurotransmitter that helps us feel good - mood enhancing
• Burns out the receptors of the neurotransmitter in your brain - basically you are unable to feel good.
• This means meth users get caught in a vicious cycle, and need more and more of the drug.
• Meth has been around a few years now; it was used in World War II on both sides to keep soldiers awake in order for them to fight longer
• Link to the methlab website of the Maryland State Police: http://www.mspmethlabs.com

 

Health Assessment Forms

As student paramedics, we are enrolled in various nursing units. Of course this means that the unit cannot be completely tailored to suit us, as we are a minority (30 odd paramedics vs. 400+ nursing students). But this transdisciplinary approach gives us an insight to nursing and other professions we will be closely dealing with.

 

A health assessment, or client assessment, is a plan of care that identifies the specific needs of the client and how those needs will be addressed by the facility (Wikipedia, 22/04/2008).

As with pretty much anything we do professionally, it needs to be documented. Documentation equals: it only happened if it has been written down. To quote Vipul Kashyap et al:

 

Structured Clinical Documentation is a fundamental component of the healthcare 

enterprise linking both clinical (e.g., electronic health record, clinical decision sup- 

port) and administrative functions (e.g., evaluation and management coding, billing).  

At its core, Structured Clinical Documentation consists of template-based, logically 

driven instruments designed to facilitate and minimize the guesswork of coding and 

documenting information regarding a patient throughout the continuum of care. 

When well implemented in the context of the clinical workflow, these instruments 

can save clinicians’ time as well as well as assure clinical thoroughness, thus reducing 

the chance of medical errors.  

 

In other words, if we document properly, it benefits the patient and the healthcare provider (us). You document your observations and treatment, hand it over to the next healthcare professional, and the treatment can continue seamlessly from where you ended it. No need to re-invent the wheel.

Now that we have a basic understanding why we need to do this, let’s take a peek at the actual assessment.

There are usually six sections (Health Assessment Form Handbook, School of Nursing, Midwifery and Postgraduate Medicine @ ECU, 2008):

 

1. Client Information/Demographic Data
2. Client Health History
3. Activities of (Daily) Living
4. Client Physical Assessment
5. Client Specialty Area Addendums
6. Client Concept Map / Care Plan

In this post, I am going to focus on #3, the Activities of Daily Living (as adapted from: Holland, K., Jenkins, J., Solomon, J., & Whitlam, S. (EDs.). (2003). Applying the Roper-Logan-Tierney model in practice. London: Elsevier Churchill Livingston.)

We will then further break these twelve activities up in to three parts:

• Physical (including environmental): What physical problems does the patient have or not have? How about the environment he lives in (e.g. stairs if he is unsteady on his feet)?
• Psychological: How does the patient feel about any of the issues he may be dealing with? Is the patient worried or anxious? Does this anxiety contribute towards his behaviour?
• Sociocultural (including politicoeconomic): Does the patient have contact with friends and family, also with a look at the history (has the social life been declining)?

Welcome!

Welcome to the elmbulance!

The intent of this blog is to keep a log of my studies as a paramedic student, and share this knowledge with you, the reader. Knowledge is not to be kept locked away and heavily guarded, it should be shared openly.

Keep your eyes open for new content coming soon, and keep in touch!

 

elm