EM · Applied anatomy and physiology (basic sciences)
Applied anatomy and physiology for emergency medicine
Also known as High-yield EM anatomy · Procedural anatomy · Applied physiology for resuscitation · Anatomical landmarks for ED procedures
Applied anatomy and physiology for emergency medicine — the body-region tour of anatomy that changes emergency management (the airway and the cricothyroid membrane for the front-of-neck access, the vocal cords and the recurrent laryngeal nerve, the femoral and internal jugular vessels for the line access, the brachial plexus and the facial nerve for the blocks and the palsies, the coronary arteries and the conduction system for the ECG, the biliary tree and the appendiceal positions for the surgical abdomen) paired with the four governing physiology principles — the Starling forces, the oxygen-haemoglobin dissociation curve, the baroreceptor reflex and the Frank-Starling mechanism — and the normal-versus-variant anatomy that misleads. ACEM-primary, globally tagged.
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- Front-of-neck access and the emergency surgical airway
- Central and arterial line insertion in the emergency department
- Regional nerve blocks in the emergency department
- Acute coronary syndromes (STEMI, NSTEMI and unstable angina)
- Acute appendicitis
- Fluid resuscitation in the emergency department
- Arterial blood gas interpretation — the systematic emergency department approach
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Target exams
Red flags
- A retrocaecal appendix produces flank, back or right-upper-quadrant pain rather than the classical right-lower-quadrant pain — a normal right-lower-quadrant examination does not exclude appendicitis
- An inferior myocardial infarction with proximal right coronary artery occlusion causes right ventricular involvement and atrioventricular block — nitrates and preload-reduction precipitate collapse, and the patient needs fluid and atrioventricular nodal pacing
- A left-dominant coronary circulation means an inferior infarct can be a left circumflex occlusion with posterolateral extension and a worse prognosis — do not assume every inferior ST-elevation is a right coronary artery lesion
- A high-riding, calcified or small cricothyroid membrane in the obese or elderly neck defeats the scalpel-bougie-tube rescue — identify the membrane by palpation and ultrasound before it is needed
- An aberrant or replaced right hepatic artery running in the Calot triangle is the unrecognised source of catastrophic bleeding in biliary procedures and trauma
Meet the patient
A 68-year-old smoker arrives with crushing central chest pain and ST elevation in II, III and aVF — an inferior STEMI. The registrar reaches for glyceryl trinitrate and the blood pressure collapses. Two pieces of anatomy decided that moment, and the registrar knew only one of them: the right coronary artery supplies the right ventricle and the atrioventricular node, and this patient was one of the 81.2 per cent in whom it does (165 cadaveric hearts: 81.2% right-dominant, 12.7% left-dominant, 6.1% codominant).[5]
Hold that image — a structure you cannot see deciding a drug you can — and the whole topic organises itself around three habits: know the landmark before the emergency, read the physiology behind the resuscitation, and always expect the textbook picture to be the minority.[1]
References16ShowHide
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- [2]Han JC, et al. Cardiac efficiency and Starling's Law of the Heart J Physiol, 2022.PMID 35998082
- [3]Sagiv D, et al. Novel Anatomic Characteristics of the Laryngeal Framework: A Computed Tomography Evaluation Otolaryngol Head Neck Surg, 2016.PMID 26861235
- [4]Singh N, et al. Computed tomography evaluation of variations in positions and measurements of appendix in patients with non-appendicular symptoms: time to revise the diagnostic criteria for appendicitis Pol J Radiol, 2023.PMID 37808175
- [5]Lane CP, et al. Anatomical variation in the external vasculature of the human heart: A cadaveric investigation of dominance in coronary artery branching and cardiac venous drainage Ann Anat, 2026.PMID 41161614
- [6]Ferrie A, et al. A Retrocaecal Appendix Presenting With Recurrent Right Upper Quadrant Pain (RUQ): A Rare Presentation of a Rather Common Surgical Pathology Cureus, 2025.PMID 41189815
- [7]Torp KD, et al. Lidocaine Toxicity StatPearls, 2026.PMID 29494086
- [8]Rosenberg PH, et al. Maximum recommended doses of local anesthetics: a multifactorial concept Reg Anesth Pain Med, 2004.PMID 15635516
- [9]Lee SH, et al. Mechanisms underlying lipid emulsion resuscitation for drug toxicity: a narrative review Korean J Anesthesiol, 2023.PMID 36704816
- [10]El-Boghdadly K, et al. Local anesthetic systemic toxicity: current perspectives Local Reg Anesth, 2018.PMID 30122981
- [11]Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases Ann Surg, 1994.PMID 8024358
- [12]Develi S, Yalcin B, Yazar F. Topographical anatomy of cricothyroid membrane and its relation with invasive airway access Clin Anat, 2016.PMID 27481637
- [13]Brass P, Hellmich M, Kolodziej L, et al. Ultrasound guidance versus anatomical landmarks for internal jugular vein catheterization Cochrane Database Syst Rev, 2015.PMID 25575244
- [14]Dash RK, Korman B, et al. Simple accurate mathematical models of blood HbO2 and HbCO2 dissociation curves at varied physiological conditions: evaluation and comparison with other models Eur J Appl Physiol, 2016.PMID 26298270
- [15]Tivakaran VS, Rout P. Inferior Myocardial Infarction StatPearls, 2026.PMID 29262146
- [16]Jindal H, Fakoya AO. Anatomy, Thorax, Heart Left Anterior Descending (LAD) Artery StatPearls, 2026.PMID 29493997