Diagnosketch: A Visual Guide to

Medical Diagnosis for the Non-Medical

Audience Sapana Adhikari
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 Advance Praise for Diagnosketch
This book is equally as useful to patients as it is to
doctors. The illustrations cover the most common
diagnoses in the ED and reflect the diversity of
patients we see every day. Everyone will find them-
selves represented here.
—​Thea James, MD, EM Physician; Vice President
of Mission and Associate Chief Medical Officer,
Boston Medical Center
Not only does Diagnosketch help patients under-
stand their anatomy, it also gives physicians, nurses,
PAs, and others the opportunity to maximize use of
the very small amount of time they have with their
patients. With this book at the bedside, we can be
more efficient and patients leave with a better un-
derstanding of their ED visit.
—​Andrew Ulrich, MD, Professor of Emergency
Medicine, Vice Chair of Operations,
Yale School of Medicine
This book is an extremely helpful tool for real-​time pa-
tient education, there is really nothing available that
is comparable to Diagnosketch. It is the best resource
for concise and easy-to-understand explanations for
patients of their diagnoses, while still maintaining
medical accuracy and appropriate level of detail. It
helps me get through to my patients and makes bed-
side education much smoother and more meaningful.
—​Celia Pagano, PA-​C in Emergency
Medicine for 6+​years
As a nurse who spends a fair amount of time edu-
cating patients and their families, this book is a bril-
liant idea! It allows me the opportunity to impact
patients’ understanding of their disease, and is an ex-
cellent resource in triage.
—​Elizabeth Gibb, BSN, RN, Emergency
Department Nurse for 41 years at the busiest EDs
in New England
I could really have used these illustrations to explain
to my patient with an ovarian cyst what was going
on! She was in the hospital with her dad and the
doctor here was a man. I had to give the poor girl a
crash course in A&P, menstruation, and explain what
was going on without scaring her to death. My art-
work is subpar at best, I really wish I had this book!
—​Kim Belton, RN, ER Nurse at Atrium Health with
11+​years’ experience
I use Diagnosketch not only with my patients at work,
but also to explain my job to my children at home. It’s
a fantastic teaching tool!
—​Jaclyn Davis, MD, EM Physician with 10+​years’
experience and Medical Staff President, Atrium
Health Pineville
I work in a rural outpatient clinic setting and make
rough drawings on my own all day for patients on the
paper covering the tables or the back of glove boxes.
I really enjoy this book; patients find the pictures
easy-​to-​understand and I like how clear they are.
—​Carol Venable, MD of 20+​years, EM/​IM
Physician, Port Townsend, WA
This book replaces the need to pull up Google at the
bedside to search for images. All common diagnoses
are compiled and easy-​to-​understand!
—​John Burger, MD, EM Physician with 10+​years’
experience in Charlotte, NC
This book is amazing! The simplicity of it, with the
wonderful illustrations, makes this an awesome
teaching tool for our patients. I can’t wait to share
this with my team.
—​Rachel Smitek, MD, Senior Director of Quality,
US Acute Care Solutions; Board-​Certified
Emergency Medicine doctor with 10+​years of
practice
I love this book, there are so many great visuals for
the bread and butter of what we see and explain all
of the time. What a great resource!
—​Katrina Barnett, MD, On Staff, El Camino
Hospital, Mountain View and Los Gatos, CA; On
Staff, Palo Alto VA, CA; ER physician for 15+​years
Physicians are expected to provide excellent med-
ical care; but it is equally important for them to ex-
plain diagnoses and treatments in a manner that
gives the non-​medical both understanding and re-
assurance. Diagnosketch, by emergency physician
Dr. Sapana Adhikari, uses simple illustrations and text
to bridge the communication gap between physi-
cian and patient so that even complex issues can be
comprehended at the bedside. This will prove to be
an essential tool for every emergency department.
—​Edwin Leap, MD, Emergency Physician with
30 years’ experience; Columnist
Diagnosketch
 Diagnosketch:
A Visual Guide to
Medical Diagnosis for the
Non-​Medical Audience

Created and Illustrated by

Sapana P. Adhikari, MD
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.

Published in the United States of America by Oxford University Press

198 Madison Avenue, New York, NY 10016, United States of America.

© Sapana Adhikari, MD 2022

All rights reserved. No part of this publication may be reproduced, stored in

a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by license, or under terms agreed with the appropriate reproduction
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above should be sent to the Rights Department, Oxford University Press, at the
address above.

You must not circulate this work in any other form

and you must impose this same condition on any acquirer.

Library of Congress Cataloging-​in-​Publication Data

Names: Adhikari, Sapana P., author.
Title: Diagnosketch : a visual guide to medical diagnosis for
the non-medical audience / created and illustrated by Sapana P. Adhikari.
Description: New York, NY : Oxford University Press, [2022] |
Includes bibliographical references and index. |
Identifiers: LCCN 2022012638 (print) | LCCN 2022012639 (ebook) |
ISBN 9780197636954 (paperback) | ISBN 9780197636978 (epub) |
ISBN 9780197636985 (online)
Subjects: MESH: Diagnostic Techniques and Procedures |
Medical Illustration | Health Communication--methods |
Patient Education as Topic | Critical Care | Pictorial Work
Classification: LCC RC71.3 (print) | LCC RC71.3 (ebook) | NLM WB 17 |
DDC 616.07/5—dc23/eng/20220525
LC record available at https://lccn.loc.gov/2022012638
LC ebook record available at https://lccn.loc.gov/2022012639

DOI: 10.1093/​med/​9780197636954.001.0001

9 8 7 6 5 4 3 2 1
Printed by WebCom, Inc., Canada

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 Contents

Introduction ix Fluid around heart: Pericarditis vs pericardial

About the Author/​Illustrator xiii effusion 33
Aortic dissection 34
1 Skin 01 Aortic aneurysm 35
Blood draw 02 Poor circulation: Peripheral artery disease &
IV: Intravenous insertion 03 venous insufficiency 36
Cut: Laceration 04
Options for repair 05 4 Gastrointestinal 37
Boil: Abscess 06 Digestion 38
MRSA: Methicillin-​resistant Staphylococcus aureus 07 Abdominal pain 39
Paronychia 08 Heartburn: Gastroesophageal reflux disease
Crushed finger: Subungual hematoma 09 (GERD) 40
Superficial clot: Superficial thrombophlebitis 10 Gastritis & ulcer 41
Airway anatomy 11 Vomiting blood: Upper gastrointestinal bleed
(UGIB) 42
2 EENT (eye, ear, nose, throat) 13 Rectal bleed: Lower gastrointestinal bleed (LGIB) 43
Eye pain: Corneal abrasion & conjunctivitis 14 Hiatal hernia 44
Toothache: Dental caries vs dental abscess 15 Hernia: Normal vs incarcerated 45
Nosebleed: Epistaxis 16 Foreign body in esophagus: Esophageal stricture 46
Sinus infection: Sinusitis 17 Bowel blockage: Small bowel obstruction (SBO) 47
Inner ear infection: Otitis media 18 Gallbladder disease: Biliary colic 48
Swimmer’s ear: Otitis externa 19 Pancreatitis 49
Sore throat: Strep pharyngitis & peritonsillar Diverticular disease: Diverticulosis,
abscess (PTA) 20 diverticulitis, & perforation 50
Constipation 51
3 Cardiopulmonary 21 Perirectal abscess 52
Bronchitis vs pneumonia 22 Hemorrhoids 53
Emphysema: Chronic obstructive pulmonary Appendicitis 54
disease (COPD) 23
Blood clot: Deep vein thrombosis (DVT) & 5 Genitourinary 55
pulmonary embolism (PE) 24 Nephrolithiasis 56
Swollen legs: Pedal edema 25 Cystitis vs pyelonephritis 57
Heart attack: Myocardial infarction (MI) 26 Enlarged prostate: Benign prostatic
Chest pain evaluation 27 hypertrophy (BPH) 58
Heart failure: Congestive heart failure (CHF) 28 Urinary retention 59
Heart failure causes: Diastolic vs systolic disease 29 Testicular swelling: Epididymitis 60
High blood pressure: Hypertension (HTN) 30 Testicular swelling: Hydrocele vs varicocele 61
HTN+Symptoms: Hypertensive urgency 31 Testicular torsion 62
Irregular heart beat: Atrial fibrillation 32 Ovarian torsion 63
viii Contents
Ovarian cyst: Normal cyst vs ruptured cyst 64 Inflamed joint: Gout vs septic joint 89
Early pregnancy: Abdominal pain &/​or vaginal Baker’s cyst 90
bleeding 65 Ankle pain: Fracture vs sprain 91
Fibroids: Leiomyoma 66 Wrist pain: Carpal tunnel syndrome 92
Irregular periods: Abnormal uterine bleeding 67 Foot pain: Plantar fasciitis 93
Yeast infection: Vaginal candidiasis 68 Broken back: Compression fracture 94
Vaginal discharge: Bacterial vaginosis 69
Pelvic infection: Pelvic inflammatory disease 7 Neurology 95
(PID) & tubo-​ovarian abscess (TOA) 70 Stroke: Cerebral vascular accident (CVA) 96
Sexually transmitted infection 71 Mini-Stroke: Transient ischemic attack (TIA) 97
Lower abdomen: Male vs female 72 Brain bleed: Intracranial hemorrhage (ICH) 98
Brain aneurysm: Subarachnoid hemorrhage
6 Orthopedics 73 (SAH) 99
Broken: Fracture 74 Meningitis 100
Growth plate injury 75 Dizziness: Benign positional vertigo (BPV) 101
Arthritis: Degenerative joint disease 76 Bell’s palsy: 7th cranial nerve palsy 102
Bursitis 77 Concussion: Closed head injury 103
Rib fracture 78
Collapsed lung: Pneumothorax 79 8 Miscellaneous 105
Back pain: Musculoskeletal 80 Cancer: Diagnosis & work-​up 106
Back pain: Sacroiliitis 81 Diabetes: Diabetes mellitus type 2 107
Back pain: Side view 82 Alternating medications: Fever control or pain
Sciatica: Lumbar radiculopathy 83 control 108
Neck pain: Cervical strain 84 Bacteria vs virus 109
Neck & back strain: Motor vehicle accident (MVA) 85 Code status 110
Knee arthritis: Osteoarthritis 86
Knee pain: Fracture vs sprain 87
Scripting 111
Joint disease: Normal anatomy 88
Index 127

D iagnosketch is a visual aid to explain med-
ical diagnoses to patients at the bedside. It
uses simplified images to illustrate compli-
cated anatomy and concepts. The title, Diagnosketch,
combines the term “diagnosis” with the term “sketch,”
paralleling the way the book combines a medical di-
agnosis with a simplified sketch. It includes common
pathologies seen in an acute care setting, especially ones
that are easier to explain with pictures.
Many American patients are unfamiliar with human
anatomy and common medical diagnoses. Research
from the US Department of Education estimates that
only 12% of English-​speaking adults in the United
States have proficient health literacy skills.1 Studies in-
dicate that almost 90% of adults have difficulty under-
standing health information that is currently available.2
These patients are often unequipped to make important
decisions about their own health care.
Diagnosketch improves health care literacy for the
non-​medical population. It simplifies human anatomy
and pathophysiology into memorable, understand-
able images. It relies on the concept of “picture supe-
riority effect.” The picture superiority effect states that
HEARING information will lead to 10% retention of
the content, but HEARING and SEEING information
leads to 65% retention of content. Diagnosketch not
only explains difficult concepts to patients, but also
helps patients remember them.
Diagnosketch serves as the visual guide that med-
ical professionals use with every patient at the bedside.
Excellent medical care involves diagnosing and treating
disease, but just as importantly, communicating well
with patients. Diagnosketch helps achieve this goal.
1 Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult
Literacy (NCES 2006-​483). Washington, DC: US Department of Education, National Center for Education Statistics.
2 US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health
Literacy. Washington, DC: Author.
INTRODUCTION
KEY COMPONENTS OF DIAGNOSKETCH
Simplicity
The images in the book intentionally simplify infor-
mation to help educate a non-​medical audience. The
images leave out details that may not be clinically rel-
evant and overemphasize those that are. Although the
general anatomy is correct, certain organs are exagger-
ated. For example, the gallbladder is quite small in the
human abdomen, yet in the images, it is depicted much
larger to emphasize its clinical relevance. Also, human
physiology has been simplified with colors. For ex-
ample, in some images blood vessels are depicted in red
whether they carry oxygenated or deoxygenated blood.
In addition, the images intentionally leave out smaller
anatomical structures (like nerves and smaller blood
vessels) for simplicity’s sake.
Practicality
The images in the book depict only the most common
diagnoses seen in an acute care setting and only those
that would benefit from an image. In busy settings,
sometimes the health care encounter lasts just a few
minutes. Diagnosketch presents a simple, clear image
that improves understanding as quickly and efficiently
as possible. In addition, the labels are minimal and
are written in colloquial, non-​medical language. This
encourages the patient to listen to the explanation from
the medical professional, rather than read and become
confused by complicated medical terminology.
 x INTRODUCTION

Inclusivity to her other organs. You show her a gallstone and ex-
plain how it blocked her biliary tract. You show her how
The images in the book intentionally use various skin this caused her pain and eventually her infection. She
tones and physical features to represent the diver- asks pertinent questions, and you give her immediate
sity seen across patients in various medical settings. answers. You have a two-​way dialogue. In just a few
Different diagnoses can affect any ethnicity. Aside from minutes, you have relieved her fears and increased her
problems that affect a particular biological sex, diag- anatomical knowledge. You know that you communi-
noses are depicted in the male or the female in a non-​ cated in a way that she understands. When you walk out
specific way. of the room, you feel confident in your skills as both a
master clinician/​diagnostician and, just as importantly,
a master communicator.

HOW DOES DIAGNOSKETCH WORK?

Diagnosketch consists of 100 images of medical illnesses
commonly diagnosed in an acute care setting. It is meant
to be used at the bedside to help communicate compli-
cated concepts to a non-​medical audience quickly. Most
medical encounters between doctors and patients occur
verbally. Although visual aids are sometimes used, they
are not standard. This book changes this paradigm by
incorporating a simplified, colorful graphic visual to
assist patients to better understand their diagnoses in
real time.
Imagine the following scenario:
A patient presents to the emergency room for se-
vere abdominal pain. You run tests: blood, urine, ul-
trasound. You diagnose cholecystitis. You verbally
explain to your patient that her gallbladder is infected,
and that she will need emergency surgery. Your pa-
tient looks dumbfounded. She never expected this.
She thought that she might have eaten something bad
but is now on her way to surgery? She quietly pretends
that she understands but does not really know where
her gallbladder is located, let alone what it does. She
does not even know what questions she should ask. You
sense that she does not completely understand every-
thing, so you quickly grab a paper towel and sketch a
crude image of her anatomy. Although you’d like to stay
longer, you feel the pressure of a waiting room full of
patients, still waiting to be seen. You rush out, knowing
that although you expertly diagnosed her condition
and arranged for proper treatment, you could have
communicated better.
Now imagine that same patient, but this time you
use Diagnosketch. You return to the patient’s room
and explain her condition verbally AND visually. You
show your patient where her gallbladder is in relation
HOW IS DIAGNOSKETCH ORGANIZED?
Diagnosketch is organized into seven different catego-
ries by organ systems. The categories are: skin, EENT
(eye, ear, nose, throat), cardiopulmonary, gastrointes-
tinal, genitourinary, orthopedics, and neurology. The
last section, Miscellaneous, includes images that do not
fit into particular organ system. There is a section on
sample scripting that corresponds to each image. This
section includes sample wording that serves as a starting
point for better patient communication. Finally, there
is an Index that includes both the medical jargon and
more colloquial language a patient may use, making it
easier to quickly find a particular image. Notice that on
a particular image, where possible, each title is written
in a colloquial language with the medical terminology
listed underneath. Notice also that the labels are written
in colloquial language to simplify what is happening for
the non-medical patient.
Different images are helpful at different stages of a
patient encounter. There are three major categories of
images: diagnosis images, procedure images, and con-
cept images.
Diagnosis images: are used to explain basic
diagnoses and basic anatomy (e.g. biliary colic,
kidney stone, pulmonary embolism). Many of
these simplified images have a “normal” side and
an “abnormal” side so that the patient can easily
compare what their body part is supposed to look
like with what it looks like when affected. The
images also may use the “1, 2, 3 approach” that
show three common problems for a particular
disease (e.g. diverticulosis, diverticulitis,
diverticular abscess/​perforation).

Procedure images: are used to explain a
procedure to a patient before performing it
(e.g. IV insertion, nasogastric tube insertion,
drainage of paronychia).
Concept images: are used to explain a concept
visually (e.g. how to alternate ibuprofen with
acetaminophen for fever reduction; how diabetes
mellitus actually causes high glucose; what “code
status” means).
Obviously, the images can be used in whatever way
is most helpful. Here are a few real-​life examples of
where Diagnosketch has been helpful in the acute care
setting:
• A nurse showed the image of “Digestion” to
explain to a reluctant 10-​year-​old why she had to
drink a bottle of contrast for an abdominal CT
scan to rule out appendicitis. After the patient
learned her anatomy and understood that her
appendix would “light up” when she drank the
contrast, she willingly drank the entire bottle
without a fuss. This saved hours of time in a busy
emergency room.
• A physician showed the image of “Back pain—​
side view” to explain the anatomy of the back to
a disgruntled patient who felt that he needed an
x-​ray. After he understood his anatomy and why
an x-​ray was not indicated, he was happy to avoid
unnecessary radiation exposure. This also saved
the cost of an unnecessary test.
• A physician showed the image of “Urinary
retention” to explain to an uncomfortable older
gentleman how his enlarged prostate blocked his
bladder, making it impossible to urinate. After he
learned his anatomy, he felt comfortable with the
insertion of the foley catheter and experienced
much relief.
• A nurse showed the image of “Intravenous
insertion” to her patient in the triage bay to
INTRODUCTION xi
explain how an IV works. She hoped to dispel the
common misconception that an IV is a needle
that stays in the arm when it is just a flexible
piece of plastic.
• A physician showed the image of a “Heart attack”
to the anxious male who presented with chest
pain after smoking cocaine. After he visually saw
how cocaine could cause his heart muscle to die,
he vowed to never use it again. This potentially
deterred future drug usage.
HOW DO PATIENTS FEEL AFTER
SEEING DIAGNOSKETCH?
Patients often ask for a copy of the Diagnosketch image
to take home. Sometimes, they take a picture on their
cell phone to explain to their family members later.
Many patients have access to the internet at home and
can extensively research their diagnosis. Yet, once they
leave the hospital, they almost always do not. Instead,
they rely on the simple, familiar images that the medical
professional explained to them that they understand.
There are many beautiful anatomy books available
with detailed pictures. There are hundreds of images
on the internet about anatomy and diagnoses. There
is helpful information on discharge paperwork from a
hospital or clinic. Diagnosketch does not try to compete
with these very useful resources. Instead, it serves as the
first basic primer to understanding the medical diag-
nosis. Once the medical encounter ends, the patient is
now equipped with solid knowledge of basic anatomy
and physiology and encouraged to further investigate
more complicated medical information.
Diagnosketch is a quick, useful tool that greatly
enhances the patient’s experience. All images are in one
place. All images are at a simplistic level of detail. And,
all images are clinically useful and relevant to the med-
ical problem at hand.
 ABOUT THE AUTHOR/​ILLUSTRATOR
I have worked as an emergency medicine physician
for 20 years and have seen poor health literacy affect
my patients firsthand. For this reason, I developed
Diagnosketch. I believe that each patient deserves cus-
tomized knowledge about their anatomy and pathology
relevant to their health care encounter.
Early in my career, I drew stick figures and anatomy
on paper towels or on whiteboards in my patients’
rooms. I saw the utility of visual aids to explain medical
concepts. Over the years, I created better images that
incorporated real-​time patient feedback. I tried many
different iterations: everything from more realistic,
traditional images to super “cartoony” images. I found
that the perfect style of illustration lies between the two.
The style in Diagnosketch works best because it relays
accurate information in a simple, colorful, and non-​
threatening way. It gets the point across without being
too cartoony or “dumbed down.” I now use these images
with the majority of my patients. It is satisfying to know
that I have not only treated diseases but also helped my
patients understand their diagnoses.
I realized that we, as medical professionals, do a great
job diagnosing disease. We run blood tests, urine tests,
x-​rays, and CT scans. We come up with an accurate di-
agnosis and start proper treatments. Yet, sometimes,
when we try to explain everything to our patients, we
may not communicate the information as clearly as
possible. I hope that Diagnosketch will be used to fill
this gap.
Diagnosketch is a multiyear project with multiple
revisions and rounds of feedback. I welcome your
suggestions, comments, and feedback to make it a
useful tool for all patient education needs. Thank you.
Sapana Adhikari, MD
https://​www.diagnosketch.com
diagnosketch@gmail.com
SKIN
2 SKIN

BLOOD DRAW

TOURNIQUET

BLOOD VESSEL
 SKIN 3

IV
INTRAVENOUS INSERTION

TOURNIQUET

BLOOD VESSEL

STEP 1 STEP 2
CATHETER WITH NEEDLE NEEDLE REMOVED; CATHETER STAYS
4 SKIN

CUT
LACERATION

REPAIRABLE
LACERATION

ABRASION

PUNCTURE

REPAIRABLE
ABRASION PUNCTURE
LACERATION
 SKIN 5

OPTIONS FOR REPAIR

LACERATION ABRASION

STITCHES STERI-STRIPS

STAPLES GLUE FILLS IN

6 SKIN

BOIL
ABSCESS

BLOCKED
FOLLICLE

SEBUM
HAIR
FOLLICLE

NORMAL EARLY LATE

ABSCESS ABSCESS
 SKIN 7

MRSA
METHICILLIN-RESISTANT STAPHYLUCOCCUS AUREUS

SKIN IS COVERED
WITH BACTERIA

MRSA

SKIN
BREAKS
DOWN

NORMAL MRSA INFECTION

8 SKIN

PARONYCHIA

CUTICLE
NAIL
PUS GETS
TRAPPED
HERE

CUTICLE

PARONYCHIA
 SKIN 9

CRUSHED FINGER
SUBUNGUAL HEMATOMA

BURN A HOLE

BLOOD TRAPPED
UNDER NAIL

BROKEN
BONE
10 SKIN

SUPERFICIAL CLOT
SUPERFICIAL THROMBOPHLEBITIS

DEEP CLOT

SUPERFICIAL
CLOT
 SKIN 11

AIRWAY ANATOMY

AIRFLOW

TONGUE

EPIGLOTTIS

ESOPHAGUS

LUNGS
EENT (EYE, EAR, NOSE, THROAT)
14 EENT (EYE, EAR, NOSE, THROAT)

EYE PAIN
CORNEAL ABRASION & CONJUNCTIVITIS

CORNEA

CONJUNCTIVA

RETINA

ULCER

DISCHARGE ABRASION

CONJUNCTIVITIS
 EENT (EYE, EAR, NOSE, THROAT) 15

TOOTHACHE
DENTAL CARIES vs DENTAL ABSCESS

CRACKED TOOTH
(exposed nerve) CAVITY
PULP NERVE
ABSCESS

NORMAL TOOTHACHE
16 EENT (EYE, EAR, NOSE, THROAT)

NOSEBLEED
EPISTAXIS

BONY RIDGE

SEPTUM

PINCH
HERE

PACKING
 EENT (EYE, EAR, NOSE, THROAT) 17

SINUS INFECTION
SINUSITIS

NORMAL SINUSITIS

NORMAL BLOCKED
SINUS PASSAGE SINUS PASSAGE
18 EENT (EYE, EAR, NOSE, THROAT)

INNER EAR INFECTION

OTITIS MEDIA

EAR
CANAL

EARDRUM BULGING
EARDRUM
EUSTACHIAN
TUBE
FLUID

NORMAL OTITIS MEDIA

 EENT (EYE, EAR, NOSE, THROAT) 19

SWIMMER’S EAR
OTITIS EXTERNA

INFLAMED
EAR CANAL

EAR
CANAL

PUS

NORMAL OTITIS EXTERNA

20 EENT (EYE, EAR, NOSE, THROAT)

SORE THROAT
STREP PHARYNGITIS & PERITONSILLAR ABSCESS (PTA)

SINUS

PERI-
TONSILLAR
TONSIL ABSCESS

UVULA STREP
THROAT

SWOLLEN
LYMPH NODE

NORMAL SORE THROAT

CARDIOPULMONARY
22 CARDIOPULMONARY

BRONCHITIS vs PNEUMONIA

BRONCHITIS PNEUMONIA
 CARDIOPULMONARY 23

EMPHYSEMA
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

NORMAL COPD
ALVEOLI CHANGES

MUSCLE

MUCOUS

NORMAL COPD

NORMAL BRONCHOSPASM
24 CARDIOPULMONARY

BLOOD CLOT
DEEP VEIN THROMBOSIS (DVT) & PULMONARY EMOLISM (PE)

BLOOD CLOT
IN LUNG

DEAD LUNG
TISSUE

PIECE OF CLOT
BREAKS OFF &
TRAVELS TO LUNG

BLOOD CLOT
SWOLLEN LEG
 CARDIOPULMONARY 25

SWOLLEN LEGS
PEDAL EDEMA

CLOSED VALVES
VALVE DON’T
WORK

OPEN
VALVE

NORMAL PEDAL EDEMA

26 CARDIOPULMONARY

HEART ATTACK
MYOCARDIAL INFARCTION (MI)

NORMAL
CORONARY
ARTERY

NORMAL CLOGGED
ARTERY ARTERY

CLOGGED
CORONARY
ARTERY

HEART MUSCLE
DOESN’T GET
ENOUGH OXYGEN
AND DIES
 CARDIOPULMONARY 27

CHEST PAIN EVALUATION

ESOPHAGUS
HEART
SKIN
LUNG
MUSCLE

GALLBLADDER
STOMACH
PANCREAS
28 CARDIOPULMONARY

HEART FAILURE
CONGESTIVE HEART FAILURE (CHF)

LUNGS
AND LEGS
FILL WITH
FLUID
IN OUT

HEART IS A PUMP

IN OUT

PUMP FAILURE
 CARDIOPULMONARY 29

HEART FAILURE CAUSES

DIASTOLIC vs SYSTOLIC DISEASE

DIASTOLIC SYSTOLIC
DISEASE DISEASE

STIFF
BLOOD
VESSEL ENLARGED
MUSCULAR HEART
HEART

HEART CANNOT ENLARGED HEART IS

PUMP AGAINST STIFF TOO WEAK TO PUMP
BLOOD VESSELS
30 CARDIOPULMONARY

HIGH BLOOD PRESSURE

HYPERTENSION (HTN)

NORMAL HTN

BLOOD THICK
FLOW MUSCLE

STIFF
VESSEL

FLUCTUATING BP

SPIKE
BP

WAKE UP 12 PM SLEEP
Another random document with
no related content on Scribd:
floor; I holding on for dear life to the tomahawk ... fastened to his
wrist by a strong thong of leather.... At last he got a lock round my
leg; and had it not been for the table on which we both fell, and
which in smashing to pieces, broke our fall, I might have been
disabled.... We now rolled over and over on the floor like two mad
bulldogs; he trying to bite, and I trying to stun him by dashing his
bullet head against the floor. Up again! another furious struggle in
course of which both our heads and half our bodies were dashed
through the two glass windows, and every single article of furniture
was reduced to atoms. Down again, rolling like made, and dancing
about among the rubbish—wreck of the house. Such a battle it was
that I can hardly describe it.
“By this time we were both covered with blood from various
wounds.... My friend was trying to kill me, and I was only trying to
disarm and tie him up ... as there were no witnesses. If I killed him, I
might have serious difficulties with his tribe.
“Up again; another terrific tussle for the tomahawk; down again
with a crash; and so this life and death battle went on ... for a full
hour ... we had another desperate wrestling match. I lifted my friend
high in my arms, and dashed him, panting, furious, foaming at the
mouth—but beaten—against the ground. His God has deserted him.
“He spoke for the first time, ‘Enough! I am beaten; let me rise.’
“I, incautiously, let go his left arm. Quick as lightning he snatched
at a large carving fork ... which was lying among the debris; his
fingers touched the handle and it rolled away out of his reach; my life
was saved. He then struck me with all his remaining fire on the side
of the head, causing the blood to flow out of my mouth. One more
short struggle and he was conquered.
“But now I had at last got angry ... I must kill my man, or sooner
or later he would kill me.... I told him to get up and die standing. I
clutched the tomahawk for the coup de grace. At this instant a
thundering sound of feet ... a whole tribe coming ... my friends!... He
was dragged by the heels, stamped on, kicked, and thrown half
dead, into his canoe.
 “All the time we had been fighting, a little slave imp of a boy
belonging to my antagonist had been loading the canoe with my
goods and chattels.... These were now brought back.”
In the sequel this desperado committed two more murders “and
also killed in fair fight, with his own hand the first man in a native
battle ... which I witnessed.... At last having attempted to murder
another native, he was shot through the heart ... so there died.”
Mr. Maning was never again molested, and making full
allowance for their foibles, speaks with a very tender love for that
race of warriors.
 LVI
A.D. 1840
A TALE OF VENGEANCE

IN the days of the grandfathers, say ninety years ago, the

Americans had spread their settlements to the Mississippi, and that
river was their frontier. The great plains and deserts beyond, all
speckled now with farms and glittering with cities, belonged to the
red Indian tribes, who hunted the buffalo, farmed their tobacco,
played their games, worshiped the Almighty Spirit, and stole one
another’s horses, without paying any heed to the white men. For the
whites were only a little tribe among them, a wandering tribe of
trappers and traders who came from the Rising Sun Land in search
of beaver skins. The beaver skins were wanted for top hats in the
Land of the Rising Sun.
These white men had strange and potent magic, being masters
of fire, and brought from their own land the fire-water and the
firearms which made them welcome among the tribes. Sometimes a
white man entered the tribes and became an Indian, winning his rank
as warrior, marrying, setting up his lodge, and even rising to the
grade of chief. Of such was Jim Beckwourth, part white, part negro,
a great warrior, captain of the Dog Soldier regiment in the Crow
nation. His lodge was full of robes; his wives, by whom he allied
himself to the leading families, were always well fed, well dressed,
and well behaved. When he came home with his Dog Soldiers he
always returned in triumph, with bands of stolen horses, scalps in
plenty.
Long afterward, when he was an old man, Jim told his
adventures to a writer, who made them into a book, and in this
volume he tells the story of Pine Leaf, an Indian girl. She was little
more than a child, when, in an attack of the Cheyennes upon the
village, her twin brother was killed. Then, in a passion of rage and
grief, she cut off one of her fingers as a sacrifice to the Great Spirit,
and took oath that she would avenge her brother’s death, never
giving herself in marriage until she had taken a hundred trophies in
battle. The warriors laughed when she asked leave to join them on
the war-path, but Jim let her come with the Dog Soldiers.
Rapidly she learned the trade of war, able as most of the men
with bow, spear and gun, running like an antelope, riding gloriously;
and yet withal a woman, modest and gentle except in battle, famed
for lithe grace and unusual beauty.
“Please marry me,” said Jim, as she rode beside him.
“Yes, when the pine leaves turn yellow.”
Jim thought this over, and complained that pine leaves do not
turn yellow.
“Please!” he said.
“Yes,” answered Pine Leaf, “when you see a red-headed Indian.”
Jim, who had wives enough already as became his position,
sulked for this heroine.
She would not marry him, and yet once when a powerful
Blackfoot had nigh felled Jim with his battle-ax, Pine Leaf speared
the man and saved her chief. In that engagement she killed four
warriors, fighting at Jim’s side. A bullet cut through his crown of
eagle plumes. “These Blackfeet shoot close,” said Pine Leaf, “but
never fear; the Great Spirit will not let them harm us.”
In the next fight, a Blackfoot’s lance pierced Jim’s legging, and
then transfixed his horse, pinning him to the animal in its death
agony. Pine Leaf hauled out the lance and released him. “I sprang
upon the horse,” says Jim, “of a young warrior who was wounded.
The heroine then joined me, and we dashed into the conflict. Her
horse was immediately after killed, and I discovered her in a hand-to-
hand encounter with a dismounted Blackfoot, her lance in one hand
and her battle-ax in the other. Three or four springs of my steed
brought me upon her antagonist, and striking him with the breast of
my horse when at full speed, I knocked him to the earth senseless,
and before he could recover, she pinned him to the earth and
scalped him. When I had overturned the warrior, Pine Leaf called to
me, ‘Ride on, I have him safe now.’”
She was soon at his side chasing the flying enemy, who left
ninety-one killed in the field.
In the next raid, Pine Leaf took two prisoners, and offered Jim
one of them to wife. But Jim had wives enough of the usual kind,
whereas now this girl’s presence at his side in battle gave him
increased strength and courage, while daily his love for her flamed
higher.
At times the girl was sulky because she was denied the rank of
warrior, shut out from the war-path secret, the hidden matters known
only to fighting men. This secret was that the warriors shared all
knowledge in common as to the frailties of women who erred, but
Pine Leaf was barred out.
There is no space here for a tithe of her battles, while that great
vengeance for her brother piled up the tale of scalps. In one
victorious action, charging at Jim’s side, she was struck by a bullet
which broke her left arm. With the wounded arm nursed in her
bosom she grew desperate, and three warriors fell to her ax before
she fainted from loss of blood.
Before she was well recovered from this wound, she was afield
again, despite Jim’s pleading and in defiance of his orders, and in an
invasion of the Cheyenne country, was shot through the body.
“Well,” she said afterward, as she lay at the point of death, “I’m
sorry that I did not listen to my chief, but I gained two trophies.” The
very rescue of her had cost the lives of four warriors.
While she lay through many months of pain, tended by Jim’s
head wife, her bosom friend, and by Black Panther, Jim’s little son,
the chief was away fighting the great campaigns, which made him
famous through all the Indian tribes. Medicine Calf was his title now,
and his rank, head chief, for he was one of two sovereigns of equal
standing, who reigned over the two tribes of the Crow nation.
While Pine Leaf sat in the lodge, her heart was crying, but at last
she was able to ride again to war. So came a disastrous expedition,
in which Medicine Calf and Pine Leaf, with fifty Crow warriors and an
American gentleman named Hunter, their guest, were caught in a pit
on a hillside, hemmed round by several hundred Blackfeet. They had
to cut their way through the enemy’s force, and when Hunter fell, the
chief stayed behind to die with him. Half the Crows were slain, and
still the Blackfeet pressed hardly upon them. Medicine Calf was at
the rear when Pine Leaf joined him. “Why do you wait to be killed?”
she asked. “If you wish to die, let us return together. I will die with
you.”
They escaped, most of them wounded who survived, and almost
dying of cold and hunger before they came to the distant village of
their tribe.
Jim’s next adventure was a horse-stealing raid into Canada,
when he was absent fourteen months, and the Crows mourned
Medicine Calf for dead. On his triumphant return, mounted on a
piebald charger the chief had presented to her, Pine Leaf rode with
him once more in his campaigns. During one of these raids, being
afoot, she pursued and caught a young Blackfoot warrior, then made
him her prisoner. He became her slave, her brother by tribal law, and
rose to eminence as her private warrior.
Jim had founded a trading post for the white men, and the United
States paid him four hundred pounds a year for keeping his people
from slaughtering pioneers. So growing rich, he tired of Indian
warfare, and left his tribe for a long journey. As a white man he came
to the house of his own sisters in the city of Saint Louis, but they
seemed strangers now, and his heart began to cry for the wild life.
Then news came that his Crows were slaying white men, and in
haste he rode to the rescue, to find his warriors besieging Fort Cass.
He came among them, their head chief, Medicine Calf, black with
fury at their misdeeds, so that the council sat bewildered, wondering
how to sue for his forgiveness. Into that council came Pine Leaf.
“Warriors,” she cried, “I make sacrifice for my people!” She told them
of her brother’s death and of her great vengeance, now completed in
that she had slain a hundred men to be his servants in the other
world. So she laid down her arms. “I have hurled my last lance; I am
a warrior no more. To-day Medicine Calf has returned. He has
returned angry at the follies of his people, and they fear that he will
again leave them. They believe that he loves me, and that my
devotion to him will attach him to the nation. I, therefore, bestow
myself upon him; perhaps he will be contented with me and will
leave us no more. Warriors, farewell!”
So Jim Beckwourth, who was Medicine Calf, head chief of the
Crow nation, was wedded to Pine Leaf, their great heroine.
Alas for Jim’s morals, they did not live happily ever after, for the
scalawag deserted all his wives, titles and honors, to become a
mean trader, selling that fire-water which sapped the manhood of the
warrior tribes, and left them naked in the bitter days to come. Pine
Leaf and her kindred are gone away into the shadows, and over their
wide lands spread green fields, now glittering cities of the great
republic.
THE END
 Transcriber’s Notes
Punctuation, hyphenation, and spelling were made
consistent when a predominant preference was found in the
original book; otherwise they were not changed.
Simple typographical errors were corrected; unbalanced
quotation marks were remedied when the change was
obvious, and otherwise left unbalanced.
Illustrations in this eBook have been positioned between
paragraphs and outside quotations.
The pages in the introductory chapter “Adventurers” were
not numbered. Transcriber did so with Roman numbers.
Page 210: “the overload Joy” may be a misprint for “the
overloaded Joy”.
*** END OF THE PROJECT GUTENBERG EBOOK CAPTAINS OF
ADVENTURE ***

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