Respiratory Dry Room 3

Question 1

What is in the intercostal spaces?

Answer 1

Intercostal muscle
Intercostal nerve
P. and A intercostal artery and vein

Question 2

What does the number of the intercostal space accord with?

Answer 2

The number of the rib above

Question 3

What are the 3 layers of intercostal muscle in order from superficial to deep?

Answer 3

External
Internal
Innermost

Question 4

What is the muscle fibre orientation of the 3 layers?

Answer 4

External - Infero-anteriorly
Internal - Infero-posteriorly
Innermost - Infero-anteriorly

Question 5

Where is the neurovascular bundle located between?

Answer 5

Internal and innermost

Question 6

Superior to inferior - name the order of the neurovascular bundle

Answer 6

VAN

Question 7

Which area of the intercostal space is the bundle located?

Answer 7

Top bit of intercostal space

Question 8

Does the internal and external muscles take up the whole intercostal space?

Answer 8

No - they become tendinous and develop into a thin aponeurosis

Question 9

How does the innermost intercostal muscle fill out the space and what fills out the rest?

Answer 9

Only fills the central half

Remainder filled anteriory by transversus thoracis muscles and posteriorly by subcostalis muscles

Question 10

What does each structure in the VAN bundle give off and where does it go?

Answer 10

A collateral bundle which goes to the top of the rib

So there is a collateral bundle on top of each rib

Question 11

Where is a chest drain normally located and where in the intercostal space and why?

Answer 11

4th/5th mid auxiliary line

Should be placed in lower half of intercostal space to avoid the VAN bundle

Question 12

Name the layers a needle goes through for a chest drain?

Answer 12

Skin
Superficial fascia
Deep fascia
External IM
Internal IM
Innermost IM
Parietal pleura into pleural cavity