Surface Anatomy

Question 1

What are the indications for a thoracotomy

Answer 1

Release clotted blood built up in the pericardial space
Perform cardiac massage
Repair any holes causing haemorrhage
Aortic compression or clamping

Essential penetrating injury to the chest or epigastrum with cardiac arrest

Question 2

How is a thoracotomy done

Answer 2

Bilateral thoracostomies meeting in the middle
Cut the sternum
Insert rib spreader
Vertical incision through pericardium !!Phrenic nerve!!

Question 3

What nerve needs to be carefully avoiding when incising the heart in a thoracotomy

Answer 3

Phrenic

Question 4

On which patients can a thoracostomy be safely carried out and why

Answer 4

They need to be ventilated because if not you risk creating a tension pneumothorax

Question 5

What are the borders of the triangle of safety

Answer 5

Base of axilla
5th intercostal space
Anterior border of latissimus dorsi
Lateral edge of pec major

Question 6

Where is a subclavian line inserted

Answer 6

Junction of the medial 1/3 and lateral 2/3
Under the clavicle
Aim for the sternal angle

Question 7

What are the complications of a subclavian line

Answer 7

Pneumothorax
Brachial plexus injury
Phrenic nerve damage
Thrombosis

Question 8

When would the EJV or femoral vein be used for central access

Answer 8

They are both relatively superficial so can be used when expertise is lacking

Question 9

Where is an IJV central line inserted

Answer 9

Apex of Sedillot’s triangle: Sternal head of SCM, clavicular head of SCM, mid 1/3 of the clavicle

Question 10

What is the convergence theory of referred pain

Answer 10

First order neurones from both the skin and organ synapse on a single second order neurone so the brain thinks the pain is coming from the more common stimuli which is the skin