1 Flashcards
corresponds to
- manubrium sterni
- body of the sternum
- 3rd and 4th thoracic vertebrae
- 5th–8th vertebrae
first spinous process that can be felt is?
C7
Position of nipple
4th intercostal space (ICS)
10cm from midline
What is apex beat? Where is it palpated?
The apex beat, which marks the lowest and outermost point at which the cardiac impulse can be palpated, is normally in the 5th intercostal space 3.5 in (9 cm) from the midline and within the midclavicular line.
Where is the trachea palpated?
The trachea is palpable in the suprasternal notch midway between the heads of the two clavicles.
What are the borders of trachea? Where does it bifurcate?
Start- lower border of cricoid cartilage C6
End- at the sterna, angle of Louis
Bifurcation at T6
Surface marking of cervical pleura?
Curved line drawn from sternoclavicular joint to the junction of medial and middle thirds of clavicle
Apex of pleura?
2.5cm above the clavicle
Possible causes of pleura injury
above the clavicle - by a stab wound including the surgeon’s knife and the anaesthetist’s needle
below the clavicle - attempted subclavian vein catheterization
Where is the lower border of the lung?
In the neutral position (midway between inspiration and expiration) it lies along a line which crosses the 6th rib in the midclavicular line, the 8th rib in the midaxillary line and reaches the 10th rib adjacent to the vertebral column posteriorly.
Marking of oblique fissure of lung
2.5 cm lateral to the spine of the 3rd thoracic vertebra along the 5th intercostal space to the 6th costal cartilage approximately 1.5 in (4 cm) from the midline.
corresponds to the position of the medial border of the scapula. Can be seen by abducting shoulder to full extent.
The surface markings of the transverse fissure?
line drawn horizontally along the 4th costal cartilage and meeting the oblique fissure where the latter crosses the 5th rib.
Why is it safe to pass a needle immediately above a rib, but dangerous to pass it immediately below?
The intercostal vessels lie immediately below their c sponding ribs (the vein above the artery)
1st rib has a prominent tubercle for scalenous anterior. State the relations of it
In front of the tubercle- Subclavian vein
Behind the tubercle in the subclavian groove- subclavian artery and lowest trunk of brachial plexus. Can be used for local anesthesia.
Crossing the front of the neck of the first rib from the medial to the lateral?
sympathetic trunk, the superior intercostal artery (from the costocervical trunk) and the large branch of the first thoracic nerve to the brachial plexus.
Rib fractures
1. Children are less susceptible. Why?
2. Weakest part of rib?
3. Least commonly fractured?
- Highly elastic
- Angle of rib
- upper two ribs, which are protected by the clavicle, and the lower two ribs, which are unattached anteriorly, and therefore swing free
paradoxical respiratory movement. Cause and treatment?
In severe crush injury several ribs may fracture in front and behind so that a whole segment of the thoracic cage becomes torn free (‘stove-in chest’). With each inspiration, this loose flap sucks in; with each expiration, it blows out; thus undergoing paradoxical respiratory movement.
urgent treatment by insertion of a chest drain with underwater seal, followed by endotracheal intubation, or tracheostomy, combined with positive pressure respiration.
Cause of notching of the ribs?
In coarctation of the aorta, the intercostal arteries derived from the aorta receive blood from
the superior intercostals (from the costocervical trunk of the subclavian artery),
from the anterior intercostal branches of the internal thoracic artery (arising from the subclavian artery)
and from the arteries anastomosing around the scapula.
Together with the communication between the internal thoracic and inferior epigastric arteries, they provide the principal collaterals between the aorta above and below the block. In consequence, the intercostal arteries undergo dilatation and tortuosity and erode the lower borders of the corresponding ribs to give the characteristic irregular notching of the ribs, which is very useful in the radiographic confirmation of this lesion.
