Clinical anatomy for procedures and the operating theatre Flashcards
Where is the angle of louis?
angle between manubrium, 2nd costal cartilage adjoins the manubriosternal joint (below this is the 2nd ICS) and body of sternum
Where do the chest leads go for a 12 lead ECG?
V1= 4th ICS R sternal edge V2 = 4th ICS L sternal edge V3 = between V2 and 4 V4 = 5th ICS MCL V5 = between V4/6 V6= 5th ICS MAL
What are the superficial veins in the ACF?
basilic vein
median cubital vein
cephalic vein
What are the borders of the ACF?
line between epicondyles of humerus
protonator teres
brachioradialis
When would you take blood from the long saphenous vein?
emergency venous access
approx 1 fingers breadth anterior and superior to medial malleolus
also important in CABG graft
Where is the IJV located?
between the 2 heads of the sternocleidomastoid
therefore apex of this triangle is a landmark for IJV catherisation
What are the potential complications of inserting a IJV line into a patient?
think about the structures within the region
- vein, artery, sympathetic chain, vagus nerve, apex lung/pleura, thoracic duct
What sites can you carry out ABG?
radial, brachial, femoral
radial is preferred
- ease of access and superficial position of the vessel, immediately lateral to flexor carpi radialis
allen’s test for radial artery ABG
Where is the femoral pulse located?
mid inguinal point = half way between pubic symphysis and ASIS - if you go to medial you;ll puncture the femoral vein
How is the tube length of a nasogastric tube determined?
estimated before insertion
nose to ear to xiphoid distance
After inserting the nasogastric tube what is the first thing that needs to be done?
check pH of aspirate (1-5.5) as first line or CXR as second line
these checks should be repeated if vomiting, retching or any clinical suspicion
What tests are not reliable for testing pH of aspirate?
Whoosh tests, acid/alkaline test using litmus paper or interpretation of the appearance are not reliable
How should IM injections be given?
deltoid - bony landmarks avoid axillary nerve
locate the lower edge of the acromial process
insert needle 2.5-5cm below the acromial process
beware of the axillary nerve as on average it is 5.58cm below the acromion
How can IM injections be given in the gluteal muscles?
bony landmarks most reliable
- preferred injection site is into the lateral part of the safe area - glut medius and glut minimus rather than glut maximus
What are the 2 narrowings to negogiate when inserting a catheter into a male patient?
prostate
external urethral sphincter
What is the safe triangle?
base of axilla, lateral edge of pectoralis major, lateral edge of latissimus dorsi and 5th ICS
Where should a paracentesis ascitic tap be administered?
3cm above and 3 cm medial to the ASIS
- lateral to both rectus abdominis and lateral to inferior epigastric vessels
diagnostic or therapeutic reasons
What is the basic anatomy involved in lumbar puncture?
cord terminates in transpyloric plane at L1 (lower in children)
nerve roots travelling within cauda equina carry on distally to S2
the surpacristal plane passes through level of the transverse process of L4 - intervertebral spaces can be counted from here
What incisions can be carried out for open appendicectomy?
surface marking = mcburney’s point
open= grid iron/lanz
layers of anterior abdominal wall
What are the 2 layers of superficial fascia in the inguinal region?
campers = fatty Scarpa's= more dense
What is the different between a direct and an indirect inguinal hernia?
direct = lies medial to the IEAs indirect = lies lateral to the IEA (inferior epigastric artery)
deep ring is lateral to the IEA which is why the indirect hernia’s tend to pass through the deep ring and travel on into the scrotum
What is calot’s triangle?
liver base, cystic duct and CHD
- cystic artery lies within if anatomy is normal
How is laparoscopic cholecystectomy done?
find calot’s triangle
- divide cystic artery and duct between ligaclips, dissect GB off its bed
