Superior mediastinum and great vessels

Question 1

What important things are at the angle of louis/ sternal angle/ T4/5 plane?

Answer 1

arch of the aorta; SVC (right ant); azygos vein; trachea (and its bifurcation); oesophagus; thoracic duct (on the left but most is on right)

Question 2

What things are on the anle of louis but are not seen?

Answer 2

Trachea bigurcation
ligamnetum arteriosum
pul. trunk bifurcation
where you measue JVP

Question 3

Layout of venous system through mediastinum

Answer 3

e diagram it

Question 4

What anatomy is at risk when putting in a central line?

Answer 4

Subclavian artery by the subclavian vein
Common carotid by the internal jugular
Lung between both

Question 5

Layout of arterial supply in sup mediastinum

Answer 5

e diagram

Question 6

What can be said abut the vagus nerve?

Answer 6

The right vagus nerve will at the level f the subclavian/brachiocephalic trunk give of the right recurrent laryngeal nerve.
The left vagus will branch at the arch of the aorta (around it) and form the right recurrent laryngeal nerve
The two vagus nerves form a plexus around the oesophagus.

Question 7

What are pros and cons of using a central line in the IJV?

Answer 7

Pros: easy, reliable
Cons: uncomfortbale, CC injury, difficult during CPR/ intubation

Question 8

What are pros and cons of using a central line in the subclavian vein?

Answer 8

Pros: comfortable, OK with intubation/ CPR
Cons: SA damage, risk of pneumothorax, brachial plexus injury

Question 9

What are pros and cons of using a central line in the EJV?

Answer 9

Pros: easy to find, little pneumothorax risk, OK with clotting
Cons: difficult to thread and uncomfortable

Question 10

What are pros and cons of using a central line in the femoral vein?

Answer 10

Pros: OK with CPR etc, easy and fast
Cons: streility, mobilisation is hard and risk of pulmonary embolism