Beruflich Dokumente
Kultur Dokumente
Block 6 Module 1
Lecturette #2
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Copyright 2015 Bobares 1nc.
THORACIC VERTEBRAE
QUESTIONS AS POINTERS (from Doc Rufon):
What are the peculiarities of the thoracic
vertebrae?
Characteristics of a typical thoracic vertebra
o Vertebral body: medium size and heart shaped;
with superior and inferior demifacets for
articulation with the heads of the ribs
o Vertebral canal/foramen: small and circular
o Spines: long and inclined upward
o Transverse process: with costal facets for
articulation with the tubercles of the ribs except
for rib 11 and 12
o Has a lamina, pedicle and superior and inferior
notches.
Intervertebral discs:
- Main structures that bind vertebral bodies
together.
Block 6 Module 1
Lecturette #2
Block 6 Module 1
Lecturette #2
oblique
Block 6 Module 1
Lecturette #2
STERNUM
- a flat bone with 3 parts: (1) manubrium sterni, (2)
body and; (3) xiphoid (ensiform) process
- slopes down; slightly forward
- convex in front; concave behind
Joints:
Manubriosternal joint corresponds to sternal
angle/angle of Louis where the costal angle of 2nd
rib attaches to sternum; landmark for locating ICS
Xiphisternal joint
Muscle attachments:
pectoralis major
sternocleidomastoid
sternohyoid
sternothyroid
transversus thoracis
diaphragm
aponeurosis of external
internal oblique and transversus abdominis
rectus abdominis
Vascular supply:
Internal mammary/thoracic artery
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Copyright 2015 Bobares 1nc.
Block 6 Module 1
Lecturette #2
SUBCOSTALES
TRANSVERSUS THORACIS
LEVATORES COSTARUM
SERRATUS POSTERIOR
Intrinsic muscles:
A.) Arteries
Internal thoracic/mammary artery
- from the undersurface of subclavian artery (first
part) opposite to the thyrocervical trunk
- descends behind the 1st six costal cartilages 1
cm from lateral sternal border
- divides
into
superior
epigastric
and
th
musculophrenic arteries at 6 ICS
Block 6 Module 1
Lecturette #2
Block 6 Module 1
Lecturette #2
4.) Mediastinum
- Broad central partition between 2 laterally
placed pleural cavities
- Regions:
Superior mediastinum
Inferior mediastinum divided by the
pericardium into: anterior, middle and
posterior inferior mediastina
5.) Pleura
- Single layer of flat cells, mesothelium and
supporting connective tissue that lines the
pleural cavity
- Types:
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SURGICAL APPLICATIONS
POINTERS (from Doc Rufon):
1.) Thoracostomy VS Thoracentecis (Why is the
tube inserted on the posterior aspect?)
2.) On which part of the chest should the needle
be inserted?
3.) On which part of the chest should the chest
tube be inserted?
A.) Thoracentesis/thoracocentesis/pleural aspiration
- Both diagnostic and therapeutic (goal: lung
reexpansion) procedure
Indications: assessment of pleural effusions (fluid)
and life threatening pneumothorax (air)
Site of election:
a.) a little posterior to posterior axillary line in the
6th, 7th or 8th ICS; others prefer midaxillary line
b.) 2nd ICS MCL on the affected side; patient in
upright position (air e.g. pneumothorax)
Parts of chest wall traversed by needle: (1) skin, (2)
superficial fascia; (3) pectoral muscles if anterior site,
(4) serratus anterior, (5) external intercostal, (6) internal
intercostal, (7) innermost intercostal, (8) endothoracic
fascia; and (9) parietal pleura
Block 6 Module 1
Lecturette #2
B.) Thoracostomy
- Opening is made through the chest wall
- Purpose: drainage
Insertion site (tube thoracostomy): 4th or 5th ICS at
anterior axillary line; though insertion in lower ICS is
possible provided the presence of the domes of
diaphragm must be considered
Parts of chest wall traversed by needle: (1) skin, (2)
superficial fascia; (3) serratus anterior, (4) external
intercostal, (5) internal intercostal, (6) innermost
intercostal, (7) endothoracic fascia, (8) parietal pleura;
and (9) pleural cavity
Surg consideration: same with thoracentesis
C.) Thoracotomy
- with incision and removal of a small rib segment
Incision site: 4th or 5th ICS from the lateral margin of
sternum to the anterior axillary line; whether left or
right will be determined by the site of injury
QUESTIONS AS POINTERS (from Doc Rufon):
1.) If you wanted to open the thoracic cage, how
will you go about it?
2.) Which particular parts of the cage will you
approach and why?
References:
1.) Clinical Anatomy by Regions Snell, R.
2.) Grays Anatomy Standring, S.
3.) Anatomy in Surgery Thorek, P.
4.) Upclass notes
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