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Role of Intercostal Drainage Tube in Chest Trauma
Published in Kajal Jain, Nidhi Bhatia, Acute Trauma Care in Developing Countries, 2023
The British Thoracic Society has recommended the triangle of safety as the site for intercostal drainage tube insertion (Figure 6.1). The area is bordered by the anterior border of latissimus dorsi, the lateral border of the pectoralis major and a line along the fifth intercostal space. The midaxillary line is the most commonly advocated position because the innermost layer of the intercostal muscles are poorly developed and the long thoracic nerve is posterior to the midaxillary line along the fibres of the serratus anterior. The apex of the lung is intimately related with the cervical ganglion and separated only by a thin layer of fascia. It is important to be at least 2–3 cm from the apex to avoid any Horner's syndrome, to be 2–3 cm lateral to the vertebrae, especially in children, to avoid the phrenic nerve and to avoid the mediastinum.
Lymphatic anatomy: lymphatics of the breast and axilla
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Lymphatic mapping of the breast is altering the long-standing approach to the breast cancer treatment model: radical mastectomy with complete axillary lymphadenectomy. It is a dramatic departure from Halsted’s modality of 100 years ago.1 The status of the axillary lymph node has consistently been shown to be the most significant prognostic factor in patients with breast cancer.2 The breast lies within the superficial fascia of the anterior thoracic wall. It is situated between the second and sixth ribs and the sternal edge and midaxillary line. The posterior surface of the breast ends abruptly at the chest wall, where it reaches the pectoralis major fascia. It is composed of skin, parenchyma, and stroma. The stroma and connective tissue are intertwined with blood vessels, nerves, and lymphatics. Beneath the nipples are five to ten milk ducts which connect to five to ten additional ducts, each draining an individual breast lobe. Each lobe is composed of 20–40 lobules, which in turn connect to 10–100 tubulosaccular units called alveoli. The subcutaneous connective tissue surrounds glands and extends as septa between the lobes and lobules, providing support for the glandular elements. Cooper’s ligaments are suspensory structures that insert perpendicular to the dermis.
Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The two main complications of needle thoracostomy are failure to puncture the pleura if the needle is too short and the creation of a simple pneumothorax. However, inadvertently creating a simple pneumothorax is far less hazardous than failing to relieve a tension pneumothorax. Both 14G and 16G cannulae are sufficiently long (45 mm) to puncture the pleura in most cases. If signs of a tension pneumothorax remain despite needle thoracocentesis with a 14G/16G needle, a second needle should be placed in the fifth intercostal space anterior to the midaxillary line. In very muscular individuals the fifth intercostal space anterior to the midaxillary line—the usual location for a ‘chest drain’—can be used as the primary site of insertion.
Transthoracic ultrasound-guided biopsy in the hands of chest physicians – a stepwise approach
Published in European Clinical Respiratory Journal, 2019
Ida Skovgaard Christiansen, Paul Frost Clementsen, Uffe Bodtger, Therese Maria Henriette Naur, Pia Iben Pietersen, Christian B Laursen
The treatment of pneumothorax consists of oxygenation and insertion of a pleural chest tube, for example, a 7F tube, followed by aspiration. When defining a management strategy, the size of the pneumothorax is less important than the degree of clinical compromise. The differentiation of a ‘large’ from a ‘small’ pneumothorax is the presence of a visible rim of >2 cm between the lung margin and the chest wall at the level of the hilum. This is easily measured on a chest X-ray, but accurate size is best measured by CT [24–26]. Using lung ultrasound, whether the lung point is located anteriorly or posteriorly to the midaxillary line correlates to a small or large pneumothorax, respectively [27]. Tension pneumothorax is a medical emergency that should be treated immediately with needle decompression followed by pleural drainage without waiting for supplemental x-ray or other investigations.
Stimulation of abdominal and upper thoracic muscles with surface electrodes for respiration and cough: Acute studies in adult canines
Published in The Journal of Spinal Cord Medicine, 2018
James S. Walter, Joseph Posluszny, Raymond Dieter, Robert S. Dieter, Scott Sayers, Kiratipath Iamsakul, Christine Staunton, Donald Thomas, Mark Rabbat, Sanjay Singh
Optimization tests for maximal expirations were conducted with electrodes placed over lower thoracic and abdominal muscles. Current-response tests were conducted first and included methods that we have previously shown to be effective.11,27 Three bilateral sets of electrodes were used that had one pole of the bipolar set of electrodes on one side of the animal and the other pole on the other side. Electrodes were equally spaced along the lateral line and were connected to separate stimulation channels. The lateral line divides the ventral from the dorsal halves of the lower thoracic and abdominal walls and is the same as the midaxillary line.11 The electrodes were placed at the 8th and 10th intercostal spaces as well as 4.25 cm caudal to the 13th rib (Fig. 1 shows 4 electrodes that are 4.5 cm dorsal to the lateral line). Stimulation parameters were 50, 80 and 100 mA, 1.4-second stimulation period, and 50 Hz frequency. Responses to stimulation were measured as the peak expired volume and peak abdominal pressure. These values usually occurred at the end of the stimulation period.
Ketamine versus neostigmine as adjuvants to bupivacaine during ultrasound-guided serratus anterior plane block in modified radical mastectomy. A randomized controlled trial
Published in Egyptian Journal of Anaesthesia, 2021
Bassant Mohamed Abdelhamid, Samuel Samy, Ahmed Abdalla, Ahmed Saad, Mohamed Ollaek, Abeer Ahmed
The patient was placed in the lateral decubitus position with the surgical side upwards and arm abducted. A linear ultrasound transducer (6–13 MHz) (Fujifilm Sonosite M-Turbo Ultrasound System) was used. The probe was placed on the transverse plane of the midaxillary line at the fifth rib level. The rib, pleural line, and overlying serratus anterior and latissimus dorsi muscles were visualized. After local skin infiltration with 3 ml of lidocaine 2%, a 38-mm 22-gauge (22-G, 50-mm Stimuplex A, BBraun, Melsung, Germany) regional block needle was advanced in-plane at an angle of approximately 45 degrees towards the fifth rib with 4 cm depth. After aspiration, a LA mixture was injected anteriorly to the rib and deep to the serratus anterior muscle.