1 / 24

REVIEW OF ANATOMY UNDERLYING PROCEDURES USED IN EMERGENCY MEDICINE

REVIEW OF ANATOMY UNDERLYING PROCEDURES USED IN EMERGENCY MEDICINE. ANATOMY OF THORACIC WALL AND THORACOSTOMY. Thoracostomy is the insertion of a tube into the pleural cavity. Thoracostomy is

swheat
Download Presentation

REVIEW OF ANATOMY UNDERLYING PROCEDURES USED IN EMERGENCY MEDICINE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. REVIEW OF ANATOMY UNDERLYING PROCEDURES USED IN EMERGENCY MEDICINE

  2. ANATOMY OF THORACIC WALL AND THORACOSTOMY Thoracostomy is the insertion of a tube into the pleural cavity. Thoracostomy is performed as a procedure to drain fluid or blood (hemothorax) or to remove air (pneumothorax) from the pleural cavity. Knowledge of the anatomy of the chest is necessary for accurate tube placement. Thoracostomy tube

  3. STRUCTURE OF ANTERIOR THORACIC WALL: MOST STRUCTURES ARE PALPABLE Rib 1 - not palpable Suprasternal notch Manubrium Rib 2 Sternal angle Body of sternum costal cartilage Xiphoid process Rib 7 The anterior thoracic wall is formed by the ribs and sternum; ribs 1-7 attach to the sternum via costal cartilages; ribs 8-10 attach to the costal cartilages above; ribs 11-12 are floating (cannot be palpated)

  4. INTERCOSTAL MUSCLES AND COURSE OF INTERCOSTAL NERVES, ARTERIES AND VEINS Intercostal muscles Intercostal vein, artery, nerve Three layers of intercostal muscles are found between the ribs (External, Internal and Innermost Intercostal Muscles) Intercostal veins, arteries and nerves course in the intercostal spaces. External Intercostal Muscle Internal and Innermost Intercostal Muscles

  5. COURSE OF INTERCOSTAL NERVES, ARTERIES AND VEINS The intercostal nerves, arteries and veins course between the Internal and Innermost Intercostal muscles: Order: Superior to Inferior: vein, artery, nerve = VAN The bundles are found along the inferior margins of the ribs, often forming a groove in the rib.

  6. SENSORY INNERVATION AND DAMAGE TO INTERCOSTAL NERVE 1. Dermatome (= area of skin innervated by single spinal nerve) - in thorax dermatome map looks like stripes. 2. Overlap - there is some overlap between adjacent dermatomes; overlap is greater on trunk than on extremities 3. Clinical signs of damage to intercostal nerve - damage (pressure) to a single spinal nerve or single dorsal root can produce pain in the skin of its dermatome. (Note: because of overlap of dermatomes in region of trunk, damage to a single intercostal nerve often will not produce loss of sensation (anesthesia); loss of sensation on skin of trunk will occur if two or more adjacent nerves are damaged. OVERLAP OF DERMATOMES GREATEST ON TRUNK

  7. ANATOMY OF THE LARYNX AND AIRWAY OBSTRUCTION Obstruction of the upper airway can occur for a variety of reasons, including ingestion of food, anaphylactic shock and trauma. This can often be life threatening. Cricothyrotomy and tracheotomy establish an opening of the lower respiratory system in the neck, below the obstruction. This requires knowledge of the anatomy of the larynx.

  8. LARYNX: CARTILAGES Larynx consists of cartilages that are linked by membranes and joints Thyroid cartilage is shield shaped and sits above Cricoid Cartilage (ring shaped, cricoid = signet ring) Cricoid Cartilage is above trachea Laryngeal Prominence Laryngeal Prominence or Notch = Adam’s Apple, more prominent in males trachea

  9. LIGAMENTS OF LARYNX - link cartilages and attach it to hyoid bone 1. Thyrohyoid Membrane links larynx to hyoid bone; Median Thyrohyoid Ligament - thickened midline part 2. Cricothyroid Membrane links thyroid to cricoid; Median Cricothyroid Ligament - thickened midline part 3. Cricotracheal ligament links Cricoid to first tracheal cartilage Median Thyrohyoid Ligament Median Cricothyroid Ligament

  10. VI. LARYNX - ARTERIAL SUPPLY Sup. Laryngeal A. from Sup. Thyroid artery Inf. Laryngeal A. from Inf. Thyroid artery

  11. OBSTRUCTION OF LARYNX: TRACHEOTOMY open airway to lungs below obstructed larynx Tracheotomy - cut between first and second or second and third tracheal cartilages

  12. BLEEDING IS PROBLEM: MIDLINE THYROID VEINS 1) Sup. Thyroid vein follows artery 2) Middle Thyroid vein - to Int Jugular 3) Inf. Thyroid vein Both sides join at midline; drain to Left Brachiocephalic Vein

  13. CRICOTHYROTOMY - OPENING OF AIRWAY THROUGH CRICOTHYROID MEMBRANE Incision is made in midline through Cricothyroid membrane at Median Cricothyroid Ligament No major veins so bleeding is minimal Arteries and nerves are unaffected as they enter larynx from lateral and posterior sides.

  14. ANATOMY OF VENOUS SYSTEM AND CATHETER PLACEMENT The placement of flexible tubes into the circulatory system (catheterization) is now widely used in medicine in treatment and diagnosis. Central venous lines are catheters placed into the venous system close to the heart. They can be used to rapidly and reliably administer drugs to the circulatory system and to the heart itself. The can also provide for sampling of blood when other veins are small (infants) Knowledge of anatomy of the venous system is essential in performing catheterization. Central venous line

  15. OVERVIEW OF VENOUS RETURN TO THE HEART All venous blood returns to the heart by entering the Right Atrium Inferior Vena Cava drains venous blood from below the diaphragm Superior Vena Cava drains venous blood from the head, upper extremities and thorax Superior Vena Cava is formed from the Right and Left Brachiocephalic Veins Right Brachiocephalic vein Left Brachiocephalic vein Superior Vena Cava Right Atrium Inferior Vena Cava

  16. VESSELS DRAINING TO SUPERIOR VENA CAVA The BRACHIOCEPHALIC VEINS are symmetrical (unlike the arteries from the Aorta) Each brachiocephalic vein forms at the junction of the Internal Jugular and Subclavian veins at the base of the neck Internal Jugular Veins Left Subclavian vein Right Subclavian vein Right Brachio-cephalic vein Left Brachio-cephalic vein Superior Vena Cava Right Brachio-cephalic vein Left Brachio-cephalic vein

  17. INTERNAL JUGULAR VEIN - VENOUS DRAINAGE OF BRAIN AND DEEP STRUCTURES OF HEAD Superior Sagittal Sinus Cavernous Sinus INTERNAL JUGULAR VEIN - drains venous sinuses of brain - also veins of face and deep structures of head - Int. Jug. Vein forms at Jugular foramen of skull - Drains to Brachiocephalic vein Common Facial Vein INTERNAL JUGULAR VEIN

  18. PATTERN OF VENOUS DRAINAGE OF FACE AND HEAD: SUPERFICIAL VEINS Post. Auricular Sup. Temp. PATTERN OF VENOUS DRAINAGE 1. Superficial Temporal & Maxillary veins form Retromandibular Vein (RM) 2. Retromandibular Vein Divides into Ant. (AD) and Post. (PD) divisions EXTERNAL JUGULAR VEIN 3. Post. Division (PD) joins Post. Auricular V. to form External Jugular V.; drains toSubclavian V. 4. Ant. Division (AD) joins Facial V. to form Common Facial V.; drains to Int. jugular V. ANTERIOR JUGULAR VEIN 5. Ant. Jugular V. forms from veins below mandible; drains toExt. Jugular vein above clavicle Max PD Facial RM AD Common facial Anterior jugular Vein External Jugular Vein

  19. LOCATION OF STRUCTURES IN NECK MAJOR LANDMARK:STERNO-CLEIDOMASTOID MUSCLE 0rigin - Two heads 1) Manubrium of sternum 2) Clavicle- medial 1/3 (cleido- means clavicle) Insertion - Mastoid process of temporal bone Action - bilateral - Flex head; unilateral Rotate head, face is directed to opposite side Innervation - CN XI (Accessory n.) STERNOCLEIDO- MASTOID Action on one side - rotate head, face is directed to opposite side STERNOCLEIDO- MASTOID

  20. LOCATION OF VEINS IN NECK: INTERNAL JUGULAR VEIN INTERNAL JUGULAR VEIN - courses in Carotid Sheath DEEP TO STERNOCLEIDO- MASTOID MUSCLE INTERNAL JUGULAR VEIN STERNOCLEIDO- MASTOID MUSCLE CUT STERNOCLEIDO- MASTOID MUSCLE INTERNAL JUGULAR VEIN Carotid sheath contains Internal and Common Carotid Arteries, Internal Jugular Vein, Vagus Nerve

  21. COURSE OF VEINS IN NECK: EXTERNAL AND ANTERIOR JUGULAR VEINS ANTERIOR JUGULAR VEINS External Jugular Vein - courses on surface of Sternocleidomastoid muscle; drains to Subclavian Vein Anterior Jugular Veins - course superficially in anterior neck; drains to External Jugular Vein EXTERNAL JUGULAR VEIN EXTERNAL JUGULAR VEIN SUBCLAVIAN VEIN

  22. LOCATION OF VEINS: DEEP BRACHIAL VEINS AXILLARY VEIN clavicle cut DEEP BRACHIAL VEINS - two large veins parallel BRACHIAL ARTERY in arm; also called Venae comitantes (accompanying veins) DEEP BRACHIAL VEINS drain to AXILLARY VEIN AXILLARY VEIN becomes SUBCLAVIAN VEIN (at lateral border of rib 1) DEEP BRACHIAL VEINS SUBCLAVIAN VEIN

  23. LOCATION OF VEINS: SUBCLAVIAN VEIN SUBCLAVIAN VEIN - parallels SUBCLAVIAN ARTERY; both SUBCLAVIAN ARTERY AND VEIN are named for their course - DEEP TO CLAVICLE clavicle SUBCLAVIAN ARTERY SUBCLAVIAN VEIN

  24. SURFACE RELATIONSHIPS OF INTERNAL JUGULAR AND SUBCLAVIAN VEINS INTERNAL JUGULAR VEIN 1- Courses deep to Sternocleidomastoid muscle 2- Vein is accessible through Sternal and Clavicular heads of Sternocleidomastoid SUBCLAVIAN VEIN - Courses posterior to clavicle, anterior to Rib 1. Accessible by needle placed 3- Superior to clavicle 4- Inferior to clavicle. INTERNAL JUGULAR VEIN SUBCLAVIAN VEIN

More Related