ABSTRACT
BACKGROUND: Although needle decompression of tension pneumothorax through the second intercostal space in the midclavicular line (Monaldi's approach) is a life-saving procedure, severe complications have been reported after its implementation. We evaluated the procedure by comparing how it was performed on cadavers by study participants with different training levels. METHODS: Six participants including one thoracic surgeon performed bilateral thoracic drainage after Monaldi on 82 torsos. After the thoraces were opened, the distances from the internal thoracic artery (A), the site of the puncture (B) and the midclavicular line (C) were measured bilaterally with reference to the median of the sternum. Further, it was determined whether the participants had correctly identified the second intercostal space. The differences between B-A and C-B were analysed. RESULTS: The needle was placed in the second intercostal space in 136 hemithoraces (83%). The thoracic surgeon showed a hit rate of 0% laceration of adjacent vessels. All the other participants had hit rates between 10% and 15%. The interval B-A ranged from 2.88 to 5.06cm in right and from 3.00 to 5.00cm in left hemithoraces. The distance C-B lay between 1.03cm and 1.87cm (right side), and 0.84cm and 2.02cm (left side). CONCLUSION: In our collective, the main problem was failure to assess correctly the lateral extension of the clavicle. If this fact is emphasized during training, Monaldi's approach is a safe method for needle decompression of pneumothorax.
Subject(s)
Decompression, Surgical/methods , Emergency Medicine , Pneumothorax/surgery , Thoracostomy , Anatomic Landmarks , Cadaver , Clinical Competence , Decompression, Surgical/education , Decompression, Surgical/instrumentation , Education, Medical, Continuing , Emergency Medicine/education , Humans , Simulation Training , Thoracic Wall/anatomy & histology , Thoracic Wall/surgery , Thoracostomy/education , Thoracostomy/methodsSubject(s)
Bronchogenic Cyst/surgery , Esophageal Cyst/surgery , Mediastinal Cyst/etiology , Mediastinal Cyst/surgery , Abdominal Pain/diagnostic imaging , Abdominal Pain/etiology , Abdominal Pain/surgery , Back Pain/diagnostic imaging , Back Pain/etiology , Back Pain/surgery , Bronchogenic Cyst/diagnostic imaging , Deglutition Disorders/diagnostic imaging , Deglutition Disorders/etiology , Deglutition Disorders/surgery , Diagnosis, Differential , Esophageal Cyst/diagnostic imaging , Female , Humans , Mediastinal Cyst/diagnostic imaging , Middle Aged , Multidetector Computed Tomography , Pulmonary Atelectasis/diagnostic imaging , Pulmonary Atelectasis/etiology , ThoracotomyABSTRACT
The branches of the ischiorectal part of the internal pudendal artery include the inferior rectal artery and small branches to the obturator internus muscle. For our research we had 164 embalmed half pelves, the arteries of which has been injected by the Thiel method. After the dissection of the ischioanal fossa the arteries were documented. Four types of branching of the inferior rectal artery were found. I. (43%) One artery on each side. II. (31%) Two arteries on one side. III. (4%) Three arteries on one side. IV. (22%) Two arteries or more on each side. In the specimens examined we found one branch to the obturator internus muscle in 31%, two branches in 43% and three branches in 11%. In 15% of cases this branch was absent. In seven cases two branches formed an anastomosis parallel to the internal pudendal artery.
