RESUMO
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.
Assuntos
Descompressão Cirúrgica/métodos , Medicina de Emergência , Pneumotórax/cirurgia , Toracostomia , Pontos de Referência Anatômicos , Cadáver , Competência Clínica , Descompressão Cirúrgica/educação , Descompressão Cirúrgica/instrumentação , Educação Médica Continuada , Medicina de Emergência/educação , Humanos , Treinamento por Simulação , Parede Torácica/anatomia & histologia , Parede Torácica/cirurgia , Toracostomia/educação , Toracostomia/métodosAssuntos
Cisto Broncogênico/cirurgia , Cisto Esofágico/cirurgia , Cisto Mediastínico/etiologia , Cisto Mediastínico/cirurgia , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/etiologia , Dor nas Costas/cirurgia , Cisto Broncogênico/diagnóstico por imagem , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Diagnóstico Diferencial , Cisto Esofágico/diagnóstico por imagem , Feminino , Humanos , Cisto Mediastínico/diagnóstico por imagem , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/etiologia , ToracotomiaRESUMO
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.
