clinical surface anatomy - dafydd loughran

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  • Dafydd LoughranCST1

  • Cover RELEVANT surface anatomy for surgical & medical procedures & presentationsInteractive, drawing on each other!Scenario based

  • Big collision ahead, car vs car, 70mph1st on scene23yr male driverObvious facial #s. Gross distortion of lower face.GCS8/15. Stridor then quiet & unable to breath.Chin lift no improvementWhat are you going to do?

  • Cricothyroidotomy pen, ventflon- Cricothyroid membrane

    Tracheostomy 2/3 tracheal rings

    Draw: Laryngeal prominence of thyroid cartilageCricoid cartilageCricothyrotomy placementThyroid gland

  • Its your first central line insertion.Your boss has asked for a jugular line insertionWhats the anatomy?

  • Draw:Anterior triangle midline, anterior sternocleidomastoid, mandiblePosterior triangle clavicle, post border sternocleidomastoid, ant border trapezium

    Internal Jugular central line:

    Done under US guidance.Imagine your pen is the needle.Locate both sternal & clavicular heads of sternocleidomastoid.Choose your spot.

    Carotid artery is medial - pulsatile

  • Airway now fixed!Increasingly SOB.Trachea deviated to Left. Reduced Right expansion. Hyper-resonant Right side.RR35, SpO2 82%Diagnosis?What are you going to do?Whats the anatomy?

  • Sternal angle (of Louis) lower than often thoughtIntercostal space belowMid-clavicular line

    Mark out angle & 2nd ribDraw your spot & save a life!

  • Definitive management?Chest drain anatomy? & in relation to rib?Triangle of safety

    Draw the triangle & pick a spot!

  • 18yr Female.Fighting in town. Other girls protective boyfriend stabs her in the upper abdomenWhats at risk?Where are those organs?

  • Draw the 9 regionsUpper transverse line = Transpyloric plane (L1)Hands breadth below xiphoid process.

    Draw: pancreas, stomach, duodenum, liver, & spleen

  • Just below nipples bilaterally!

    Base of Rightcostal margin

    Hiding under Left 9-11th ribs

    At risk especially with blunt trauma

    Spleen Transpyloric plane (L1)

    Tail & Body of pancreasPylorus of stomach2nd part of duodenumSuperior mesenteric artery

  • Lumbar puncture, Reg asks you to crack onWhere are you aiming for?What level, why, and how to find it?

    Work your way up & draw the kidneys

  • 60yr old male. Noticed lump in groin for last few days.No obstructive symptoms.Cough impulse present

    What will help you get to a diagnosis?

    Pubic tuberclePubic symphysis ASISMid inguinal point = ASIS to PS. Femoral arteryMid point of inguinal ligament = ASIS to PT. Deep inguinal ringIdentify on yourself:

  • Inguinal vs Femoral -

    Direct vs Indirect -

    Deep ring- IndirectHasselbachs triangle Direct (weakness of

    abdominal wall)Superficial ringAbove & Medial to PT = InguinalBelow & Lateral to PT = FemoralControlled at Deep ring (mid-point of inguinal ring)= Indirect hernia

  • 90yr femaleIntertrochanteric NOF # overnightNOF pathway states Fascia-Iliaca block to be done by F1

    A&E sister kindly reminds you the last one your colleague did punctured the femoral artery. (I was told exactly this!)Whats the anatomy? Where will you inject?

  • Point out where youd perform a needle cricothyrotomy.What are the boundaries of the posterior triangle?What are the boundaries of the triangle of safety?Chest drain will you go above or below the rib?What nerve is at risk during chest drain insertion?

  • Show the boundaries of the liver.How do you find the position for a lumbar puncture? What spinal level is this?How to differentiate between a direct or indirect hernia?What lies at the mid-inguinal point?Whats the anatomical landmark for a fascia iliaca block?

  • Any questions?

    Any surgical topics would you like covered before you finish the job?