Case 17 Part 6



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What's inside?


 

Chest cavity
Neck
Aorta
Brachiocephalic vein, left
Right brachiocephalic artery
Aortic arch
Descending aorta
Plaque
Ostium of posterior intercostal artery
Trachea
Tracheal ring
Tracheal fluid
Pulmonary edema fluid
Thyroid gland
Right lobe
Left lobe
Isthmus
Spine
Diaphragm
Liver
Liver, right lobe
Liver capsule
Esophagus



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Discussion Questions


 

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1. The physician works at times from the right of the patient and at times from the left, going back and forth. This sometimes puts the head (superior) at the left of the video; and sometimes at the right of the video. Identify each change of orientation. [Or jump to interactive video] Add an “S” (“superior”) by the left or right edge to mark each switch of orientation.
 
 
2. At the start of the video (during the mediastinal dissection), there is a brief view of a vessel which is cut and then bleeds. What is the name of that vessel. Where did it drain from and where does it go?
 
 
3. Identify the aorta and the right brachiocephalic artery near the start of the video.
 
 
4. Order from anterior to posterior near the aortic arch: esophagus, aorta, tracheartery
 
 
5. Order from anterior to posterior near the diaphragm: esophagus, aortartery
 
 
6. Identify the thyroid.
 
 
7. [Jump to interactive video] Pause the video at about 1:10. Outline roughly where the larynx, vocal cords, thyroid and trachea are positioned. If the structures are not visible, draw where you think they would be.
 
 
8. Identify the endotracheal tube tip inside the tracheartery
 
 
9. (Estimate) Based on your outline in 7., about how many centimeters below the vocal cords is the endotracheal tube tip? Is that correct positioning?
 
 
10. Why is there a crunching sound on opening the anterior trachea? What kind of tissue makes up the anterior trachea?
 
 
11. There is some liquid in the patient’s airway. Describe its appearance. Where did the liquid come from? Did the patient aspirate? How might it relate to Part 5 in this case?
 
 
12. Describe the contents of the esophagus. Compare it to the contents of the airway. Do you need to revise your decision about aspiration? Why or why not?
 
 
13. Distal to the aortic arch, which is anterior, the heart or the aorta?
 
 
14. What structure is immediately to the right of the aorta as it passes towards the diaphragm?
 
 
15. Is there a lot of plaque in the aorta or a little? How do you reconcile this with the coronary artery findings in Part 5?
 
 
16. Is the liver assessed via the chest cavity or the abdominal cavity?
 
 
17. Identify the central tendon of the diaphragmuscle
 
 
18. Does the liver look normal?
 
 
19. What would a cirrhotic liver typically look like.




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