BackgroundAfter successfully demonstrating it was possible to meld an airway manikin and a sheep’s ribcage to make a realistic resuscitative clamshell thoracotomy model1 we decided to see if an improved version could be employed in high fidelity simulations at a regional deanery simulation day for senior registrars.MethodsA trimmed lamb’s thorax with a split thoracic spine was gently splayed and mounted over the lungs of an airway manikin to resemble a human chest in form, dimension and anatomical construction. A lower torso manikin was attached. This was firstly utilised in a burns simulation with restrictive burned skin analogue on the chest wall and a custom made oedematous burnt airway. A cricothyroidotomy, escharotomies and thoracostomy were performed. Then the model was prepared for a stabbed heart simulation by returning the normal airway and replacing the burnt skin on the ribcage with chamois leather. A heart with a haemopericardium and a long bladed knife were inserted in appropriate places into thorax. This was followed by a simulation culminating in a successful resuscitative clamshell thoracotomy with release of the tamponade. Subsequent all attendees had opportunity to practise this skill.ResultsThis airway manikin clothed in lamb’s thorax visually resembled the human anatomy and providing scope for high fidelity burn and stab heart simulations allowing realistic escharotomy and clamshell thoracotomy practise. The orientation of the ribs, the feeling of the bilateral intercostal incisions and transverse sternotomy were true to life. Evaluation by ten attendees on a 5 point Likert scale rated it median 5/5 for realism and 5/5 for teaching value and 4.5/5 for having gained enough confidence to manage these conditions and 4.5/5 for skill acquisition to perform the procedures.DiscussionMorphing a sheep thorax into human dimensions creates an ideal model for high fidelity simulation involving chest procedures.ReferenceHews J, Willers J, Goosen L, Dearing J, Bisht L, Uncles D. Transforming a sheep thorax into an anatomical human shape for clamshell thoracotomy simulation. Anaesthesia 2013;68:18–18

Snippet Cracking ampoulesRather than risk personal injury, we have found that resilient glass ampoules (< 5 ml volume) can be opened safely by encasing the neck within variable diameter oxygen tubing, cut at its widest point (Fig. 1). Existing devices are commercially available for this purpose, but incur additional costs.