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

BackgroundThe use of animal tissue in simulation based medical education (SBME) is an important part of teaching surgical/technical skills. Unfortunately this has logistic, cost and health and safety implications which restrict its use. We set out to organise a Regional Anaesthesia and Surgical Skills workshop that would maximise the use of our animal tissue specimens.MethodWe sourced a lamb thorax (simulating elderly patient) and a pig thorax with skin attached (simulating young well-padded patient) from a butcher. These had already passed abattoir health checks. Eight attendees were sequentially taught techniques of Seldinger chest drain insertion, intercostal blocks, interpleural catheter insertion, and paravertebral blocks. Everybody successfully carried out these procedures on both specimens with and without ultrasound. Then surgical chest drains was done, with its conversion to interpleural catheters. This was repeated by another eight on the same day by flipping the specimens. The lamb thorax was then used for a clamshell thoracotomy workshop.ResultFeedback from getting hands-on practice in these rarely needed skills were universally positive. Following a logical sequence it was possible perform multiple procedures. Using two types of meat to represent our patient spectrum meant both increased opportunity and variation in technique, as well as providing for cultural sensitivities. A combination of low cost (<£80 for meat) and hands-on training of multiple procedures to multiple clinicians meant that it was easy to obtain funding. Presentations emanating from these workshops have won several prizes at international flagship congresses and been published in peer reviewed high impact journals.1,2,3 Using food dyes to confirm successful procedure ensured that specimens could be disposed of in an ecofriendly manner by grateful canines.ConclusionsEmploying sequential use of animal specimens as a force multiplier gets more bang-for-buck. This can be useful in SMBE during these days of budgetary and regulatory restraints.ReferencesDawes T, Nicholas C, Willers J. A longitudinal, in-plane oblique approach to the ultrasound guided intercostal nerve block. Anaesthesia 2011;66(1):31Dawes T, Nicholas C, Willers J, Samuels T, Uncles D. Comparing the pressures required for pleural puncture between different types of needle and different angles of approach in a porcine model. Brit J Anaesth 2012;109(3):473P–484PGoosen L, Parker S, Willers J, Hariharan S, Bukunola B, Crossland C, Shaw C. The occasional thoracotomist – which tool is top? Anaesthesia 2012;67:78