A Suggestion for a Method of Opening the Pericardial Sac, Founded Upon a Case of Purulent Pericarditis.

Abstract

the patient sustained his injury by falling during an epileptic fit under his own cart, the wheel of which ran over his right shoulder and the lower part of his neck. The accompanying diagram of the brachial plexus will serve to recall the chief anatomical distribution of the plexus. It will be observed that in this case the nerve to C 5, C 6, C 7, C 8, Anterior branches of the four lower cervical nerves. D 1, Anterior branch of the first dorsal nerve. A, Supplying rhomboid. E, Supplying supra-and infraspinati. c, Supplying subclavian. D, Supplying pectoralis major. E, Supplying serratus magnus. F, Brancb. to pupil and orbit. G, Phrenic nerve. H, Supplying subscapularis. I, Circumflex. J, Musculo-spiral nerve. K, Musculocutaneous nerve. L, Median nerve. M, Ulnar nerve. N, Internal cutaneous nerve. o, Lesser internal cutaneous nerve.

Pneumomediastinum in the COVID-19 era: to drain or not to drain?

“…In performing a subxiphoid drain insertion we need to consider that some patients receive anticoagulation, normally with low molecular weight heparin, as part of COVID-19 protocols [28] for pulmonary emboli, which increases the risk of periprocedural bleeding. The technique of subxiphoid drains insertion for pneumomediastinum can be adapted from the previously described technique of subxiphoid pericardial drainage techniques first described by Larrey [29] and popularised by Allingham [30]. By making the incision on the xiphoid process and palpating the xiphoid, a tunnel can be made underneath it close to the sternum and above the pericardium through the usual insertions of the diaphragmatic defects described by Larrey [29].…”

“…A small diameter drain can be inserted in that space and the channel created is enough for air to escape, along the path of least resistance, especially with the use of suction (-3kpa to -5kpa) [30], [31].…”