“Mediastinal/Cardiac Box”
- Classical Borders:
- Anterior Borders: Nipples (Lateral), Clavicles (Superior) & Xiphoid (Inferior)
- Posterior Borders: Scapula (Lateral), Trapezius (Superior) & Scapular Tip (Inferior)
- Should Raise Concern for Mediastinal Injury (Cardiac, Esophagus & Trachea)
- *Serves More Historical Significance but Should Still Raise Concern – Think “Outside the Box” as Bullets Do Not Respect Anatomic Landmarks
General Orders to Consider
- Within Box Orders
- Pericardial Window/FAST
- Positive: Median Sternotomy & Repair
- Bronchoscopy
- Esophagoscopy or Esophagram
- Strongly Consider Chest Tube if Patient Requires ETT
- Chest Below T4/Nipple Line – Considered Both “Thoracic” & “Abdominal”
Thoracic Incisions