(Apologies for the delay, this was written on Wednesday waiting on the tarmac and later during take off at Stanstead. A basic introduction to a tool we use, hopefully you will find interesting!)
I said I would write a post on tools starting with the photo at the end of my last post, then I got either another cold or my original one came back with a vengeance and now I find myself on a plane heading for Copenhagen. Life really does take us in some funny directions, this time to the cold land of pastry and schnapps that is Denmark.
Ceiling of the auditorium at the Medical Museion in Copenhagen. More on this in another blog post soon!
However I do also find myself with a little under two hours to kill which seems like a good time to get the article I had planned out of my brain. No one actually guessed what the tool was, well no one who didn’t work or previously work in a mortuary so that doesn’t count! One guess for their similarity to scissors used in fabric cutting with the curved edge underneath to protect the fabric below. That guess made me realise why the bottom of this tool is curved to protect the organs below.
Many different types (and brands!) of rib shears available
The tool in question is a set of rib shears. They do come in many different shapes and sizes, I’ve tried out many different ones and I do have a preference but they all very much work the same way. Rib shears are used to remove the sternum and the area around it, opening up the cavity of the body to access the organs underneath. I’ve been shown that the right way is to remove them from the areas of the ribs made of cartilage, this means the edges left behind from the cut are smooth and do not leave sharp edges to tear your gloves or yourself on. Although you can place a pad or similar over these edges if this happens.
Before using these, we expose the ribcage from the initial incision and ‘loosen’ the clavicles (collar bones) at the top by cutting them free from the attachment to the sternum. Sometimes the clavicles come away easily and pop upwards, other times they can be harder to cut around and this has even snapped the blade of the scalpel I have been using on a couple of occasions. Note, if a blade snaps like this it can be very dangerous so it is important to locate the tip of the blade (probably stuck inside the patient somewhere) and remove it with tweezers or another tool before continuing to work.
The lower ribs cut through easier than the upper ones, and the first rib is the toughest. Sometimes so tough it requires you to rock back and forth a bit to get it to go, I have broken out in a sweat before in all the PPE trying to do this. Once the ‘plate’ consisting of the sternum and ribs sections is cut, we raise the edge from the base and lift while cutting it free from the attachments underneath. I’ve been told this is a common time to accidentally cut yourself and it’s easy to see why. I’ve also been shown how to make a notch between two of the ribs about halfway up while cutting so you can use this to grip better. When I’ve witnessed people come in and watch post-mortems I’ve noticed that they mainly wince at the noise the rib shears make, a loud crunch occasionally when a bone is tough.
The Medezine saw like we use (I’m not being paid to advertise!) with the round blades we use for the cranium and the other ‘fan’ shapes blades.
In really tough cases or other scenarios we can use the bone saw. For example, I recently used the bone saw on the spine to remove the spinal cord from a patient who was donating it for research. We mainly use the bone saw for the skull, but there is another blade you can use to cut through other bones like below.
There you have it, the rib shears! I wanted to start my tool posts with something interesting so I hope this has been a good place to start. If you think I’ve missed anything or have any questions then please let me know by the usual ways, you can see my contact page if you’re not sure.