Date Published

February 11, 2020

Updated For

ALS PCS Version ALS PCS 5.2


Now that we have your attention¦ when trying to remember how many ribs there are, you have to know how many vertebrae there are. Think of the common meal times, 7am, 12noon, and 5pm, which corresponds with breakfast, lunch and supper respectively. Of course you can enjoy ribs at any meal of the day. This also corresponds to the divisions between the vertebrae: cervical (7), thoracic (12), and lumbar (5). Each rib is associated with its own thoracic vertebrae, hence there are 12 pairs of ribs.Part 2: Land marking to decompress¦Rib 1 is not palpable because it is buried under the clavicle and subclavian vessels. Therefore, when counting intercostal spaces, you always begin by land marking the second rib. This can be accomplished by locating the sternal angle (Angle of Louis). Think of the sternum as being a sword, it can be divided into three parts, the manubrium (the handle), the body, or gladiolus (the blade), and the xyphoid (the tip of the blade). The sternal angle is the palpable "step" that divides the handle and the blade. It marks the location of the second rib. Insertion of a needle for decompression should be performed at the lower part of the second intercostal space, to avoid damaging the vessel bundle that runs along the lower edge of each rib.Now you can œTake a Stab at it!

References: Drake R., Vogl A., & Mitchell A. (2010) Grey's Anatomy for Students. Philidelphia, PA: Churchill Livingstone, p.14


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