The anatomy and structure of the chest forms a strong frame for reliable protection of internal vital organs, such as the heart and lungs. The physiological structure of the human chest includes several types of bones. These are costal arches that are attached at the back to the spinal column, and at the front to the sternum. This is one of the most important parts of the human skeleton.

This structure of the chest provides a certain mobility for the ribs. Between them are located muscles, nerve endings and other important parts of the anatomical skeleton, which provide not only support and motor function. Due to the coordinated work of the intercostal muscles, a person has the ability to fully inhale and exhale.

Look at the structure of the human chest in the photo, which illustrates all the most important structural parts:

Features of the structure of the human skeleton and bones of the chest

Anatomical and topographical information gives an idea of ​​the structural features of the chest, which is a unique articulation of bones. According to the anatomical atlas, according to its bone structure, the human chest is a part of the body, the bone base of which is the thoracic vertebrae, ribs and sternum.

The structure of the chest skeleton is such that it consists of the thoracic spine and 12 pairs of ribs, the sternum and costal cartilages. Only the first 7 pairs of ribs reach the sternum; The VIII, IX and X ribs with their cartilages connect to the overlying rib and form a costal arch; The XI and XII ribs end freely. The connection of the manubrium with the body of the sternum usually occurs at a certain angle, open posteriorly (angle of Louis - angulus sterni seu Ludovici). This angle in the form of a roller is well defined on the sternum upon palpation (at the place of attachment of the cartilage of the second rib to the sternum), and in asthenic patients it is even visible. The bony wall of the chest, devoid of soft tissues, especially muscles, is a truncated cone, with a wide base facing the abdominal cavity, and a tapering apex towards the neck.

Look at the structure of the chest in the photo, which illustrates the ribs and their attachment to the sternum and spine:

Sternum and ribs in the structure of the chest

Due to the special structure of the chest, the manubrium of the sternum articulates with the sternal ends of the clavicles and connects (without forming a joint) with the cartilages of the 1st and 2nd ribs. The body of the sternum has semilunar notches for III and. IV rib. The chest has 2 openings: upper and lower. The superior inlet (apertura thoracis superior) is formed by the 1st thoracic vertebra, 1st rib and the upper edge of the manubrium of the sternum. Due to the fact that the upper edge of the manubrium of the sternum together with the jugular notch (incisura jugularis sterni) is located approximately at the level of the lower surface of the body of the second thoracic vertebra, the virtual plane laid through the entrance to the chest descends in the anterior direction. Since the apex of the pleura and part of the upper lobes of the lungs extend beyond the anterior border of the entrance to the chest, we can say that the chest cavity, in fact, extends to the neck.

Below, at the outlet of the chest, the position is opposite: the border of the outlet of the chest is indicated by a line running from the xiphoid process in both directions along the costal arches. Further, this conditional line, in contact with the apex of the last three ribs, ends posteriorly at the spinous process of the XII thoracic vertebra. The exit from the chest is covered by the diaphragmatic muscle, part of which starts from the lower ribs. The two arches of the diaphragm with their apices face the pharyngeal cavity, thus, the abdominal organs are already located in the subdiaphragmatic (still protected by the Ribs) space.

The ribs in the structure of the chest are connected to the vertebrae at their posterior ends; from here they go outward, fixing in the region of the costal tubercle to the transverse processes, and then sharply curl anteriorly and downward, forming obtuse costal angles (angulus costae). In front (in the cartilaginous part) the ribs rise obliquely upward.

Muscles in the structure of the chest

On the inside, the ribs and intercostal muscles are lined with intrathoracic fascia (fascia endothoracica), to which the parietal pleura is closely adjacent. In addition to the intercostal muscles, the chest in its structure is covered with the following main muscle layers: pectoralis major and minor, vastus, serratus and trapezius muscles. The intertwining teeth of the serratus anterior and external oblique muscles form a zigzag line on the lower-lateral surface of the chest wall - the Zherdi line - a relief serrated contour of the beginning of the serratus anterior muscle on the lateral surface of the chest.

At the lower end of the median sulcus, in the region of the substernal angle (angulus infrasternalis), there is an epigastric fossa (fossa epigastrica seu scrobiculus cordis). The depression or angle is divided by the xiphoid process, palpable in the depths, into the right and left costoxiphoid angles (angulus costoxiphoideus), which are laterally limited by the joint formed by the cartilage of the 7th rib and the sternum. Puncture of the deepest point of the pericardium is carried out by inserting a needle to a depth of approximately 1.5-2 cm precisely in the angulus costoxiphoideus - at Larrey's point. The chest wall is supplied with blood through the internal mammary artery, the anterior and posterior intercostal arteries, and the axillary artery. The chest wall is innervated by segmental spinal nerves (nervi intercostalis) and branches of the brachial plexus. The trapezius muscle in the structure of the chest is innervated by the accessory nerve of Willis - nervus Willisii.

In the human body, despite its relative fragility, there are still effective structures that provide a protective function. All vital internal organs - the head, heart, lungs - are hidden behind reliable bone formations. But if the skull or spinal canal have fairly stable dimensions, then the chest requires their constant change in the process of movement or breathing.

The anatomy of this formation is quite simple - its external supporting frame is formed only. But the volume is already determined by their total number - the sternum, twelve paired ribs and a similar number of vertebrae form the second largest cavity in the body. Also, the human chest is not only a supporting, but also a mobile formation, directly participating in the work of the lungs.

Mobility is given to it by a large number of joints - each rib and vertebrae has a separate connection to each other, as well as the strength of the surrounding muscles and ligaments. This combination of properties provides reliable protection for the heart, lungs and large vessels located inside the cavity formed. Therefore, damage to any part of the chest poses a threat to these vital organs.

Support structures

Before considering individual elements, you should pay attention to the general properties of this anatomical formation. Many people have difficulty imagining where exactly their chest is, pointing only to its upper part. Therefore, it is necessary to describe some of its external qualities:

1. The upper border is located approximately at the level of the shoulder girdle, behind which the first pair of ribs is located. Since they are at the same level, a kind of bone ring is closed - an aperture.
2. The lower part of the formation does not form a smooth border - it runs in an oblique direction. In the lateral and posterior sections, the chest reaches the level of the lower back, and in the abdominal area, the line rises along the lower edge of the ribs.
3. Normally, the supporting structures are formed in the form of a slightly compressed and truncated cone, with the base directed downward. This structure is due to the shoulder girdle at the top, which requires some space for mobility.

The formation has elasticity due not only to ligaments and muscles, but also to the type of bones included in its composition - the ribs, sternum and vertebrae are formed mainly by spongy tissue.

Sternum

This structure forms the anterior rib cage and is the attachment site for most costal cartilages. Externally, it is a wide and slightly concave plate, consisting of three sections. Together they are connected by dense strands of connective tissue that form sutures. This structure is due to the need for slight stretching that occurs during movement and breathing.

The anatomy of this bone is considered from the point of view of each department, which has its own characteristics. But together they still form a strong and indivisible structure:

• The uppermost and widest part is the handle - in shape it resembles an inverted trapezoid, attached from below to the body of the sternum using a suture. On top it has paired symmetrical notches in which the sternal ends of the clavicles are located. In the same area, bundles of the largest muscle of the neck, the sternocleidomastoid, depart from it.


• The middle section is the body - it usually connects to the handle not directly, but at a slight angle. This feature is due to the fact that the chest narrows slightly in the upper segment. This section of the bone is the longest, representing an elongated rectangle.
• The lower part of the sternum is considered to be the xiphoid process, a small movable bony segment. Its structure is very variable - each person has its own size and shape. It can be felt just below the body of the sternum in the area of ​​​​the junction of both costal arches.

This bone structure not only performs supporting functions, but is also one of the important hematopoietic organs in an adult.

Ribs

It is quite simple - it is a thin bone curved laterally. At its posterior end there is a rounded surface necessary for attachment to the spine. In front, the rib, on the contrary, ends with a sharp edge, from which a cartilaginous outgrowth extends to the sternum.

It is difficult to find such a large number of identical bones in the human musculoskeletal system. Even the vertebrae in different sections have characteristic features that make it possible to separate them from their “brothers”. And almost all ribs differ in appearance only in size, since their anatomy obeys its own rules. Therefore, it is necessary to consider individual groups and elements that stand out from the crowd:

• Only those ribs that are attached directly to the sternum with their cartilage are considered true ribs. Usually these are the top seven pairs - they have a relatively straight direction.
• Next comes a group of false ribs - usually about two or three on each side. Their cartilages are no longer fixed to the sternum, but to the surface of the overlying similar bone.
• The eleventh and twelfth pairs are considered free - they are held in a transverse position only by the surrounding soft tissues. Their anterior edge is located in the area of ​​the lateral borders of the abdomen.

The ribs are given simultaneous strength and elasticity by their special structure - their upper and outer edges are formed by thin compact bone, and their inner and lower sections are formed by spongy substance.

Spine

In addition to the bones listed, the chest also has a main supporting element - the thoracic segment of the spinal column. Thanks to the special structure of the joints between the ribs and the spine, they work together during breathing and movement:

• The main joint is the costovertebral joint - it is located in the depression, which is located between adjacent vertebrae. The head of the rib is securely attached to it with the help of ligaments. Due to the anatomy of the surrounding tissues, movements in these joints are always joint.
• For additional support, a costotransverse joint is formed a little further, which does not play a big role in the mobility of the chest. Its purpose is to prevent excessive displacement of the ribs up and down. It is formed between the costal tubercle and the inner surface of the transverse process of the vertebra.

With any rotation of the torso or tilt, the chest stretches along with the spine, providing a person with freedom of movement.

Soft fabrics

In addition to the external bone frame, which plays a predominantly supporting role, there are also dynamic elements. The structure of the human chest also includes a large number of muscles involved in the act of breathing. Based on localization, they can be divided into the following groups:

1. The most important anatomical structure separating the chest cavity from the abdomen is the diaphragm. It is a wide and flat muscle, shaped like a dome. When it contracts and relaxes, a significant change in pressure inside the chest cavity occurs, which ensures proper functioning of the lungs.
2. Also, intercostal muscles - narrow muscle cords that connect the lower and upper edges of adjacent bones - are actively involved in breathing. In humans, they consist of two differently directed layers - the contraction of each of them ensures inhalation or exhalation.
3. Some muscles of the shoulder girdle are attached to the surface of the ribs, providing them with mobility. These include the pectoralis major and minor, subclavian and serratus anterior muscles. During quiet breathing, they practically do not work, but during heavy loads, their contraction allows you to more effectively expand the chest.

The abdominal muscles can also be classified as respiratory muscles - they change intra-abdominal pressure, indirectly affecting the functioning of the lungs.

Thoracic cavity

Inside, the resulting space is quite densely filled with internal organs covered with special membranes. Based on this feature, it can be divided into the following parts:

• On both sides there are lungs covered with layers of pleura - tissue that ensures their free movement. It consists of two sheets, between which there is a little liquid that prevents friction between them.
• The anterior mediastinum is located immediately behind the sternum - in an adult there are only lymph nodes, blood vessels and adipose tissue. And in children there is an important organ of immunity - the thymus gland.
• The middle mediastinum is formed by the pericardial cavity - it contains the heart and large vessels extending from it. It also contains the terminal section of the trachea and the main bronchi leading to the lungs.
• The posterior mediastinum is entirely filled with anatomical formations - the esophagus, the lymphatic duct, as well as large nerve trunks and veins pass between the heart sac and the spine.

It is these important formations that are protected by a strong and elastic chest frame, ensuring their uninterrupted operation. Without the protection and support of bones and muscles, they would easily be subject to life-threatening injuries.

Protrusion of the manubrium of the sternum occurs with congenital or acquired pathology of the chest. After a severe injury, the front bone becomes displaced and protrudes outward. In congenital diseases, the defect develops gradually. The incorrect structure of the musculoskeletal system leads to disruption of the functions of internal organs and is a difficult psychological aspect.

Structure of the manubrium of the sternum

The sternum is a flat, elongated shape located in the frontal zone of a person. It consists of three separate fragments: the manubrium of the sternum, the body, and the process. During childhood, the parts of the sternum are connected by cartilage tissue, which hardens over time and acquires a bone-like structure.

The manubrium sternum is the upper portion of the sternum. It has an irregular quadrangular shape and is the widest part of the bone. On the sides there are special notches for fastening to the collarbone. Just below there are symmetrical grooves for connection with the cartilages of the first ribs. The upper notch of the manubrium of the sternum is called the jugular. In people of asthenic type, the manubrium can be easily felt through the muscle layer.

The anterior bone is one of the important components of the pectoral corset. It protects internal organs from mechanical stress and damage from bruises. One of the main zones of the chest contains bone marrow and is a hematopoietic organ. In case of injuries and congenital anomalies of the sternum, the following systems are affected:

• respiratory;
• musculoskeletal;
• cardiovascular.

Let's look at common reasons why the manubrium of the sternum protrudes and hurts.

Keeled chest

If the structure of the bone corset is incorrect, the handle of the sternum protrudes. The causes of the disease are associated with a birth defect called “keeled breasts.” This malformation is more common in patients with structural features of the body: tall stature, elongated limbs, lack of subcutaneous fat. Peel-shaped deformity of the chest (KDCH) has received an apt name among the people - “breast of a pigeon.” Clinical picture of the disease:

• prominent bone in the middle front of the chest;
• retraction of connective cartilaginous tissue;
• sunken, weakly defined ribs.

The pathology is detected at the birth of a child, and with age the symptoms only intensify. Patients experience shortness of breath and rapid heartbeat when walking, and complain of fatigue. If the defect is not treated, then over time the person’s lung capacity decreases and the supply of oxygen to the body decreases.

Treatment of CDHA

To improve the general condition of the patient, the following measures are taken:

• regular exercise;
• pressing on the keel (in adolescents);
• breathing exercises;
• wearing orthopedic devices;
• physical therapy.

To completely eliminate the cosmetic defect, surgery will be required.

With a barrel-shaped chest, the intercostal spaces increase, the chest frame moves forward and the manubrium of the sternum protrudes. Why does this deformation occur? There may be several answers:

1. The most common cause of pathology is emphysema. There is an increase in the lungs and displacement of the costal arches. The disease occurs against the background of chronic bronchitis, tuberculosis and smoking, and is accompanied by coughing attacks and shortness of breath.
2. Osteoarthritis is a joint disease in which the cartilage tissue wears out. If arthritis affects the anterior ribs, the sternum moves forward.
3. Bronchial asthma. As a consequence of chronic pneumonia, the upper part of the osseous frame expands and loses its correct anatomical proportions.
4. Cystic fibrosis. The genetic disease causes mucus to accumulate in organs, including the lungs. Often the pathology leads to the appearance of a barrel-shaped chest.

To reduce sternum deformity, the underlying disease is treated first.

Sternum fracture

A car accident, blunt force trauma, or fall often causes a fracture between the manubrium and the body of the sternum. In severe cases, due to injury, the manubrium of the sternum protrudes, and the structure of the bones is disrupted. The victim experiences unbearable pain, which intensifies with a deep breath.

A hematoma with edema forms in the area of ​​the fracture. With a significant displacement of the sternum in some patients, bone fragments are felt during palpation. Damage to internal organs is also possible: lungs, heart, pleura. If medical care is not provided in a timely manner, complications occur - accumulation of air and blood in the chest cavity. To diagnose a fracture, complex measures are carried out: computed tomography and radiography.

Treatment

Patients are prescribed an oral or intramuscular course of painkillers. A novocaine blockade is placed in the injured area. To speed up the fusion of the sternum, a reposition is made in which the bone fragments are correctly compared. In case of a displaced fracture, the manubrium of the sternum is fixed in the desired position with special screws.

After a month, the sternum is completely fused. In the future, it is recommended to carry out rehabilitation measures:

• massage;
• water aerobics;
• breathing exercises;
• swimming;
• exercises for posture.

After an injury, the chest is tightened with a medical elastic band or bandage. To prevent the risk of cracks appearing at the site of injury, excessive physical exertion should be avoided.

If the manubrium of the sternum hurts due to a bruise, do the following:

1. Provide the victim with bed rest.
2. To reduce the pain of the injury, a tight bandage is applied to the chest and secured on the healthy side.
3. Ice is applied to the manubrium of the sternum; this procedure will reduce hemorrhage and swelling.
4. For severe pain, take painkillers (Nise, Spazgan, Baralgin).
5. On the third day after the injury, they begin to treat the hematoma - they apply warm compresses.

If pain in the manubrium of the sternum does not go away within a week, you need to consult a specialist. The doctor will conduct a medical examination and, based on the results, prescribe treatment procedures, such as electrophoresis. The medical procedure involves applying direct electric current to the injured area. Positive effects during treatment:

• swelling decreases;
• muscle tone relaxes;
• tissue regeneration accelerates;
• the body's defenses increase;
• microcirculation improves;
• pain syndrome is eliminated.

In case of serious damage to blood vessels, treatment is carried out surgically. If after a week the tumor has not resolved, then blood stagnation in the sternum is suspected. The doctor makes a puncture in the injured area, and excess fluid comes out.

Folk remedies for bruises

For a slight bruise of the manubrium of the sternum, you can use traditional methods of treatment:

1. Horseradish root is grated on a fine grater and a compress is applied to the injured area. This method of treatment relieves pain well, but it cannot be used during the first two days after the injury.
2. To resolve the hematoma, vinegar (9%) is mixed with honey and applied as a bandage to the sternum.
3. Cilantro has a good analgesic effect. Take 50 g of fruit for 1 liter of boiling water and leave for 15 minutes. Strain and take warm, 2-3 cups per day.
4. Chopped parsley is used for dressings. Crushed leaves are applied to the sternum and secured with a bandage.

If a person slips on ice, the fall may injure the ribs, sternum, and arm. With such bruises, the body aches and hurts for a very long time. To reduce suffering, it is recommended to apply a circular elastic bandage. When tugging, the mobility of the sternum is limited, and it is easier for a person to endure pain.

When pressing on the manubrium of the sternum, pain may appear, radiating to other parts of the chest. The causes of the pathology are degenerative changes in the joints, disorders in the cardiovascular, digestive and respiratory systems.

1. If, when pressing the handle, unpleasant sensations occur in the process of the sternum, then this may indicate diseases of the gastrointestinal tract.
2. If there is nagging pain in the manubrium of the sternum that lasts more than a week, an aortic aneurysm is suspected.
3. If, when pressing on the bone corset, a burning sensation is felt, and the pain moves to the left shoulder or shoulder blade, then this is a clear sign of latent angina.
4. Often, pain in the sternum is caused by pathological processes in the respiratory organs: sarcoidosis, bronchitis, tuberculosis, pneumonia. Associated symptoms are weakness, severe cough, sweating.

Pathologies in which the manubrium of the sternum protrudes and hurts can be quite serious. Therefore, if you feel discomfort when pressing and notice external changes in the sternum area, then consult a specialist.

Sternum(sternum) is an unpaired long flat spongy bone *, consisting of 3 parts: the manubrium, the body and the xiphoid process.

* (Spongy bone is rich in the circulatory system and contains red bone marrow in people of any age. Therefore, it is possible: intrathoracic blood transfusion, taking red bone marrow for research, red bone marrow transplantation.)

Sternum and ribs. A - sternum (sternum): 1 - manubrium sterni; 2 - body of the sternum (corpus sterni); 3 - xiphoid process (processus xiphoideus); 4 - costal notches (incisurae costales); 5 - angle of the sternum (angulus sterni); 6 - jugular notch (incisure jugularis); 7 - clavicular notch (incisure clavicularis). B - VIII rib (inside view): 1 - articular surface of the rib head (facies articularis capitis costae); 2 - neck of the rib (collum costae); 3 - rib angle (angulus costae); 4 - body of the rib (corpus costae); 5 - rib groove (sulcus costae). B - I rib (top view): 1 - rib neck (collum costae); 2 - tubercle of the rib (tuberculum costae); 3 - groove of the subclavian artery (sulcus a. subclaviae); 4 - groove of the subclavian vein (sulcus v. subclaviae); 5 - tubercle of the anterior scalene muscle (tuberculum m. scaleni anterioris)

Lever makes up the upper part of the sternum, on its upper edge there are 3 notches: unpaired jugular and paired clavicular, which serve for articulation with the sternal ends of the clavicles. On the side surface of the handle two more notches are visible - for the 1st and 2nd ribs. The manubrium, connecting to the body, forms an anteriorly directed angle of the sternum. At this point the second rib is attached to the sternum.

Body of the sternum long, flat, widening at the bottom. On the lateral edges it has notches for attaching the cartilaginous parts of the II-VII pairs of ribs.

xiphoid process- This is the most variable part of the sternum in shape. As a rule, it has the shape of a triangle, but can be bifurcated downwards or have a hole in the center. By age 30 (sometimes later), parts of the sternum fuse into one bone.

Ribs(costae) are paired bones of the chest. Each rib has bone and cartilage parts. Ribs are divided into groups:

1. true from I to VII - attached to the sternum;
2. false from VIII to X - have a common attachment by a costal arch;
3. wavering XI and XII - have free ends and are not attached.

The bony part of the rib (os costale) is a long, spirally curved bone, which distinguishes the head, neck and body. rib head is located at its rear end. It bears an articular surface for articulation with the costal fossae of two adjacent vertebrae. The head goes into rib neck. Between the neck and body, a tubercle of the rib with an articular surface for articulation with the transverse process of the vertebra is visible. (Since the XI and XII ribs do not articulate with the transverse processes of the corresponding vertebrae, there is no articular surface on their tubercles.) Rib body long, flat, curved. It distinguishes between the upper and lower edges, as well as the outer and inner surfaces. On the inner surface of the rib along its lower edge there is a rib groove in which intercostal vessels and nerves are located. The length of the body increases up to the VII-VIII rib, and then gradually decreases. In the 10 upper ribs, the body directly behind the tubercle forms a bend - the angle of the rib.

The first (I) rib, unlike the others, has an upper and lower surface, as well as outer and inner edges. On the upper surface at the anterior end of the first rib, the tubercle of the anterior scalene muscle is noticeable. In front of the tubercle is the groove of the subclavian vein, and behind it is the groove of the subclavian artery.

Rib cage in general (compages thoracis, thorax) is formed by twelve thoracic vertebrae, ribs and sternum. Its upper aperture is limited posteriorly by the 1st thoracic vertebra, laterally by the 1st rib and in front by the manubrium of the sternum. The lower aperture of the chest is much wider. Its border is formed by the XII thoracic vertebra, XII and XI ribs, costal arch and xiphoid process. The costal arches and the xiphoid process form the substernal angle. The intercostal spaces are clearly visible, and inside the chest, on the sides of the spine, there are pulmonary grooves. The back and side walls of the chest are much longer than the front. In a living person, the bony walls of the chest are supplemented by muscles: the lower aperture is closed by the diaphragm, and the intercostal spaces are closed by muscles of the same name. Inside the chest, in the chest cavity, are the heart, lungs, thymus gland, large vessels and nerves.

The shape of the chest has gender and age differences. In men, it expands downward, cone-shaped, and is large in size. The chest of women is smaller, egg-shaped: narrow at the top, wide in the middle and tapering again at the bottom. In newborns, the chest is somewhat compressed from the sides and extended anteriorly.

Rib cage. 1 - upper aperture of the chest (apertura thoracis superior); 2 - sternocostal joints (articulationes sternocostales); 3 - intercostal space (spatium intercostale); 4 - substernal angle (angulus infrasternalis); 5 - costal arch (arcus costalis); 6 - lower aperture of the chest (apertura thoracis inferior)

The top of the sternum is the upper part of the triangular shape, connecting to the collarbones and ribs. The body of the sternum, in the middle part of the sternum, is a long, narrow, flat plate of spongy, inert tissue that forms the center of the front of the chest. It has three parts: top, middle and bottom. The sides of the sternum are pointed where they meet the costal cartilages. These structures, together with the ribs, form the rib cage, which protects and supports the internal organs: the heart, lungs and important blood vessels... [Read below]

• Top part
• middle part
• Bottom part

[Start at the top] ...

xiphoid process

This is the smallest and lowest area of ​​the sternum. At birth, it is a thin, roughly triangular area of ​​cartilage that slowly ossifies and fuses with the body of the sternum. The xiphoid process plays an important role as a bony anatomical landmark in the body and can be damaged by improperly administered artificial respiration.

The xiphoid process is located below the body of the sternum. It is attached by a movable fibrous joint (syndemosis). From syndesmosis it gradually narrows.
The xiphoid process exists as a structure composed of hyaline cartilage at birth and during childhood, then slowly ossifies. In fact, ossification of the xiphoid process is so slow that it often does not end until a person reaches 40 years of age.

The xiphoid process acts as a vital attachment point for several large muscles, as one of several origins for the diaphragm muscle, which forms the floor of the chest and performs the vital process of breathing. The xiphoid process also acts as a ligament for the rectus abdominis and transverse abdominis muscles, which compress and flex the abdomen. During cardiopulmonary resuscitation (CPR), the xiphoid process can be used as a landmark to determine the location for chest compressions. It is extremely important that the pressure exerted on the xiphoid process of the sternum during chest compressions does not exceed the permissible limit, as this can separate the xiphoid process from the sternum, possibly puncturing the diaphragm or liver.