The Thorax and Abdomen Injuries

Anatomy of the Thorax Known as chest Contains: –Thoracic vertebrae –12 pairs of ribs –Sternum Main function: –Protect vital respiratory and circulatory organs –Assist lungs in inspiration and expiration

Anatomy of the Abdomen Abdominal cavity lies between diaphragm and pelvis Abdominal muscles –Rectus abdominis –External oblique –Internal oblique –Transversus abdominis

Abdominal viscera –Hollow organs Stomach - storage and mixing chamber Intestines - digestion Gallbladder - storage resevoir for bile Urinary bladder - stores urine

–Solid organs Kidneys - filters metabolic wastes, ions, drugs from blood Spleen - resevoir for RBC’s; regulates number of RBC’s; destroys ineffective; produces antibodies for immunological function Liver - absorbs and stores excess glucose; processes nutrients; detoxifies harmful chemicals Pancreas - digestion of fats, carbs, proteins; produces insulin Adrenal glands - secretes hormones: epinephrine, norepinephren, cortisol, estrogen

Recognition and Management of Thoracic Injuries Rib contusions Cause: blow to rib cage can contuse intercostal muscles between the ribs or if severe enough cause fracture S&S: sharp pain during breathing; point tenderness; pain with rib compression Care: RICE; NSAIDs; xray; rest!

Rib fracture Cause: direct blow; highest incidence in football and wrestling; ribs 5-9 most common; possible lung puncture S&S: severe pain during inspiration; sharp pain and point tenderness during palpation Care: xray; support; rest; simple fracture will heal in 3-4 wks

Costal cartilage injury Cause: direct blow to thorax; indirect from sudden twist or fall; signs are similar to rib fracture except pain is localized in the junction of the rib and rib cartilage S&S: sharp pain during sudden trunk movement; difficulty breathing deeply; pt. tenderness; swelling; possible rib deformity and crepitus Care: immediate cold and compression; immobilization

Injury to the lungs Cause: rare Pneumothorax - pleural cavity fills with air that has entered through an opening in the chest. As the pleural cavity fills with air, the lung on that side collapses –Pain, difficulty breathing, anoxia

Tension pneumothorax - pleural cavity on one side fills with air and displaces the lung and heart toward the other side, thus compressing the opposite lung –Shortness of breath, chest pain on side of injury, cyanosis, distention of neck veins

Hemothorax - blood in pleural cavity. Results from tearing or puncturing of the lung or pleural tissue –Difficulty breathing, cyanosis, pain, coughing up blood, shock

Traumatic asphyxia - violent blow to rib cage causing cessation of breathing and medical attention –Purple discoloration of upper trunk and head, bright red color of eyes –Care: each of these conditions is a medical emergency that requires immediate physician attention

Recognition and Management of Abdominal Injuries

Blow to the solar plexus Cause: blow to middle of abdomen producing transitory paralysis of the diaphragm - “wind knocked out” S&S: paralysis of diaphragm stops respiration and leads to anoxia Care: talk in confident manner; loosen tight clothing; bend knees; encourage athlete to relax by inhaling short inspirations and long expirations

Hernia –Protrusion of abdominal viscera through abdominal wall Cause: most often occur in groin area  Inguinal = men, femoral = women

Intra-abdominal tension produced in these areas  muscles produce contraction around canal openings and if muscles fail to react  the abdominal contents may be pushed through these openings S&S: previous history of a blow or strain to the groin area that has produced pain and prolonged discomfort; superficial protrusion in groin area increased by coughing; weakness; pulling sensation Care: no hard physical activity until after surgery; 2-4 wks recovery

Kidney contusion Cause: external force applied to back of athlete which will cause abnormal extension of engorged kidney resulting in an injury S&S: shock; nausea; vomiting; rigidity of back muscles; hematuria; referred pain around trunk and lower abdomen; Care: look for blood in urine; referral; 24 hr hospital observation; possible surgery

Spleen Injuries Cause: fall/direct blow to upper left quadrant of the abdomen; infectious mononucleosis S&S: history of severe blow to abdomen and possible signs of shock; abdominal rigidity; nausea; vomiting; pain radiating to left shoulder and 1/3 down the arm (kehr’s sign); hemorrhaging profusely into abdominal cavity causing death days or weeks after injury Care: conservative; nonoperative treatment is recommended initially with a week of hospitalization and return to activity within 4 wks; with surgery the athlete will require 3-6 months of recovery

Appendicitis Cause: chronic or acute; fecal obstruction; lymph swelling; carcinoid tumor; mistaken for gastric complaint; bacterial infection is a complication of rupture of the inflamed appendix S&S: mild to severe pain in lower abdomen; nausea; vomiting; fever; McBurney’s point (abnormal rigidity and point tenderness on the right side at the anterior superior spine of the ilium and umbilicus) Care: ER; surgery