The Thorax and Abdomen Chapter 21

Anatomy of Thorax Thoracic Cavity Ribs, Costal Cartilage, and Sternum Thoracic Muscles Lungs Respiratory Muscles Blood Supply Heart blood supply Thymus Abdominal Muscles Abdominal Viscera

Preventing/Assessing Injuries to Thorax and Abdomen History Observation Palpation Abdomen - ausculation and percussion Special Tests

Preventing Injuries to Thorax and Abdomen Appropriate protective equipment Abdominal muscle strengthening Empty hollow organs before competition

Assessing Injuries to Thorax and Abdomen History What happened? Direct blow or contact? What was body position at time of injury? Type of pain, immediate or gradual? Location of pain? Difficulty breathing? Position of comfort? Feel faint? Light headed? Nauseated? Sounds? Muscle spasm? Blood in urine? Difficulty urinating? Was bladder empty? When was last meal? Look at History of family and other injuries.

Assessing Injuries to Thorax and Abdomen Observations Is athlete breathing? Having difficulty breathing? Pain with breathing? Position of athlete, holding chest? Look for symmetry of chest movement during breathing. deformity, muscle spasm coughing up blood?, cyanosis? Other colouring of face or injury area.

Assessing Injuries to Thorax and Abdomen Palpations Feel surrounding structures. Bone changes Muscle and attachments Ligaments and attachments Spasm Bleeding pulses Special Tests Ausculation Percussion Rebound

Recognition and Management of Specific Injuries Rib Contusion Rib Fracture Costochondral Separation and Dislocations Sternum Fracture Muscle Injuries Breast Injury

Rib Contusion Etiology Blow to rib cage - bruise to intercostal muscles or to rib or fracture to rib  Signs and Symptoms Pain on inspiration and expiration Sharp pain when rib cage is compressed Point tenderness (local)  Management X-ray examination, PIER, anti-inflammatory, rest

Rib Fracture Etiology Highest incidence in collision sports, caused by direct and indirect trauma, may be result of violent muscle contraction, sneezing - ribs 5-9 are commonly injured Signs and Symptoms Severe pain on inspiration point tenderness, crepitus, palpable deformity if spring outward, collapse of lung Management X-ray exam, support and rest

Costochondral Separation and Dislocations Etiology direct blow to anterolateral aspect of thorax or indirectly from sudden twist or fall that compresses rib cage  Signs and Symptoms sharp pain during sudden movement difficulty breathing deeply point tenderness over costal cartilage deformity crepitus  Management X-ray, rest, support, PIER

Recognition and Management of Specific Injuries Injuries to the Lungs Pneumothorax Hemothorax Traumatic Asphyxias Heart Contusion Sudden Death Syndrome Abdominal Injuries Kidney Contusions Kidney Stones

Pneumothorax Etiology Signs and Symptoms Management hole in chest allowing air to fill the pelural cavity space between pleural membrane and lung causing the lung to be compressed and collaps Signs and Symptoms Pain difficulty breathing anoxia Management EAP cover hole on three sides with plastic

Tension Pneumothorax Etiology Signs and Symptoms Management EAP air fills pleural sac on one side displacing the lung and heart toward the opposite side eventually compressing the opposite lung Signs and Symptoms shortness of breath, chest pain may have absence of breath, cyanosis, distension of neck veins, deviation of trachea away from side of injury collapse of lungs Management EAP

Heamothorax Etiology Signs and Symptoms Management EAP presence of blood within the pleural cavity resulting from puncture or tearing of lung or pleural tissue may be caused by rib fracture Signs and Symptoms severe pain difficulty breathing Cyanosis coughing up frothy blood shock Management EAP

Heart Contusion Etiology Signs and Symptoms Management EAP Compression of heart between spine and sternum strong outside force. Signs and Symptoms Severe shock and heart pain. May have heart arrhythmias leading to decreased cardiac output. death. Management CPR treat for shock EAP

Kidney Contusion Etiology Signs and Symptoms Management blow to lower back degree of injury is a result of the degree of engorgement of the kidney Severe shock and heart pain. May have heart arrhythmias leading to decreased cardiac output. death. Signs and Symptoms Shock Nausea Vomiting rigidity in back muscles blood in the urine referred pain into upper back and lower abdomen Management have athlete urinate two or three times if blood is present refer immediately to physician, may require surgery

Recognition and Management of Specific Injuries of the Abdomen Contusion of Ureters, Bladder, and Urethera Cystitis Hernia Urinary Tract Infection Urethritis Contusion of Abdominal Wall Gastrointestinal Bleeding Indigestion (Dyspepsia) Solar Plexus “stitch in side” Food Poisoning Peptic Ulcer

Recognition and Management of Specific Injuries of the Abdomen Liver Contusion Pancreatitis Diarrhea Hemorrhoids Constipation Appendicitis Spleen Contusion

Recognition and Management of Specific Injuries of Reproductive Organs Scrotal Contusion Spermatic Cord Torsion Contusion of Female Genitalia Vaginitis