12 Thorax and Abdomen

Observe surroundings and athlete. On-Field Assessment: Primary Survey Establish consciousness. Assess vitals early (pulse, respirations, blood pressure). Check airway, breathing, and circulation.

Nausea On-Field Assessment: Secondary Survey Chest or abdominal pain Respiratory or cardiac distress History—note symptoms: Difficulty breathing Pain increase on inspiration Observation—note overall response: Pain Shock

Chest wall (tenderness, deformity, swelling, asymmetry) On-Field Assessment: Secondary Survey Bony and soft tissue landmarks Palpate to assess potential structures involved: Abdomen (distension, guarding, rebound tenderness) Pulse

Decreased blood pressure Cardinal Signs of Internal Injury Rapid and weak pulse Wet, white, and weak appearance Rapid and shallow respirations

Chief complaint Sideline and Off-Field Assessment: History Mechanism of injury Onset, duration, and change in symptoms Pain profile Presence and location of referred pain (continued)

Nausea, vomiting, difficulty breathing Sideline and Off-Field Assessment: History Presence of hematuria General health and previous injury history

Response, position and posture Sideline and Off-Field Assessment: Observation Skin coloration and moisture Abdomen (rigidity, guarding, distension) Thorax (breathing pattern, signs of cardiac distress) (continued)

Genitalia (swelling or abnormal appearance) Sideline and Off-Field Assessment: Observation Hematuria and hemoptysis Vital signs Swelling, discoloration, lacerations, deformity, asymmetry

Pulse Sideline and Off-Field Assessment: Palpation Chest (tenderness, deformity, crepitus, asymmetry) Soft tissue Bony landmarks (continued)

Abdomen Sideline and Off-Field Assessment: Palpation Muscle guarding Deep organ palpation (liver, spleen, kidney) Rebound tenderness Ridigity and distension Testicles (swelling, tenderness, masses, abnormalities)

Abdominal quadrants anterior view posterior view

Liver palpation

Spleen palpation

Anatomical position of the kidneys

Kidney palpation

Anterior-posterior rib compression Abdominal Sideline and Off-Field Assessment: Special Tests Lateral rib compression Auscultation (heart, lungs, bowel)

Anterior-posterior rib compression

Lateral rib compression

Auscultation

Active for trunk, scapular, and shoulder motions Sideline and Off-Field Assessment: ROM and Strength Bilateral comparisons Range of motion Same motions as for ROM Note weaknesses and bilateral differences Strength

Thoracic dermatomes Sideline and Off-Field Assessment: Neurological Tests Visceral pain referral patterns Neurological assessment is primarily sensory.

Cardiorespiratory (aerobic exercise) Functional Assessment Musculoskeletal (active sport-related movements) Reassess signs and symptoms during and after each functional activity.

Follow-Up Assessment Signs and symptoms may not be present until hours or days postinjury. Ongoing follow-up care is important along with frequent evaluation and instruction.