1. The Thorax and Abdomen
Chapter 21

2. 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

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

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

5. 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.

6. 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.

7. 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

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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

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

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