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

– 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

– 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

– 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

– 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

– 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 referimmediately 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 ofReproductive Organs Scrotal Contusion Spermatic Cord Torsion Contusion of Female Genitalia Vaginitis