Abdomen

1
Abdomen Thorax Evaluations

• Whats in your gut?

2
Anatomy

• Bony
• Sternum
• Manubrium, body, xiphoid process
• Ribs 12 pair
• 1 - 7 true ribs
• 8 - 10 false ribs (attach to costal cartilage)
• 11 12 floating ribs
• Thoracic vertebrae T1-T12

3
True False
Floating
4
Anatomy

• Muscles
• Scalene elevates 1st 2nd ribs
• Rectus Abdominis
• Intercostals muscles
• External Internal Obliques
• Transverse Abdominis
• Diaphragm

5
Anatomy
6
Anatomy - Organs

• Lungs
• Right 3 lobes Left 2 lobes
• Visceral pleura lines thoracic wall
• Parietal pleura surrounds lungs
• Pleural cavity between visceral pleura
  parietal pleura
• Alveoli (exchange of gases occurs at this level)

7
Anatomy - Organs

• Spleen
• Solid organ
• Largest lymphatic organ
• Reservoir of RBCs
• Produces lymphocytes
• Regulates of RBCs in circulation
• Cleans blood of foreign matter
• Destroys ineffective RBCs
• Located on left side between 9th-12th ribs
• Produces antibodies

• Liver
• Part of digestive system
• Produces bile - help break down fat
• Absorbs excess glucose (stores as glycogen)
• Located on right side of torso inferior to
  diaphragm protected by lower ribs and costal
  arch of false ribs
• Filters toxins wastes out of blood produces
  mediators for blood clotting

8

• Kidneys
• Filters toxins and cleanses blood
• Regulates electrolytes by maintaining water,
  sodium potassium balance
• Located at T12-L1 vertebrae slightly lower
  lower portion of each is unprotected

• Pancreas
• Secretes most digestive enzymes for breakdown of
  food
• Secretes hormones
• insulin - decreases sugar levels
• glucagon - increases sugar levels

9

• Reproductive Tract
• Male
• Testes produce sperm testosterone hormone
• Epididymis coiled tube on posterior aspect of
  tests (stores sperm)

• Reproductive Tract
• Female
• Ovaries
• Source of estrogen progesterone
• House reproductive eggs
• Fallopian tubes
• Uterus

10
Assessment of the Thorax Abdomen

• Injuries to this region can produce
  life-threatening situations
• ATs evaluation should focus on signs and
  symptoms that indicate potentially
  life-threatening conditions
• Continually monitor breathing, circulation and
  for any indication of internal bleeding or shock

11
The Evaluation Process

• History
• Same questions as previous evaluations (where,
  when, previous history, etc.)
• What happened to cause this injury?
• Was there direct contact or a direct blow or an
  overstretch?
• What position were you in?
• Did you hear or feel snap, crack or pop in your
  chest or abdomen?
• What is the pain like? Chest pain?
• Breathing - difficulty breathing shallow/deep
  rapid/slow Do you have asthma?
• Location of pain
• What type of pain? Pain level?
• Location(s)? Musculoskeletal to ribs tender
  over site
• Internal organs may be diffuse or specific
  (referred pain)
• Radiating pain in (L) shoulder Kehrs sign
  spleen
• Abdominal pain Does breathing cause pain?
• What increases/decreases the pain?
• Onset may take hours if internal
• Was it immediate or gradual?

12

• Inspection/Observation
• Throat alignment - symmetrical, movement
• Nailbeds cyanosis - respiratory difficulty
• Skin Appearance Pale, cool, clammy skin
  indicates low BP
• Discoloration of skin contusion, wound, abrasion
• Check for areas of discoloration, swelling or
  deformities
• Around umbilicus intra-abdominal bleed
• Sides/Flanks swelling outside the abdomen
• Protrusion or swelling in any portion of abdomen
  (internal bleeding)
• Breathing pattern ? abnormalities rate, depth,
  wheezing
• Is the athlete breathing?
• Is the athlete having difficulty breathing?
• Is there symmetry of the chest during breathing?
• If the athletes wind was knocked out, is normal
  breathing returning? How rapidly?
• Postural observation bent over, guarding to one
  side
• Body position
• Thorax injury - leaning towards side that is
  injured and splinting area w/ hand

13

• Vomiting ? internal injuries
• Blood in vomit may signify stomach/esophagus/lung
  injury
• Bright red lung injury
• Bright red and frothy injury to esophagus
  stomach although blood may be swallowed from
  mouth nose
• Hematuria ? blood in urine - injury to kidneys
  ??referral to Doctor
• Monitor vital signs (pulse, respiration, BP)
• Rapid weak pulse or drop in BP is an indication
  of a serious internal injury (involves blood
  loss)

14

• Palpation
• Thorax
• Check for symmetry of chest wall movement -
  search for areas of tenderness, rigidity/softness
• Sternum
• Rib cage
• Palpate along ribs, intercostal spaces,
  costochondral junctions
• Semi-reclining position is useful if athlete is
  having difficulty breathing
• Abdomen
• Place in a comfortable position - arms at side,
  knees hips flexed to relax abdomen (may
  position in hook-lying position)
• Palpate four quadrants (move clockwise starting
  from upper right quadrant)
• Feel for guarding tenderness, rigidity
  (internal bleeding) - pain or accumulation of
  blood
• Rebound tenderness - (inflamed) -peritoneum is
  sensitive to stretching pain with release of
  pressure
• Percussion determines density place one hand
  palm down over area of assessment using index
  and middle fingers, tap DIP joints of hand on
  abdomen.
• Solid organs dull thump
• Hollow organs more resonant (vibrating) sounds,
  crisp.
• Internal bleeding abdomen feels sounds
  solid.

15
Auscultation

• Sounds w/ stethoscope normal gurgling as
  peristalsis occurs if abdomen trauma there is a
  decrease or elimination of the normal noise
• Do before palpation of abdomen
• Chest
• Listen to the front and back on each side
• Best place down and in from tip of scapula
  (depression)
• Perform over apex, centrally and at base of each
  lung
• Normal listen for slight sound in exhale
  (light wind sound)
• If fluid in alveoli crackling sound heard (its
  the popping open of the alveoli)
• sounds like hair crackling between fingers
• If pneumonia/pulmonary contusion/congestive heart
  failure a rattling sound is heard (coming from
  bronchiole tubes)
• Breath sounds
• Should be consistent
• Abnormal patterns
• Cheyne-Stokes breathing (rate changes over 1-3
  minutes)
• Biots breathing - normal rate followed by
  cessation
• Apneustic breathing - pauses in respiratory cycle
  at full inspiration
• Wheeze or rhonchi or rales

16

• Heart Sounds
• Lubbdupp
• Listen for murmur (abnormal period due to valve
  insufficiency)
• Bowel sounds
• Liquid-like gurgling due to peristalsis
• Diminished paralytic ilieus or peritonitis
• High pitched sounds intestinal obstruction

17

• Functional tests Take VITAL signs
• heart rate 60-100 bpm following injury
  rapid
• respiration 12-20 breaths/min.
• rapid/shallow - internal injury, shock
• deep/quick - pulmonary obstruction, asthma
• Blood Pressure
• Pulse
• ROM of abdominal muscles
• Signs of Shock rapid, weak pulse decrease BP,
  rapid, shallow breathing, excessive thirst,
  nausea/vomiting
• pale, bluish skin (cyanotic) restlessness/irrita
  ble, drowsiness, Loss of consciousness

18

• Special tests
• Kernig-Brudzinski Test (combo of 2 tests)
  meningeal irritation, n. root irritation or dural
  irritation
• Lying supine flex neck then actively flex hip
  w/ knee extended until pain is felt in back or
  leg. Keep hip in position where pain is 1st
  felt, flex the knee. () test if pain disappears.
• Lateral Rib Compression Test rib fracture
• Anterior/Posterior Rib Compression Test rib
  fracture, costochondral junction
• Inspiration/Expiration Breathing Test
• Normal breathing rapid, shallow rib fracture
• Deep inspiration rib fracture, costochondral
  separation, or external intercostals muscle
  strain
• Abdominal Percussion (see palpation section)

19
What Type of Injuries Can Occur?

• Fractures (Flail chest)
• Contusions
• Inflammations
• Dislocations
• Lung stuff
• Strains
• Infections
• Torsion
• Cancer
• Menstrual irregularities
• Breathing irregularities

• Abdomen
• Thorax
• Urinary Reproductive
• Kidney Contusion
• Kidney Stones
• Contusion of Ureters, Bladder and Urethra
• Urinary Tract Infections
• Urethritis

20
HOW TO USE AN INHALER

• Read the package insert.
• Dont breathe in rapidly (most hits the back of
  throat and is of no use).
• Shake it up.
• Take a deep breath, let it out, and then expire
  that extra amount.
• Breathe in slowly 5 seconds while breathing
  in inhaler.
• Hold breath as long as you can. Slowly expire.
• Repeat inhaler blast.