Thorax and Abdomen

1
Thorax and Abdomen

• Chapter 26

2
Thorax

• Contained within the thoracic vertebrae, 12 ribs,
  and sternum
• Main function is to protect the vital respiratory
  and circulatory organs and to assist the lungs in
  inspiration and expiration

3

• Ribs are attached to the sternum in front by
  cartilage and thoracic vertebrae in the back.
• Upper 7 are true or sternal ribs
• 8-10 are false because they have cartilages
  that unite and join the sternum
• 11-12 are floating ribs because they are not
  attached to the sternum.

4
Muscles

• Intercostal muscles lie between the ribs and
  function in breathing (inspiration and
  expiration)
• Diaphragm muscle separates the thoracic cavity
  from the abdominal cavity and function in
  inspiration and expiration.

5
Rib Contusions

• Mechanism
• blow to rib cage that contuses the intercostals
• Sx Sx
• sharp pain with breathing
• point tenderness
• pain with rib cage compression.

6

• Management
• x-ray to r/o fracture
• RICE and NSAIDS
• rest is best way to heal

7
Rib Fractures

• Mechanism
• direct impact (kick) or compression of the rib
  cage.
• Ribs 5-9 are most commonly fractured. May
  puncture lung.

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• Sx Sy
• Severe pain during inspiration
• point tenderness during palpation
• Management
• x-ray, support (rib belt)
• Rest, Will heal within 3-4 weeks.

9
Costal Cartilage Injury

• Mechanism
• (higher incidence of than fx)
• Direct blow
• sudden twist or a fall on a ball, compressing the
  rib cage.

10

• Sx Sy
• to differentiate between fx look at location of
  pain.
• Sharp pain during sudden movement of trunk and
  difficulty in breathing deeply.
• Point tenderness with swelling. May be deformity
  and crepitus as rib moves in and out of place

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• Management
• rest and immobilization with rib belt.
• Healing may take 1-2 months.
• No activity until pain free.

12
Intercostal Muscle Injury

• Mechanism
• direct blow or sudden torsion of the trunk
• Sx Sy
• pain with active motion.
• Pain during inspiration and expiration, laughing,
  coughing or sneezing.
• Management
• Ice and compression, immobilization

13
Pneumothorax

• Pleural cavity surrounding the lung becomes
  filled with air that has entered through an
  opening in the chest. As the pleural cavity
  fills with air, the lung collapses.

14

• Sx Sy
• Pain and breathing difficulty
• anoxia (without oxygen)
• Management
• 911, maintain vitals

15
Tension Pneumothorax

• When the pleural cavity on one side fills with
  air and displaces the lung and heart toward the
  opposite side, compressing the opposite lung.

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• Sx Sy
• shortness of breath, chest pain on side of
  injury, absence of breath sounds, cyanosis,
  distention of neck vein, trachea may deviate away
  from side of injury.
• Management
• 911, maintain vitals

17
Hemothorax

• Blood in the pleural cavity from tearing or
  puncturing of the lung or pleural tissue,
  involving the blood vessels in the area.

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• Sx Sy
• Pain and breathing difficulty
• cyanosis
• coughing up frothy blood
• signs of shock
• Management
• 911, maintain vitals

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Traumatic Asphyxia

• Mechanism
• Result of a violent blow to or compression of the
  rib cage, causing a cessation of breathing
• Sx Sy
• breathing difficulty - shortness of breath or no
  breathing

20

• Sx Sy (cont.)
• chest pain on side of injury
• coughing blood
• Cyanosis
• potential shock
• Management
• 911, rescue breathing

21
Sudden Death Syndrome

• Most common cause is a congenital cardiovascular
  abnormality (numerous conditions)
• Noncardiac causes
• Drugs and/or alcohol
• Bleeding in the brain
• Respiratory diseases

22

• Sx Sy
• May be no symptoms prior to death
• Cardiac sx sy
• chest pain or discomfort during exertion
• heart palpitations or flutters, or heart murmurs
• nausea, profuse sweating
• shortness of breath, or no breathing
• general discomfort, fever

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• Management
• 911
• maintain vitals.

24
Coopers Ligament Injury

• Mechanism
• violent up and down and lateral movements of
  breasts which stretches the Coopers ligament
• Sx Sy
• Premature ptosis (sagging)
• Management/Prevention
• wear a well designed bra

25
Runners Nipple

• Mechanism
• shirt rubs the nipples and causes an abrasion
• Management
• band-aids over nipples

26
Bicyclists Nipple

• Mechanism
• result of a combination of cold and evaporation
  of sweat, causing nipples to be painful
• Management
• wearing a wind breaker