The Thorax and Abdomen

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
• 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
• 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
• 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
• 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
• 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
ofReproductive Organs

• Scrotal Contusion
• Spermatic Cord Torsion
• Contusion of Female Genitalia
• Vaginitis