The Thorax and Abdomen

1. The Thorax and Abdomen Chapter 21

2. Thoracic Cavity Ribs, Costal Cartilage, and Sternum Thoracic Muscles Lungs Respiratory Muscles Blood Supply Heart blood supply Thymus Abdominal Muscles Abdominal Viscera Anatomy of Thorax

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. 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

6. 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

7. Palpations Feel surrounding structures. Bone changes Muscle and attachments Ligaments and attachments Spasm Bleeding pulses Special Tests Ausculation Percussion Rebound Assessing Injuries to Thorax and Abdomen

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

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. Injuries to the Lungs Pneumothorax Hemothorax Traumatic Asphyxias Heart Contusion Sudden Death Syndrome Abdominal Injuries Kidney Contusions Kidney Stones Recognition and Management of Specific Injuries

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. 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

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