kin 188 thoracic and abdominal evaluation and injuries
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KIN 188 – Prevention and Care of Athletic Injuries
Thoracic and Abdominal
Evaluation and Injuries
Anatomy
Bony Anatomy
Thorax Anterior – sternum Lateral – ribs Posterior - vertebrae
Abdomen Posterior – vertebrae Lateral – ribs (lesser extent)
Muscular Anatomy
Muscles of inspiration Diaphragm Intercostals
Muscles of expiration Abdominal muscles
Rectus abdominus Internal/external
obliques Transversus abdominus
Respiratory Tract Anatomy
Lungs Left – 2 lobes Right – 3 lobes
Trachea Divides into bronchi
Pleural linings Parietal – lines cavity Visceral – lines lungs Creates potential space
Cardiovascular Anatomy
Heart 2 atria 2 ventricles
Vascular structures Aorta Inferior/superior vena
cava Pulmonary arteries/veins
Digestive Tract/Lymphatic Anatomy
Esophagus
Stomach
Small intestine Duodenum, jejunum,
ileum
Large intestine (colon) Cecum (appendix),
ascending/transverse/descending, sigmoid, rectum, anus
Liver/gall bladder
Spleen
Digestive Tract/Lymphatic Anatomy
Genitourinary Anatomy
Urinary anatomy Kidneys, ureters, bladder,
urethra Male reproductive
anatomy Testes, epididymis, penis
Female reproductive anatomy Ovaries, fallopian tubes,
uterus, vagina
Evaluation
History
Mechanism of injury/etiology Almost all etiology associated with direct trauma
to abdomen/thorax Another competitor Equipment Ground Increased incidence with trauma to unprotected areas
Location of pain Must know anatomy
History
Onset of symptoms If musculoskeletal, usually rapid onset If organ related, may have quick or slow onset depending
upon structure and amount/rate of bleeding
Symptoms/chief complaint/s Dyspnea, abdominal pain, nausea/vomiting (appearance),
dizziness, hematuria, blood in stool
Medical history Any prior thoracic/abdominal injuries?
Inspection/Observation
Posture/guarding Often lean toward painful area for splinting
Breathing pattern Rate/depth/quality of breaths
Capillary refill Best done at fingers for cursory vascular
evaluation
Inspection/Observation
Muscle tone Tension due to spasm/guarding or internal bleeding
Discoloration/ecchymosis Typically not visible, abrasions/etc. indicative of potential
underlying trauma
Vomiting “Coffee grounds” if blood in it
Hematuria If visible, significant for genitourinary conditions May need urinalysis for ultimate determination
Palpation
Abdominal quadrants Upper left Upper right Lower left Lower right
Palpation
Positioning Best done in “hook laying” position
Rigidity Guarding/spasm vs. internal bleeding
Rebound tenderness Tension on peritoneum (lining of abdominal cavity)
Percussion Hollow vs. solid organs
Auscultation Listen for bowel sounds (“gurgling”)
Special Tests
Vital sign assessment for shock secondary to internal bleeding Increased heart/respiratory rates, decreased blood
pressure
Neurological signs – referred pain sites L shoulder – spleen (Kerr’s sign) R shoulder – liver Flanks – kidneys Groin – gonads Medial thigh - bladder
Injuries
Thoracic Injuries
Bony injuries Rib fracture
Most common to anterior/lateral aspect of 5th-9th ribs
Flail chest 4 or more ribs fractured
in 2 or more places Sternum fracture
Potential for significant injury if posterior displacement
Thoracic Injuries
Pneumothorax Accumulation of air in
pleural cavity that affects ability of lung to expand Decreased oxygen,
hypoxia, respiratory distress
Dyspnea, pain with respirations, guarding or splinting of affected area, possible cyanosis
Decreased or absent breath sounds on auscultation of affected lung
Thoracic Injuries
Hemothorax Accumulation of blood in
the pleural cavity Bleeding from lacerated
lung and/or rupture of blood vessel within thoracic cavity
May be from penetrating injury
Often occurs simultaneously with pneumothorax
Abdominal Injuries
Liver injury Typically associated with blunt force trauma to upper right
quadrant – contusion vs. laceration
Splenic injury Typically associated with blunt force trauma to upper left
quadrant – may be atraumatic Risk is higher if spleen enlarged due to systemic condition
(mono, pneumonia, etc.)
Kidney injury Well protected anatomically by rib cage, vertebrae and spinal
musculature Typically associated with blunt force trauma to “flank” region
Organ Injuries
Abdominal Injuries
Appendix injuries Appendicitis
Initial general systemic symptoms Initial tenderness in lower right quadrant (McBurney’s
point) – rebound tenderness May have referred pain to right chest, upper trap and/or
umbilicus
Appendix rupture May be more risk with blunt force trauma to lower
right quadrant if appendix is inflamed
Appendicitis
Abdominal Injuries
Male reproductive injuries/conditions More common than in women due to external location of
male genitalia Testicular contusion
Etiology is direct trauma Calm injured person Signs and symptoms (localized pain, often severe,
nausea/vomiting Must inspect for abnormalities (self-exam unless unable) once
symptoms minimize (swelling, abnormal tissue density) Testicular torsion
Twisting of spermatic cord within scrotum Signs and symptoms (intense pain, nausea/vomiting, swelling
and/or mass in scrotum from occlusion of vascular structures
Testicular Torsion
Abdominal Injuries
Female reproductive injuries/conditions Less common due to protection afforded by
abdomen/anatomical location
Amenorrhea Primary vs. secondary
Primary – absence of onset of menstruation by age 16 Secondary – cessation of menstruation for 6+ months
Contributing factors Exercise, weight loss, stress, anxiety Body image, societal pressures
Abdominal Injuries
Female reproductive injuries/conditions Dysmenorrhea
Pain and/or cramping in lower abdomen and pelvis prior to menstruation
Signs and symptoms (nausea/vomiting, diarrhea or constipation, bloating)
Female athlete triad Comprised of three elements
Amenorrhea, disordered eating, osteoporosis Presence of one component requires screening for the others
In combination, can be life threatening Best treatment is prevention (screening) and education
Team approach to clinical treatment – physiological and psychological
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