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Kin 2236 Athletic Injuries > (3) Lecture 16: Abdominal and Thoracic Injuries > Flashcards

(3) Lecture 16: Abdominal and Thoracic Injuries Flashcards

1
Q

Common causes of abdominal and thoracic injuries

A
  • high-velocity sports
  • being struck w/ an object
  • inadequate protective equipment
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2
Q

Thorax

A
  • portion of the body btwn neck and diaphragm
  • made up of spine posteriorly, ribs laterally and sternum anteriorly

FUNCTION: protect circulatory and resp. organs

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3
Q

Ribs as a ring

A

Ribs wrap around thorax + attach at front

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4
Q

Thoracic injuries

A
  • most are due to BLUNT trauma but can happen due to forceful contractions
  • RIB injuries are common - painful + debilitating
  • heart + lung injuries are less common but serious
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5
Q

Rib contusions

A
  • blow to FRONT/SIDE = rib contusion
  • blow to back, usually paraspinal contusion
  • LOCALIZED PAIN (during inspiration + w/ palpation)
  • manipulation of rib at distance/ “through the ring”
    does NOT increase pain
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6
Q

Rib Fractures

A

can be direct (fracture at site of trauma) or indirect (fracture way from impact due to COMPRESSION)

  • Ribs 5-9 are MOST injured due to rigid fixation
  • usually fractures at weakest point (posterior) angle of ribs

can be DISPLACED or UNDISPLACED
-if displaced (bone poking out), do an exam of internal structures – check ORGANS
- spleen trauma in 20% of lower L rib fracture (liver is less)

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7
Q

Symptoms of rib fractures

A
  • pain w/ coughing and/or deep inspiration
  • trunk movements increase pain
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8
Q

Signs of rib fractures

A
  • may have visible contusion + palpable crepitus (creaking)
  • athlete splints themselves/leans towards injured side
  • pain w/ manipulation AWAY from injury, through ring
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9
Q

Intercostal muscle strain

A
  • most common strain is intercostal muscles
  • usually violent exertional forces/trauma
  • overstretching via ROTATION
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10
Q

Symptoms of intercostal muscle strain

A
  • pain over local area
  • pain w/ inspiration and movement
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11
Q

Signs of intercostal muscle strain

A
  • NO pain w/ pressure through ring
  • positive STTT
  • findings for manual muscle testing
  • tender on palpation btwn ribs over muscle
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12
Q

Pain with fracture

A

indirect pressure causes pain w/ fracture

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13
Q

Management of rib injuries

A
  • send for imaging if fracture is suspected
  • POLICE/PEACE & LOVE
  • stabilize/wrap - may predispose to hypostatic pneumonia (can’t take full breath if splinted too tight)
  • pad for return to play
  • usually out 4-8 weeks
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14
Q

Lung injuries

A
  • NOT common but need to watch out for them
  • pneumothorax
  • tension pneumothorax
  • hemothorax
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15
Q

Pneumothorax

A

PARTIAL collapse (can happen +/- rib fracture)

  • happens when air enters pleural cavity btwn chest wall and lung
  • can progress to complete collapse (tension pneumothorax)

Signs and symptoms
- difficulty breathing (dyspnea)
- shortness of breath
- cyanosis (pale, blue lips)

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16
Q

Tension pneumothorax

A

COMPLETE collapse

Pneumothorax PLUS
- pleural sac fills w/ air until lung collapses = DISPLACES lung and heart to other side
- TRACHEA MAY DEVIATE

CRITICAL

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17
Q

Hemothorax

A
  • presence of blood in pleural cavity
  • can happen +/- rib fracture
  • difficulty breathing, shortness, of breath, cyanosis

coughing up FROTHY BLOOD

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18
Q

Commotio Cordis

A

Traumatic blunt trauma over heart = hit during narrow window of REPOLARIZATION

  • results in cardiac arrest
  • young athletes more at risk b/c of pliability of chest wall
  • hockey, baseball, lacrosse, football
  • get AED ASAP
  • when defibrillation is delivered within ONE MIN, reported survival rate as high as 90%
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19
Q

Abdomen

A
  • lies btwn diaphragm and pelvis
  • lined by PARIETAL PERITONEUM
  • organs are covered by visceral peritoneum
  • enough room btwn organs to bleed to death
  • injury to abdominal wall produces LOCAL PAIN
  • injury to viscera often initially causes localized pain that may spread to entire abdomen if INTRAPERITONEAL irritation develops
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20
Q

Abdominal wall injuries

A
  • muscular contusions
  • abdominal muscle strain
  • solar (celiac) plexus contusion
  • intra-abdominal injuries (penetrating or blunt)
21
Q

Muscular contusions

A
  • LOCALIZED area of tenderness
  • increased pain on contraction/decreased on relaxation
  • with internal bleeding, abdominal wall NOT relax
  • no referred pain (only pain at affected place)
  • treat w/ cold pack and compression
  • position of comfort: on side, curled up
22
Q

Referred pain

A

NO pain @ affected organ BUT will feel pain elsewhere
- ex. during heart attack, feel pain in jaw or arm

23
Q

Abdominal muscle strain

A

RECTUS ABDOMINUS is most commonly injured
- lower rib origin or pubic insertion
- may pull periosteum of pubic rami = osteitis pubis

  • may be seen w/ INTERNAL/EXTERNAL OBLIQUES
  • MOI: violent contraction/twisting or recurrent mcirotrauma
  • LOCALIZED pain + spasm at sight of injury
  • STTT positive
  • manual muscle testing positive
24
Q

Solar (Celiac) Plexus Contusion

A
  • collection of nerves UNDER DIAPHRAGM
  • trauma to relaxed abdominal wall or back
  • “WIND KNOCKED OUT” = transitory paralysis of diaphragm
  • make sure airway is clear
  • loosen belt/restrictive clothing
  • FLEX HIPS + BRING KNEES TO CHEST = take abs off stretch
  • slow expiration, followed by short inspiration
25
Q

Penetrating intra-abdominal injuries

A
  • NOT COMMON
  • usually superficial
  • leave object in place unless ability to stop bleeding is compromised
  • focus on CONTROLLING bleeding
26
Q

Blunt intra-abdominal injuries

A
  • MOST COMMON athletic trauma
  • severity of symptoms varies
  • possibility of PERITONEAL irritation from blood and/or bacterial/intra-abdominal contamination
27
Q

Abdominal quadrants

A

RUQ, LUQ, RLQ, LLQ, Midline

28
Q

RUQ abdominal quadrant

A

Liver
Right Kidney
Gall bladder
Colon
Pancreas

29
Q

LUQ

A

Stomach
Left kidney
Spleen
Colon
Pancreas

30
Q

RLQ

A

Appendix
Colon
Small intestine
Ureter
Major vein and artery to right leg

31
Q

LLQ

A

Colon
Small Intestine
Ureter
Major vein and artery to left leg

32
Q

Midline abdominal quadrants

A

Aorta
Pancrease
Small inetstine
Bladder
Spine

33
Q

Signs of Peritoneal Irritation

A

aka PERITONEAL SIGNS = MEDICAL EMERGENCY

  • abdominal rigidity (inability to relax muscles)
  • guarding
  • referred pain
  • loss of bowel sounds

caused by BLOOD in peritoneal cavity/viscera

34
Q

Heart and spleen referral

A

Left chest

35
Q

Liver and gallbladder referral pattern

A

Right shoulder area and below left boob/chest

36
Q

Pancreas referral pattern

A

Slightly left of stomach area and lower/to left of back middle

37
Q

Stomach referral pattern

A

Middle of stomach on front and middle of bacl

38
Q

Urinary bladder referral pattern

A

Above penis/ and btwn butt cheeks

39
Q

Kidney referral pattern

A

Lower back and front area

40
Q

Appendix referral pattern

A

Right area under stomach

41
Q

Spleen

A
  • deep to left 9-11 rib in LEFT UPPER quadrant (LUQ)
  • injured w/ BLUNT trauma or primary to rib fracture
  • spleen’s capsule can bleed + signs of splenic injury are often delayed = physical exam is unreliable
42
Q

Order of most common organ injuries

A
  1. Spleen
  2. Liver
    3.Kidney
  3. Bladder
43
Q

Most frequently injured organ in sports

A

Spleen

Most common cause of death due to abdominal trauma in athletics

44
Q

Symptoms of spleen injuries

A
  • slow onset b/c symptoms develop SECONDARY to bleeding
  • LUQ pain/left shoulder pain caused by diaphragmatic irritation = KEHR’S SIGN

MEDICAL EMERGENCY

45
Q

Kehr’s sign

A

LUQ pain/left shoulder pain due to diaphragmatic irritation

46
Q

Liver

A

SECOND most commonly injured organ
- located in RUQ = RUQ pain
- REFERRED pain to RIGHT SHOULDER/SCAPULA
- occasional nausea + vomiting

Can be bruised or lacerated
- contusion: NO peritoneal signs
- lacerated: will SHOW peritoneal signs

MEDICAL EMERGENCY

47
Q

Kidney

A

MOI: BLUNT trauma to flank or abdomen
- upper 1/2 of kidneys are above 12th rib

  • flank/low back pain, tenderness, ecchymosis and hematuria (blood in urine)
  • hematuria will also occur w/ repetitive microtrauma (jostling)

MEDICAL EMERGENCY

48
Q

Hematuria

A

blood in urine

49
Q

Bladder

A
  • protected by pelvic ring
  • DECREASED trauma w/ EMPTY bladder
  • blunt trauma over pubic rami = INABILITY TO URINATE DESPITE URGE
  • tenderness over supra-pubic region
  • may have visible ecchymosis over pubic area
  • hematuria

MEDICAL EMERGENCY

Kin 2236 Athletic Injuries (20 decks)

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