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241 > leccture 6- thorax > Flashcards

leccture 6- thorax Flashcards

1
Q

3 respiratory muscles

A

-diaphragm
-intercostal muscles
-sternocleidomastoid

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2
Q

5 boundaries of the thorax

A

neck
diaphragm
thoracic vertebrae
ribs, sternum
muscles

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3
Q

Bones of the thorax

A

-12 thoracic vertebrae

-sternum
(manubrium, body, xiphoid process)

-12 pairs of ribs

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4
Q

Explain the attachments of the 12 thoracic ribs

A

1 to 7 attach to the sternum by individual cartilage (costochondral)

8, 9 and 10 share one attachment

11 and 12 are not attached to the sternum

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5
Q

contents of the thorax

A

lungs
heart
aorta and branches
superior vena cava
azygous vein
trachea
esophagus
vagus nerve

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6
Q

injuries: muscle strains

A

most common in running
intercostals, diaphragm and others

SSx:
-pain on deep inspriration, dypsnea
-tenderness

Tx:
rest, analgesics

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7
Q

injuries: rib fracture

A

direct blow, compression (tackle)

SSx:
severe inspiratory pain and dyspnea

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8
Q

costochondral sprain or dislocation

A

same Hx, Ssx, Tx as strain

plus crepitus deformity (surgery?)

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9
Q

life threatening injuries: pneumothorax (open vs closed)

A

open pneumothorax= air accumulates between chest wall and lung
**if open, there would be a puncture

closed= tear within lung
–> can happen spontaneously in very tall, skinny people

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10
Q

Pneumothorax SSx

A

severe dyspnea (running out of air), shock, cyanosis, rapid respiratory rate (RR)

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11
Q

life threatening injuries: flail chest

A

= multiple rib fractures

  • paradoxical motion of part of chest wall
    –> opposite motion of thoracic cage in place of injury!!! in and out in reverse of normal movement
  • SSx and Tx same as pneumothorax
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12
Q

Abdomen boundaries

A

diaphragm
pelvis
abdominal muscles
vertebrae
lower ribs
back muscles

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13
Q

abdomen quadrants

A

right upper quadrant/RUQ, LUQ, RLQ, LLQ

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14
Q

abdomen blood vessels

A

abdominal aorta, inferior vena cava

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15
Q

abdomen “visitors”

A

bladder if it is v full

uterus in pregnancy

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16
Q

Inguinal area contains

A

inguinal ligament
ASIS to pubic tubercle

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17
Q

What is above the inguinal ligament?

A

the inguinal canal!! which is the site of inguinal herniation

–> the inguinal ligament also has internal and external inguinal rings

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18
Q

The inguinal canal is a passage in the

A

lower part of the abdominal wall for spermatic cord in males or round ligament of uterus in females

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19
Q

What is below the inguinal ligament?

A

the femoral triangle!!!

–> femoral artery, nerve and vein
–> site of femoral herniation

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20
Q

Abdominal organs

A

liver RUQ
spleen LUQ
kidneys

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21
Q

abdominal intestines and glands

A

stomach, duodenum, ileum, jejunum, colon (appendix in RLQ)

pancreas, gallbladder

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22
Q

injuries: blow to coeliac (solar) plexus
(Hx, SSx, Tx)

A

Causes (Hx):
-trauma to central abdomen leads to nerve concussion

-transient paralysis (due to weakness, muscle control comes and goes periodically) of diaphragm

SSx:
Ache, shortness of breath/dyspnea, anxiety

Tx:
relaxation (short inhalation, long exhalation), reassurance, observe!!!

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23
Q

injuries: Side stretch
(Hx, SSx, Tx)

A

Hx:
strain or contusion of abdominal muslce

SSx: crampy pain, worse w inspiration

Tx: stretching, analgesics, rest

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24
Q

Injuries: herniae
definition and mechanism

A

= protrusion of abdominal contents through defect in muscle/fascia

mechanism:
-predisposition (weakness)
-valsalva or direct blow

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25
Q

Degrees of herniae (3)

A
  1. Reducible
  2. Incarcerated
  3. Strangulated
26
Q

types of herniae

A

inguinal: mostly males

femoral: uncommon, mostly females

27
Q

herniae SSx

A
  • “pull” or weakness
  • aching pain
  • swelling, tenderness above (inguinal) or below (femoral) ligament
  • pain swelling worse w valsalva or coughing?
28
Q

herniae Tx

A

strengthen abdomen
surgery

29
Q

Strangulated herniae

A

is an emergency!!!!

nausea, vomiting, intense pain
NPO, transport to hospital!!!!

30
Q

injuries: sports hernia/athletic pubalgia

A

not the same as herniae!

same buildup as MTSS but occurring at the pubic bone

SSx: chronic groin pain, pain w twisting, hip extension, possible pain into testicle
AxL pt history, physical exam, MRI

tear of abdominal muscles or tendon at attachment to pubic tubercle

entrapment of inguinal or genitofemoral nerve

often labral tear with adductor strain

Tx: rest, surgery

31
Q

mononucleosis

A

enlarged spleen

not allowed to play contact sports to protect the area

–> delayed abdominal pain after contusion to abdomen??? send to MD!!!!!

32
Q

C spine anatomy

A

C1= altas (skull flexion/extension)

C2= axis (rotation, C1 pivots on C2)

C7= vertebra prominens

33
Q

Spinal nerves

A

C1-C7 exit above the same vertebrae

C8 exits between C7 and T1

C5-T1 form brachial plexus

C3-C5 innervate diaphragm

34
Q

facial bones are

A

Fragile (except mandible)

TMJ (temporomandibular joint; hinge and gliding joint)

35
Q

common mechanism of injuries for neck (neck strains and sprains Hx)

A
  • flexion/extension
  • torsion
  • compression
36
Q

Neck injury SSx

A

SSx:
Pain, tenderness
Muscle spasm
Restricted ROM
Headaches

**check for neurological SSx

37
Q

Neck injury management

A
  • Stabilize
  • If neurologic or severe trauma assume fracture/nerve damage. May lead to permanent brachial plexus or spinal cord injury
38
Q

Neck sprain or strain Tx

A
  • Rest, NSAIDs, physio, massage, flexibility, strengthening
  • Recurrence is common
39
Q

neck injury or concussion (what force?)

A

sprain or strain only require 4.5 G of force

concussions need 70 to 120 G of force

–> you CANNOT have a concussion without injuring your neck

40
Q

concussion=

A

Immediate, transient, neurologic dysfunction due to trauma of the brain

Mild traumatic brain injury

41
Q

the spreading depression phase is an —- problem

A

energetic management

42
Q

Excitation phase
(ca+, k+, glutamate, glucose and blood flow)

A

calcium is elevated 500% for up to 6 days

potassium is elevated 400% within 12 minutes

glutamate elevated 133% for 6 miniutes

glucose elevated 200% of normal in first 20 min, then drops below normal for up to 10 days

40% decrease in cerebral blood flow

43
Q

brain injury; grey and white matter

A

grey matter and white matter move at diff rates

causes shearing/damage of axons

44
Q

neurometabolic cascade

A

dramatic increase in neurotransmitters after a brain inury

  1. excitation phase
  2. spreading depression phase
45
Q

explain spreading depression phase

A

Na+/K+ pump maintains balance of Na+, Ca+ inside cells and K+ outside cells

requires ATP

BUT high level of Ca+ is poisonous for mitochondria

ENERGY crisis!!!!
- increased ATP demand by Na+/K+ pump
- decreased ATP production by mitochondria

46
Q

why are people fatigued/not feeling good after a brain injury?

A

spreading depression phase results in decreased ATP production

47
Q

3 categories of concussion SSx

A
  1. Physical
    = headache, dizziness, ringing in ears, pressure in head, neck stiffness/pain, vision problems, balance problems, vomiting/nausea
  2. Behavioural/emotional
    =personality changes, concentration problems, confusion, fatigue, irritable, emotional, anxious, depressed
  3. Thinking/cognitive
    = memory, confusion, concentration, hard to find the words to say, slow to respond, disorientation, brain fog
48
Q

SCAT 5

A

=sports concussion assessment tool

49
Q

can we use imaging to determine if someone has had a concussion?

A

no

50
Q

Concussion Tx:

A

Stabilize neck
ABCDs serial assessment
Rest
High carb diet
No absolute rest—light physical activity, gradually increase
Limit screen time
Don’t go in a dark room!

51
Q

symptoms gone= recovered?!

A

we can indirectly measure ATP activity

full ATP recovery in the brain is 30 days or longer

return to sport before brain is metabolically recovered= inc risk of reinjury

52
Q

FULL metabolic recovery from concussion takes

A

30 to 45 days!!!

53
Q

concussion RTP

A

Absence of Sx before RTP

Clearance from medical professional

Physical testing
(Buffalo treadmill test and Blackhawk test)
gradually increasing intensity of exercise (walking on treadmill and using bike)

  • fatigue will show us when mitochondria production fails

Return to school protocol before return to play protocol

54
Q

concussion complications

A
  • Epidural haematoa (arterial)
  • Subdural haematoma (venous)
  • Airway obstruction
  • Skull fracture (leads to infection

–> Protein deposits in the brain (CTE)
- impacts blood brain barrier, depression, mood disorders

55
Q

most dangerous movement for brain

A

rotational deceleration

56
Q

NFL RTP protocol: 5 phases

A

Phase 1: symptoms limited activity
Phase 2: aerobic exercise
Phase 3: football specific exercise
Phase 4: club-based non-contact training drills
Phase 5: full football activity clearance

57
Q

Mandibular fracture and/or temporomandibular dislocation
(Hx, SSx, Tx)

A

Hx: direct blow

SSx: deformity, spasm (airway is threatened)

Tx: ABCDs, stabilize, hospital ASAP

58
Q

Nasal fracture

A

Hx: direct blow
SSx: pain, swelling crepitus, deformity, epistaxis, uneven air entry
Tx: cold compress, go to MD

59
Q

Epistaxis

A

Hx: direct blow, sinusitis, “digital”= sticking finger up nose
Tx: elevation, cold, pressure

60
Q

External ear contusion

A

Hx: direct blow
SSx: swelling, bruising, tenderness
Conplication: deformity
Tx: cold pack, compress
Prevention: ear protection

61
Q

Eye injuries

A

Contusion
Foreign body, laceration, abrasion
Infection

go to MD

62
Q

Tooth fracture

A

Save fragment (cold milk)
Go to dentist within 2 hours

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