Lecture 16 - Abdominal and Thoracic Injuries Flashcards
how do abdominal and thoracic injuries occur?
- high-velocity sports
- being struck with an object
- use of inadequate protective equipment
where is the thorax?
- the portion of the body that lies between the neck and the diaphragm
- made up the spine, ribs and sternum
- protects circulatory and respiratory organs
what are thoracic injuries?
- occur due to blunt trauma but can occur as a result of forceful contractions
- rib injuries are common (painful and debilitating)
- heart and lung injuries are rare but serious
what are rib contusions?
- muscle bruises on the ribs
what causes rib contusions?
- blow to the front/side usually leads to a rib contusion
- blow to back, usually paraspinal contusion
what are the symptoms and signs of rib contusions? and how do you treat them?
- localized pain (during inspiration, with palpation)
- behaves like a typical muscle bruise so treat it like one
- manipulation of rib at distance/ “through the ring” does not increase pain
- indirect test/squeeze test (at front and back of the ring) will not increase pain
what causes a rib fracture?
- direct or indirect trauma
- fracture at site of trauma (kick/punch)
- fracture away from impact as a result of compression (in tackle sports)
what are the details and complications of a rib fracture?
- ribs 5-9 commonly injured (rigid fixation)
- fractures at the weakest point (posterior - the angle of ribs)
- can be displaced or undisplaced
- if displaced = examine internal structures
- spleen trauma may occur with lower L rib fractures
- liver trauma may occur with lower R rib fractures
what are the signs and symptoms of rib fractures?
- pain with coughing and/or deep inspiration
- trunk movements increase pain
- may have visible contusion and palpable crepitus (creaking sound if cracked)
- athletes splint themselves by leaning towards the injured side
- pain with manipulation away from the injury (through ring)
what is the cause of intercostal muscle strains?
- the most common strain
- usually caused by a violent exertional force/trauma
- overstretching via rotation
what are the symptoms of intercostal muscle strains?
- typical muscle strain and will behave like one
- pain over local area
- pain with inspiration and movement
what are the signs of intercostal muscle strains?
- no pain with pressure through the ring
- positive STTT
- findings for manual muscle testing
- TOP between the ribs over the muscles (tender on palpation)
how do you manage rib injuries?
- send for imaging if a fracture is possible
- POLICE/peace and love
- stabilize/wrap (but not too tight, don’t want hypostatic pneumonia)
- pad for return to play
- usually out for 4-8 weeks (painful first few weeks)
what are the details of lung injuries?
- no common, but life-threatening
- know what to look for
- emergency assessment if they can’t be ruled out
what are the details, signs and symptoms of pneumothorax? (partial collapse)
- occurs when air enters the pleural cavity (between chest wall and lung)
- can progress to a complete collapse
- difficulty breathing (dyspnea), shortness of breath and cyanosis (pale/blue lips)
what are the details, signs and symptoms of tension pneumothorax? (complete collapse)
- same as pneumothorax
- pleural sac continues to full with air until lung collapses
- displaces lung and heart to other side
- trachea may deviate (not at middle because of pressure)
- this is critical
what are the details, signs and symptoms of hemothorax?
- the presence of blood in the pleural cavity
- can happen with/without rib fracture
- difficulty breathing, shortness of breath and cyanosis
- coughing up frothy blood (pinkish and foamy blood)
what is commotio cordis?
- traumatic blunt trauma over the heart
- hit during narrow window of heart repolarization
- results in cardiac arrest
- young athletes more at risk due to pliability of chest wall (more common in kids)
- hockey, lacrosse (more because of a heavy ball), baseball
what should you do if commotio cordis occurs?
- immediate death in 50% of cases
- 50% brief period of consciousness prior to collapse
- resuscitation seldom successful
- get AED asap
where is the abdomen?
- between the diaphragm and the pelvis
- lined by the parietal peritoneum
- organs are covered by the visceral peritoneum
- cavity for abdominal organs more freely
- enough room between organs to blood to death
what are the signs/symptoms of abdominal injury?
- local pain
- injury to viscera may cause pain that spreads (if significant bleed is present)
what are the signs/symptoms of abdominal wall contusions?
- localized area of tenderness
- increased pain on contraction
- with internal bleeding, abdominal wall will not relax
- no referred pain
- treat with cold pack and compression
what abdominal muscles may get injured?
- rectus abdominus or internal/external obliques
what is the MOI of an abdominal muscle strain?
- sudden violent contraction/twisting or recurrent microtrauma
what are the signs/symptoms of abdominal muscle strains?
- localized pain and spasm at site
- STTT positive
- manual muscle testing positive
what is solar (celiac) plexus contusion?
- collection of nerves under the diaphragm
- trauma to relaxed abdominal wall or back
- transitory paralysis of the diaphragm (wind knocked out)
how do you deal with solar plexus contusions? (wind knocked out)
- make sure airway is clear
- loosen belt/restrictive clothing/assure person they will live
- flex hips and bring knees to chest (take abdomen off stretch)
- slow expiration, followed by a short inspiration
what are the characteristics of an intra-abdominal penetrating injury?
- not very common
- usually superficial
- leave the object unless ability to stop bleeding is compromised
- focus on controlling bleeding
what are the characteristics of an intra-abdominal blunt injury?
- most common athletic trauma
- severity of symptoms will vary widely
- possibility of peritoneal irritation from blood and/or bacterial/intra-abdominal contamination (if a tear in bowel/intestine)
what organs are found in the right upper quadrant?
- liver
- right kidney
- gallbladder
- colon
- pancreas
what organs are found in the left upper quadrant?
- stomach
- left kidney
- spleen
- colon
- pancreas
what organs are found in the right lower quadrant?
- appendix
- colon
- small intestine
- ureter
- major vein and artery to right leg
what organs are found in the left lower quadrant?
- colon
- small intestine
- ureter
- major vein and artery to left leg
what organs are found on the midline?
- aorta
- pancreas
- small intestine
- bladder
- spine
what are the signs of peritoneal irritation? (aka peritoneal signs)
- signs of acute abdominal injury
- abdominal rigidity (can’t relax)
- guarding
- referred pain
- loss of bowel signs ***
- caused by blood in the peritoneal cavity/viscera
where is the referred pain of liver and gallbladder injury?
- right shoulder/trap region
- at surface of right upper quadrant (organ location)
- directly behind the organ
where is the referred pain of appendix?
- entire flank/hip region (both anterior and posterior)
where is the referred pain of the heart and spleen?
- left upper quadrant and down interior of left arm
where is the referred pain of the stomach?
- middle below sternum near upper quadrants
- same location posterior
where is the referred pain of the pancreas?
- left upper quadrant (both anterior and posterior)
where is the spleen?
- deep to the left 9-11 rib in the left upper quadrant
what causes spleen injuries?
- blunt trauma or 2nd degree to rib fracture
what are the symptoms of spleen injury?
- slow onset (second-degree to bleeding, and bleeding is contained in the capsule)
- left upper quadrant pain/left shoulder pain (diaphragmatic irritation- Kehr’s sign)
- tender ever if no referred pain should still get checked out
- the most frequently injured organ in sport, and most common cause of death due to abdominal trauma in sports
what are the symptoms of liver injury?
- 2nd most common organ injured
- located in the right upper quadrant
- pain at location
- referred pain in right shoulder/scapula
- occasional nausea or vomiting
- can be bruised or lacerated
- contusion = no peritoneal signs
- lacerated = peritoneal signs
what are the symptoms of kidney injury?
- MOI = blunt trauma to flank or abdomen
- upper 1/2 of kidneys are above the 12th rib
- pain at location
- tenderness
- ecchymosis
- hematuria (blood in the urine)
- hematuria may also occur from repetitive microtrauma (jostling) –> not a medical emergency
- should not play contact sports if you only have 1 kidney
what are the symptoms of bladder injury?
- protected by pelvic ring
- decreased trauma with empty bladder (more likely to tear when full because stretched and increased pressure)
- blunt trauma to pubic rami (inability to urinate despite urge)
- tenderness of supra-pubic region
- may have visible ecchymosis over pubic area
- hematuria
