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Athletic Injuries > Lecture 16 - Abdominal and Thoracic Injuries > Flashcards

Lecture 16 - Abdominal and Thoracic Injuries Flashcards

1
Q

how do abdominal and thoracic injuries occur?

A
  • high-velocity sports
  • being struck with an object
  • use of inadequate protective equipment
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2
Q

where is the thorax?

A
  • 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
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3
Q

what are thoracic injuries?

A
  • 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
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4
Q

what are rib contusions?

A
  • muscle bruises on the ribs
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5
Q

what causes rib contusions?

A
  • blow to the front/side usually leads to a rib contusion
  • blow to back, usually paraspinal contusion
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6
Q

what are the symptoms and signs of rib contusions? and how do you treat them?

A
  • 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
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7
Q

what causes a rib fracture?

A
  • direct or indirect trauma
  • fracture at site of trauma (kick/punch)
  • fracture away from impact as a result of compression (in tackle sports)
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8
Q

what are the details and complications of a rib fracture?

A
  • 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
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9
Q

what are the signs and symptoms of rib fractures?

A
  • 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)
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10
Q

what is the cause of intercostal muscle strains?

A
  • the most common strain
  • usually caused by a violent exertional force/trauma
  • overstretching via rotation
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11
Q

what are the symptoms of intercostal muscle strains?

A
  • typical muscle strain and will behave like one
  • pain over local area
  • pain with inspiration and movement
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12
Q

what are the signs of intercostal muscle strains?

A
  • no pain with pressure through the ring
  • positive STTT
  • findings for manual muscle testing
  • TOP between the ribs over the muscles (tender on palpation)
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13
Q

how do you manage rib injuries?

A
  • 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)
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14
Q

what are the details of lung injuries?

A
  • no common, but life-threatening
  • know what to look for
  • emergency assessment if they can’t be ruled out
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15
Q

what are the details, signs and symptoms of pneumothorax? (partial collapse)

A
  • 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)
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16
Q

what are the details, signs and symptoms of tension pneumothorax? (complete collapse)

A
  • 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
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17
Q

what are the details, signs and symptoms of hemothorax?

A
  • 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)
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18
Q

what is commotio cordis?

A
  • 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
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19
Q

what should you do if commotio cordis occurs?

A
  • immediate death in 50% of cases
  • 50% brief period of consciousness prior to collapse
  • resuscitation seldom successful
  • get AED asap
20
Q

where is the abdomen?

A
  • 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
21
Q

what are the signs/symptoms of abdominal injury?

A
  • local pain
  • injury to viscera may cause pain that spreads (if significant bleed is present)
22
Q

what are the signs/symptoms of abdominal wall contusions?

A
  • 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
23
Q

what abdominal muscles may get injured?

A
  • rectus abdominus or internal/external obliques
24
Q

what is the MOI of an abdominal muscle strain?

A
  • sudden violent contraction/twisting or recurrent microtrauma
25
Q

what are the signs/symptoms of abdominal muscle strains?

A
  • localized pain and spasm at site
  • STTT positive
  • manual muscle testing positive
26
Q

what is solar (celiac) plexus contusion?

A
  • collection of nerves under the diaphragm
  • trauma to relaxed abdominal wall or back
  • transitory paralysis of the diaphragm (wind knocked out)
27
Q

how do you deal with solar plexus contusions? (wind knocked out)

A
  • 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
28
Q

what are the characteristics of an intra-abdominal penetrating injury?

A
  • not very common
  • usually superficial
  • leave the object unless ability to stop bleeding is compromised
  • focus on controlling bleeding
29
Q

what are the characteristics of an intra-abdominal blunt injury?

A
  • 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)
30
Q

what organs are found in the right upper quadrant?

A
  • liver
  • right kidney
  • gallbladder
  • colon
  • pancreas
31
Q

what organs are found in the left upper quadrant?

A
  • stomach
  • left kidney
  • spleen
  • colon
  • pancreas
32
Q

what organs are found in the right lower quadrant?

A
  • appendix
  • colon
  • small intestine
  • ureter
  • major vein and artery to right leg
33
Q

what organs are found in the left lower quadrant?

A
  • colon
  • small intestine
  • ureter
  • major vein and artery to left leg
34
Q

what organs are found on the midline?

A
  • aorta
  • pancreas
  • small intestine
  • bladder
  • spine
35
Q

what are the signs of peritoneal irritation? (aka peritoneal signs)

A
  • 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
36
Q

where is the referred pain of liver and gallbladder injury?

A
  • right shoulder/trap region
  • at surface of right upper quadrant (organ location)
  • directly behind the organ
37
Q

where is the referred pain of appendix?

A
  • entire flank/hip region (both anterior and posterior)
38
Q

where is the referred pain of the heart and spleen?

A
  • left upper quadrant and down interior of left arm
39
Q

where is the referred pain of the stomach?

A
  • middle below sternum near upper quadrants
  • same location posterior
40
Q

where is the referred pain of the pancreas?

A
  • left upper quadrant (both anterior and posterior)
41
Q

where is the spleen?

A
  • deep to the left 9-11 rib in the left upper quadrant
42
Q

what causes spleen injuries?

A
  • blunt trauma or 2nd degree to rib fracture
43
Q

what are the symptoms of spleen injury?

A
  • 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
44
Q

what are the symptoms of liver injury?

A
  • 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
45
Q

what are the symptoms of kidney injury?

A
  • 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
46
Q

what are the symptoms of bladder injury?

A
  • 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

Athletic Injuries (13 decks)

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