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athletic injuries 2036 > Lecture 16: Abdominal and thoracic injuries > Flashcards

Lecture 16: Abdominal and thoracic injuries Flashcards

1
Q

abdominal and thoracic injuries

A
  • athletic injuries affect the abdomen (spleen, liver and kidney)
    -can be from being struck with an object or use of inadequate protective equipment
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2
Q

the Thorax

A
  • is the portion of the body that lies between the neck and the diaphragm
  • it is made up of the spine posteriorly, the ribs laterally and the sternum anteriorly
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3
Q

what is the main function of the thorax?

A
  • to protect circulatory and respiratory organs
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4
Q

Thoracic injuries

A
  • most occur due to blunt trauma but can occur as a result of forceful contractions
    -rib injuries are common (usually very painful and debilitating)
  • heart and lung injuries less common but are serious and require immediate attention
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5
Q

rib contusions

A
  • results from a blow to front/side (blow to back, usually is a paraspinal contusion)
  • localized pain
    • during inspiration
    • with palpation
  • manipulation of rib at distance/ “through the ring”; DOES NOT increase pain
  • it is a typical bruise
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6
Q

rib fractures:

A
  • can be direct or indirect
    • fracture at site of trauma -
      kick/punch
    • fracture away from impact
      as a result of
      compression-football,
      wrestling
      -can be displaced or undisplayed
    • if displaced, then an
      examination of internal
      structures should be
      conducted
    • spleen trauma reported
      in 20% of lower Left rib
      fracture
    • liver trauma in 10% of
      lower Right rib fractures
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7
Q

where to ribs usually fracture?

A
  • at the weakest point (posterior)
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8
Q

what ribs are most commonly injured? why?

A

ribs 5-9 and because their rigid fixation

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9
Q

symptoms of rib fractures

A
  • pain with coughing and/or deep inspiration
  • trunk movements increase pain
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10
Q

what makes fractures different from contusions

A
  • fractures have pain with manipulation through the ring
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11
Q

signs of rib fractures

A
  • may have visible contusion and palpable crepitus
  • usually find athlete splinting themselves/leaning towards the injured side
  • pain with manipulation AWAY from injury, through ring
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12
Q

intercostal muscle stain

A
  • most common strain is the intercostal muscles
  • usually violent external forces/trauma
  • overstretching via rotation
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13
Q

symptoms of intercostal muscle strains

A
  • pain over local area
  • pain with inspiration and movements
    (this is a typical muscle strain, it will behave like one!)
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14
Q

signs of a intercostal muscle strain

A
  • no pain with pressure through ring
  • postive STTT
  • findings for mannul muscle testing
  • Tender on palpation between the ribs over the muscles
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15
Q

management of rib injuries

A
  • send for imaging if fracture is suspected or can not be ruled out
  • peace & love / police
  • stabilize/wrap
    • watch out may predispose
      to hypostatic pneumonia
  • pad for return to play
  • usually out 4-8 weeks
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16
Q

what is hypostatic pneumonia

A

when you squeeze the patient so much that when they try to breath they can not get air in all parts of their lungs which causes fluid to build up

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17
Q

lung injuries

A
  • these are NOT common, but you need to watch out for them
  • know what they look like
  • refer for emergency assessment if you cannot rule them out
18
Q

types of lung injuries

A

1: pneumothorax (partial collapse)

2: tension pneumothorax (complete collapse )

3: hemothorax

19
Q

signs and symptoms of pneumothorax ( partial collapse)

A
  • occurs when air enters the pleural cavity located between the chest wall and the lung
  • this can progress to a complete collapse (tension pneumothorax)
  • signs and symptoms:
    • difficultly breathing
      (dyspnea), shortness of
      breath and cyanosis
20
Q

signs and symptoms of tension pneumothorax (complete collapse)

A
  • pleural sac continues to fill with air until lung fully collapses
    • displaces lung and heart
      to other side
  • trachea may deviate
  • this is critical
21
Q

sings and symptoms of hemothorax

A
  • is presence of blood in pleural cavity
  • can happen with/without rib fracture
  • difficulty breathing, shortness of breath and cyanosis
  • coughing up frothy blood
    • will not be bright red
22
Q

What are you looking for with Cyanosis?

A

looking for pale blue skin, body is not getting enough oxygen, blueness around the lips

23
Q

commotio cordis

A
  • traumatic blunt trauma over the heart
    • hit during narrow window
      of heart reploarization
  • results in cardiac arrest
  • i.e. hockey, baseball, lacrosse
  • when defibrillation is delivered within one minute, the reported survival rate can be as high as 90 %
24
Q

the abdomen

A
  • lies between the diaphragm and the pelvis
  • lined by the parietal peritoneum
  • organs are coered by visceral peritoneum
    -injury to the abdominal wall usually produced local pain
  • injury to the viscera often initially causes localized pain that may spread to the entire abdomen if intraperitoneal irritation develops
25
Q

abdominal wall injuries

A
  • muscular contusions
    • localized area of tenderness
    • increased pain on contraction/decreased on relation (with internal bleeding, abdominal wall WILL NOT relax)
  • no referred pain
  • treat with cold pack and compression

(typical muscle bruise, it will also behave like one, so treat as such!)

26
Q

solar (Celiac) plexus contusion

A
  • collection of nerves under diaphragm
  • trauma to relaxed abdominal wall or back
  • getting the wind knocked out of you
27
Q

how do you help someone with solar (celiac) plexus contusion?

A
  • make sure airway is clear
  • loosen belt/restrictive clothing / assure person they will live!
  • flex hips and brings knees to chest
  • slow expiration, followed by short inspiration
28
Q

what are the types of intra-abdominal injuries?

A

1: penetrating

2: blunt

29
Q

penetrating inta-abdominal injuries

A
  • not very common
  • usually superficial
  • leave the object in place unless ability to stop bleeding is compromised
  • focus on controlling bleeding
30
Q

Blunt intra-abdominal injuries

A
  • most common athletic trauma
  • severity of symptoms will vary widely
  • possibility of peritoneal irritation from blood and/or bacterial/intra-abdominal contamination
31
Q

What are the different abdominal quadrants?

A

1: RUQ
2: LUQ
3: RLQ
4: MIDLINE
5: LLQ

32
Q

RUQ abdominal quadrants

A

contains liver, right kidney, gall bladder, colon, pancreas

33
Q

LUQ abdominal quadrants

A

contains stomach, left kidney, spleen, colon, pancreas

34
Q

RLQ abdominal quadrants

A
  • contains appendix, colon, small intestine, ureter, major vein and artery to right leg
35
Q

LLQ abdominal quadrants

A
  • contains colon, small intestine, ureter, major vein and artery to left leg
36
Q

midline of abdominal quadrants

A

contains aorta, pancreas, small intestine, bladder, spine

37
Q

signs of peritoneal irritation

A

signs of an acute abdominal injury
- abdominal rigidity (they will not be able to relax)
- guarding (everything will be tightened up)
- referred pain (they will have pain in elsewhere places not just over the site)
- loss of bowel sounds

caused by blood in the peritoneal cavity/viscera

REFER PERSON TO HOSPITAL

38
Q

Spleen

A
  • located deep to the left 9-11 rib in the left upper quadrant
  • injured with blunt trauma or 2 degree to rib fracture
  • MEDICAL EMERGENCY
39
Q

symptoms of a spleen injury

A
  • slow onset because symptoms develop 2 degrees to bleeding
  • left upper quadrant pain/left shoulder pain caused by diaphragmatic irritation - Kehr’s sign
40
Q

liver

A
  • second most commonly injured organ
  • located in right quadrant
  • right upper quadrant pain
  • referred pain to right shoulder/scapula
  • occasional nausea and vomiting
  • can be bruised or lacerated
    • contusion - no peritoneal
      sings
    • lacerated - will display
      peritoneal sings (because
      they are bleeding out)

MEDICAL EMERGENCY

41
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 with repetitive microtrauma (jostling)

MEDICAL EMERGENCY

42
Q

Bladder

A
  • protected by pelvic ring
  • decreased trauma with 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

athletic injuries 2036 (20 decks)

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