Lecture 16: Abdominal and thoracic injuries Flashcards
abdominal and thoracic injuries
- athletic injuries affect the abdomen (spleen, liver and kidney)
-can be from being struck with an object or use of inadequate protective equipment
the Thorax
- 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
what is the main function of the thorax?
- to protect circulatory and respiratory organs
Thoracic injuries
- 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
rib contusions
- 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
rib fractures:
- 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
- fracture at site of trauma -
where to ribs usually fracture?
- at the weakest point (posterior)
what ribs are most commonly injured? why?
ribs 5-9 and because their rigid fixation
symptoms of rib fractures
- pain with coughing and/or deep inspiration
- trunk movements increase pain
what makes fractures different from contusions
- fractures have pain with manipulation through the ring
signs of rib fractures
- 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
intercostal muscle stain
- most common strain is the intercostal muscles
- usually violent external forces/trauma
- overstretching via rotation
symptoms of intercostal muscle strains
- pain over local area
- pain with inspiration and movements
(this is a typical muscle strain, it will behave like one!)
signs of a intercostal muscle strain
- no pain with pressure through ring
- postive STTT
- findings for mannul muscle testing
- Tender on palpation between the ribs over the muscles
management of rib injuries
- 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
- watch out may predispose
- pad for return to play
- usually out 4-8 weeks
what is hypostatic pneumonia
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
lung injuries
- 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
types of lung injuries
1: pneumothorax (partial collapse)
2: tension pneumothorax (complete collapse )
3: hemothorax
signs and symptoms of pneumothorax ( partial collapse)
- 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
- difficultly breathing
signs and symptoms of tension pneumothorax (complete collapse)
- pleural sac continues to fill with air until lung fully collapses
- displaces lung and heart
to other side
- displaces lung and heart
- trachea may deviate
- this is critical
sings and symptoms of hemothorax
- 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
What are you looking for with Cyanosis?
looking for pale blue skin, body is not getting enough oxygen, blueness around the lips
commotio cordis
- traumatic blunt trauma over the heart
- hit during narrow window
of heart reploarization
- hit during narrow window
- 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 %
the abdomen
- 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
abdominal wall injuries
- 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!)
solar (Celiac) plexus contusion
- collection of nerves under diaphragm
- trauma to relaxed abdominal wall or back
- getting the wind knocked out of you
how do you help someone with solar (celiac) plexus contusion?
- 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
what are the types of intra-abdominal injuries?
1: penetrating
2: blunt
penetrating inta-abdominal injuries
- not very common
- usually superficial
- leave the object in place unless ability to stop bleeding is compromised
- focus on controlling bleeding
Blunt intra-abdominal injuries
- most common athletic trauma
- severity of symptoms will vary widely
- possibility of peritoneal irritation from blood and/or bacterial/intra-abdominal contamination
What are the different abdominal quadrants?
1: RUQ
2: LUQ
3: RLQ
4: MIDLINE
5: LLQ
RUQ abdominal quadrants
contains liver, right kidney, gall bladder, colon, pancreas
LUQ abdominal quadrants
contains stomach, left kidney, spleen, colon, pancreas
RLQ abdominal quadrants
- contains appendix, colon, small intestine, ureter, major vein and artery to right leg
LLQ abdominal quadrants
- contains colon, small intestine, ureter, major vein and artery to left leg
midline of abdominal quadrants
contains aorta, pancreas, small intestine, bladder, spine
signs of peritoneal irritation
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
Spleen
- 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
symptoms of a spleen injury
- slow onset because symptoms develop 2 degrees to bleeding
- left upper quadrant pain/left shoulder pain caused by diaphragmatic irritation - Kehr’s sign
liver
- 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)
- contusion - no peritoneal
MEDICAL EMERGENCY
Kidney
- 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
Bladder
- 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
