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KIN 3160 > Thorax, abdomen, and pelvis injuries > Flashcards

Thorax, abdomen, and pelvis injuries Flashcards

1
Q

how many pairs of ribs do we have?

A

12

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2
Q

what are the three rib classifications?

A

true ribs: 1-7
false ribs: 8-10
floating ribs: 11-12

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3
Q

which muscle contribute to respiration?

A

main muscle is the diaphragm

-actively contracts during inhalation, flattens to decrease pressure and air enters

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4
Q

what are the 4 main abdominal muscles?

A

transversus abdominis, rectus abdominis, external oblique, internal oblique

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5
Q

which viscera are in each of the 4 quadrants of the abdomen?

A

URQ: liver, kidney
ULQ: stomach, pancreas, spleen, kidney
LLQ: viscera, intestines, colon, bladder (between right and left)
LRQ: appendix

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6
Q

which bones form the pelvic girdle?

A

2 innominate bones, and the sacrum in the middle

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7
Q

which landmarks can you palpate on the innominate bones of the pelvis?

A
  • ASIS
  • iliac crest
  • PSIS
  • ischial tuberosity
  • pubic tubercle
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8
Q

what is important about the assessment of thorax, pelvis, and abdominal injuries?

A

an injury that may seem insignificant can rapidly develop into a life threatening condition

  • disrupt breathing or circulation
  • internal hemorrhage

be aware of S&S and continually monitor patient

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9
Q

what are some common MOIs of thorax, abdomen, and pelvic injuries?

A

1) direct blow impacts
- compression in contact sports
- MVA’s; falls from a height
2) crushing
- blunt force
3) shearing
- sudden acceleration, deceleration, and change of direction
4) bursting
- sudden increase in pressure (hollow organs)
5) penetration
- disruption of organ (bony or foreign objects)

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10
Q

what are the S&S with thoracic injuries

A
  • cyanosis: bluish color of lips/fingernails
  • dyspnea: difficulty breathing
  • hemoptysis:coughing up frothy blood
  • chest pain with breathing
  • reduced chest movements
  • shifting of trachea with each breath
  • deformity, crepitus, or paradoxical movements
  • S&S of shock
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11
Q

what are the S&S of abdominal injuries?

A
  • ecchymosis around umbilicus
  • hematuria: urine in the blood
  • severe abdominal pain or prolonged discomfort
  • point tenderness
  • abdominal muscle rigidity/spasm (rebound pain)
  • nausea or vomiting
  • sensation of weakness
  • palpable defect or deformity
  • distending/irregularly shaped abdomen
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12
Q

what are the different things we look for when we palpate the thorax?

A
  • symmetry of chest wall during respiration

- locate specific areas of point tenderness

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13
Q

how can we identify a rib fracture via palpation?

A

A/P compression

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14
Q

how can we identify a constochondral injury with palpation?

A

transverse compression

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15
Q

in what order should the abdominal quadrants be palpated?

A

RUQ, LUQ, LLQ, RLQ

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16
Q

what should you assess for in abdominal palpation?

A
  • muscle guarding or rigidity

- rebound tenderness (hurts when pressure is removed; common in appendix injury, RLQ)

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17
Q

rib contusion & rib fracture: MOI

A
  • direct blow/contact - compression force

- occasionally fracture due to a forceful muscle contraction (coughing/sneezing)

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18
Q

what are the S&S of rib contusion/fracture?

A
  • localized pain, pain upon compression, bruising (ecchymosis), painful.difficulty breathing (dyspnea), pain with coughing, person leans towards injured side and breathes shallowly
  • fracture - deformity (especially with flail chest; when multiple ribs are broken, crepitus on palpation)
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19
Q

how can we manage a rib contusion?

A
  • physician referral; R/O rib fracture with negative X-ray
  • modification or cessation of strenuous activities
  • POLICE
  • NSAIDs and or pain meds
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20
Q

how can we manage a rib fracture?

A
  • physician referral, R/O lung injury, positive X-ray
  • modification or cessation of strenuous activities
  • POLICE
  • NSAIDs and or pain meds
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21
Q

how does the etiology differ between rib fractures and costochondral injuries?

A

fracture: simple transverse or oblique fracture

costochondral: separation or dislocation of rib from the costal cartilage (1-7 true ribs)
- reporting hearing a “pop”

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22
Q

which ribs are most susceptible to fracture? Why?

A

5-9

  • clavicle often fracture higher up rather than the upper ribs
  • floating ribs are not fully attached, have more give to them/more mobility
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23
Q

rib fracture vs costochondral injury: RTP

A
  • when strenuous activity participation is symptom free
  • simple fracture: 3-4 weeks
  • costochondral injury: 1-2 months
  • protection upon RTP
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24
Q

pneumothorax - def

A

pleural cavity becomes fulled with air that has entered through an opening in the chest
-lung on that side collapses

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25
Q

tension pneumothorax - def

A

pleural sac on one side fills with air and displaces the lung and heart to the opposite side

  • compresses the lung on the opposite side
  • tracheal deviation
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26
Q

hemothorax - def

A
  • presence of blood within the pleural cavity

- results from tearing or puncturing the lung or pleural tissue

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27
Q

pneumothorax and hemothorax - S&S

A
  • chest pain
  • dyspnea (difficulty breathing) or shortness of breath
  • cyanosis (bluish lips/skin)
  • anoxia (absence of oxygen)
  • S&S of shock

tension pneumothorax: tracheal deviation
hemothorax: coughing up frothy blood

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28
Q

traumatic asphyxia - def

A

cessation of breathing due to violent blow of compression of rib cage

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29
Q

S&S of traumatic asphyxia

A
  • purple discoloration of head and upper trunk

- bright red eyes

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30
Q

lung injury: treatment

A
  • medical emergency - call 911
  • treat fractures and or address any penetrating wounds
  • treat for shock - administer oxygen
  • monitor vitals and maintain airway and breathing
  • if breathing stops = AR
  • if heart stops = CPR and AED
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31
Q

sternum fracture: MOI

A
  • high impact to chest
  • typically from MVA
  • rib fracture and costochondral injuries are more common in athletics
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32
Q

S&S of sternum fracture

A
  • point tenderness over sternum and pain on respiration

- weak, rapid pulse or shock indicate internal injury

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33
Q

what is a secondary complication of a sternum fracture?

A

heart contusion

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34
Q

heart contusion - def

A

-heart compressed between the sternum and the spine

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35
Q

heart contusion: MOI

A

blow to the chest or barbell dropped on chest in bench press

  • right ventricle affected
  • violent impact can rupture aorta
36
Q

S&S of heart contusion

A
  • heart pain

- arrythmias that decrease cardiac output

37
Q

treatment of heart contusion

A
  • immediate medical attention - 911

- be prepared to start CPR and manage for shock

38
Q

commotio cordis - def

A

cardiac arrest from traumatic blunt impact to chest

  • young healthy athletes most at risk - chest wall is still pliable
  • impact during the repolarisation phase of the cardiac cycle - causes ventricular fibrillation
39
Q

S&S of commotio cordis

A
  • cardiac arrest

- immediate death in 50% of cases

40
Q

management of commotio cordis

A
  • immediate AED and CPR essential

- resuscitation seldom successful

41
Q

how common in sudden cardiac death in athletes?

A
  • young individuals die for no apparent reason

- 1 in 280,000 men under the age of 30 years

42
Q

sudden cardiac death in athletes: S&S

A
  • typically have no symptoms prior to death
  • may experience chest pain or discomfort during exertion, heart palpitations/flutters/murmurs, syncope (fainting), nausea, profuse sweating, shortness of breath, general malaise, and fever
43
Q

what are the most common causes of sudden cardiac death in athletes?

A
  • hypertrophic cardiomyopathy - thickened cardiac muscle
  • anomalous origin of the coronary artery - obstructs flow
  • Marfan’s syndrome - weakened aorta and cardiac valves
44
Q

how can we manage sudden cardiac death in athletes?

A

pre-participation examination and screening, not a lot can be done

45
Q

abdominal contusion are common in which types of athletes?

A

contact or combative sports

46
Q

how can abdominal contusions be prevented?

A
  • good conditioning - tensed abdominal muscles provide protection
  • proper protective equipment
  • enforcing safety rules (esp. in sports with sticks)
47
Q

superficial abdominal contusion - def

A

hematoma in fascia surrounding rectus abdominis muscles

  • pain and tightness or muscle
  • POLICE
48
Q

deep abdominal contusion - def

A

visceral contusions

49
Q

blow to the solar plexus - def

A

“wind knocked out”

  • transitory paralysis of the diaphragm
  • respiration stops, leads to anoxia (absence of oxygen)
  • athlete unable to inhale = fear or hysteria (may lead to hyperventilation - rapid breathing resulting in lowered CO2 levels)
50
Q

management for blow to the solar plexus

A
  • speak confidently to athletes to lower anxiety

- controlled breathing - short inspirations and long expirations

51
Q

kidney contusion - def

A

severe blow to abdomen or back can cause abnormal extension of an engorged kidney (RUQ/LUQ)

52
Q

S&S of kidney contusion

A

Referred pain:
-high in the costovertebral angle posteriorly, may radiate forward around the trunk into the lower abdominal region

Shock, nausea, vomiting, rigidity of back muscles and hematuria
-hematuria = immediate referral to physican

53
Q

management of kidney contusion

A
  • hospital observation (24 hours) with possible surgery

- 2 weeks of best rest and monitor when resumes activity

54
Q

what is the second most common organ injury from blunt trauma?

A

liver contusion

55
Q

liver contusion - etiology

A

-blow to the RUQ

56
Q

liver contusion S&S

A
  • hemorrhage and shock
  • especially at risk if liver is enlarged due to hepatitis or alcoholism
  • referral pain: just below the right scapula, right shoulder and sub-sternal area
  • immediate referral to physician
57
Q

apendicitis: S&S

A
  • patient complains of mild-severe pain in lower abdomen
  • cramps later localize to right side - may also have nausea, vomiting and low grade fever
  • point tenderness in LRQ (mcburney’s point: between ASIS and umbilicus)
  • often mistaken for a psoas or gastric complaint
  • can be mistaken for hernia
  • urgent situation may require surgical removal prior to rupture
58
Q

intercostal muscle strain - MOI

A

direct blow or sudden twisting of trunk

59
Q

S&S of intercostal muscle strain

A

-pain on active movement, respiration, laughing, coughing, or sneezing

60
Q

management of intercostal muscle strain

A
  • POLICE
  • cannot fully immobilize because of breathing
  • R/O rib fracture (very similar pain)
61
Q

abdominal muscle strain - MOI

A
  • overstretching of the muscle in combination with a twisting motion
  • muscle is maximally contracted in a shortened position and then stretched
  • repetitive movements while lifting
62
Q

S&S of abdominal muscle strain

A
  • pain contracting muscle (trunk flexion or rotation)
  • muscle spasm
  • swelling and bruising less common
63
Q

management of abdominal muscle strain

A
  • POLICE (rest from activity, difficult to splint)
  • later gentle massage
  • focus on strengthening (core stability and eccentric loading)
  • R/O hernia (fascial layers connection to groin)
  • rectus abdominis attachment to ribs down to pelvis - a lot of fascial layers down in pelvis)
64
Q

which abdominal muscle is most prone to strain? why?

A

rectus abdominis

  • other abdominal muscles are more for stability, rotation
  • rectus abdominis is the power muscle of the group
65
Q

hernia - def

A
  • protrusion of abdominal viscera through a portion of the abdominal wall
  • acquired - heavy lifting (increase intra-abdominal pressure)
  • congenital - born with it
66
Q

S&S of hernia

A
  • prolonged pain and discomfort, deformity (superficial protrusion) that appears with coughing, sneezing, or going to bathroom, weakness or pulling/dragging sensation in groin
  • refer to a physician - surgical repair
67
Q

which type of hernia is more common in males?

A

inguinal hernia

-testicles have travelled through inguinal canal, more prone to viscera following the same path)

68
Q

which type of hernia is more common in females?

A

femoral hernia

69
Q

athletic pubalgia (sports hernia) - def

A
  • chronic pubic region or inguinal pain
  • repetitive stresses from kicking, twisting, and forceful hip adduction (soccer, hockey)
  • shearing forces at symphysis pubis and micro tears of TA/abdominal wall aponeurosis
  • pain on insertion point of muscle
70
Q

S&S of athletic pubalgia

A
  • chronic pain during exertion
  • sharp, burning pain lower abdominals
  • radiates to adductors and testicles
  • pain with IS (hip flexion and adduction, internal rotation, abdominal contractions)
  • no pain on palpation of adductor muscles
  • point tenderness on pubic tubercle
71
Q

management of athletic pubalgia

A
  • conservative treatment
  • deep tissue massage affected areas
  • stretch hip flexors, adductors and rotators, hamstrings and low back
  • strengthen abdominals and hip adductors and flexors
  • begin activities as tolerated

if conservative treatment fails, cortisone injections, surgical tightening of pelvic floor

72
Q

osteitis pubis - MOI

A
  • stress on pubic symphysis from repetitive overload (distance running)
  • restricted movement at SI joint and or hip flexors
73
Q

S&S of osteitis pubis

A
  • gradual onset of pain in groin and symphysis pubis
  • aggravated by running, kicking, and pivoting on 1 leg
  • pain increases with sit ups and abdominal strengthening
74
Q

management of osteitis pubis

A
  • POLICE - prolonged rest, NSAIDs, and gradual return to activity
  • increase mobility of surrounding joints

-need to find the cause, tight muscles, training, etc.

75
Q

iliac crest contusion (hip pointer) MOI

A

direct blow to iliac crest

76
Q

S&S of hip pointer

A
  • localized pain, spasms, sometimes transitory paralysis of soft tissue structures
  • pain which increases with hip flexion and trunk rotation
  • can result in deep bleeding and swelling in surrounding soft tissue
  • flexed body posture and antalgic gait (hurts to walk)
77
Q

management of hip pointer

A
  • POLICE (rest and ice)
  • physician - R/O fracture of iliac crest or ASIS
  • protect upon RTP
  • address acute symptoms so it doesn’t become chronic
78
Q

apophysitis - def

A 
bony outgrowth (similar to growth plate in long bones)
-common injury in adolescent population (skeletally immature)
79
Q

where are the common sites in the pelvis in which apophysitis/avulsion fracture occurs

A
  • ischial tuberosity - attachment of hamstrings
  • AIIS - attachment of rectus femoris
  • ASIS - attachment of sartorius
80
Q

pelvic avulsion fractures/apophysitis - MOI

A

sudden acceleration/deceleration

-football, soccer, basketball

81
Q

S&S of pelvic avulsion fracture/apophysitis

A

sudden localized pain and limited movement

82
Q

management of pelvic avulsion fracture/apophysitis

A
  • POLICE with crutches (partial WB) 1-2 months
  • can’t cast the area
  • when pain and inflammation controlled, begin gradual stretching
  • ROM and strengthen exercise prior to RTP
83
Q

stress fractures in the pelvis - S&S, management

A
  • most common in inferior pubic ramus
  • femoral neck and sub trochanteric area
  • common in distance runners
  • pain standing on one leg (trendelendburg sign)
  • rest for 2-5 months, with swimming for cross training
  • anti gravity treadmill
84
Q

stress fractures in the ribs - S&S, management

A
  • 1st rib due to repetitive movements such as rowing or pitching
  • repeated coughing or laughing
85
Q

scrotal contusion - S&S and treatment

A

hemorrhage, fluid effusion and muscle spasm

-Tx: comfortable position and ice

86
Q

testicular torsion MOI

A

spermatic cord twists in the scrotum, impairing blood flow to testicle

  • occurs several hours after vigorous activity
  • abdominal and groin pain, scrotum swelling and testicle positioned higher
  • immediate medical attention
87
Q

traumatic hydrocele - def

A

enlargement of venous plexus on posterior aspect of testicle due to a severe blow

  • rupture results in rapid accumulation of blood in the scrotum
  • pain and swelling create a significantly larger sac
  • ice and immediate medical attention for pain relief

KIN 3160 (10 decks)

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