Thorax and Abdomen

Question 1

preventing injuries to the thorax/abdomen

Answer 1

• use of protective equipment
• strengthen abdominal muscles to protect underlying viscera (best protection)
• empty hollow organs prior to activity to reduce injury
• eat meals 3 to 4 hours before activity (clears stomach)/empty bladder

Question 2

Assessment of the Thorax/Abdomen

Answer 2

• injuries can produce life-threatening situations
• focus on signs and symptoms that indicate potentially life-threatening conditions
• monitor breathing, circulation, and any indication of internal bleeding or shock

Question 3

History

Answer 3

• what, where, how
• direct contact or blow
• position
• chest pain?
• blood or pain during urination
• family history?

Question 4

Observations

Answer 4

• breathing? difficulty breathing? pain w/breathing
• holding their chest wall?
• symmetry of the chest during breathing?
• wind knocked out of them? is it returning?
• thorax injury - leaning towards side that is injured and splinting with hand
• abdominal injury - lying on side with knees pulled to chest
• male genitalia injury

Question 5

Observations - visible changes

Answer 5

• discoloration, swelling or deformity
• around umbilicus = intra-abdominal bleed
• flanks = swelling outside the abdomen
• protrusion or swelling in any portion of abdomen (internal bleeding)
• symmetrical thorax?
• abdominal muscles tight and guarding?
• bright red blood = lung injury
• vomiting bright red and frothy = injury to esophagus and stomach although blood may be swallowed from mouth and nose

Question 6

Other observations

Answer 6

• cyanosis indicates respiratory difficulty
• pale, cool, clammy indicates low BP
• vital signs
• rapid weak pulse or drop in BP is an indication of a serious internal injury involving blood loss

Question 7

Palpation (Thorax)

Answer 7

• check for symmetry of chest wall movement
• palpate for areas of tenderness
• palpate ribs and intercostal spaces and costochondral junctions

Question 8

Palpation (Abdomen)

Answer 8

• patient should have arms at side, knees and hips flexed to relax abdomen
• four abdominopelvic quadrants
• feel for guarding and tenderness, rigidity (internal bleeding)
• rebound tenderness
• assess each organ (if possible)

Question 9

Auscultation

Answer 9

• should be done prior to obtaining a history
• auscultation should be done immediately if athlete is experiencing respiratory difficulties or is incapable of providing a history

Question 10

Heart Sounds

Answer 10

• lubbdubb (may hear third sound in children)
• listen for murmur (abnormal period due to valve insufficiency)
• listen at a variety of points

Question 11

Breath Sounds

Answer 11

• should be consistent
• abnormal patterns
• cheyne-stokes breathing (rate changes over 1-3 minutes)
• bit’s breathing - normal rate followed by cessation
• apneustic breathing - pauses in respiratory cycle at full inspiration
• wheeze, crackles, stridor, rales
• perform over apex, centrally and at base of each lung, both anteriorly and posteriorly

Question 12

Bowel sounds

Answer 12

• liquid-like gurgling due to peristalsis
• diminished = paralytic milieus or peritonitis
• high pitched sounds = intestinal obstruction

Question 13

Percussion

Answer 13

• place fingers on abdomen and strike with other hand
• solid organ = dull sound
• hollow organ = tympanic or resonant sound

Question 14

Patterns of referred pain

Answer 14

• Heart/spleen = left thorax and inner left arm

- kidneys = back

Question 15

Rib Contusion

Answer 15

• blow to the rib cage
• painful breathing (particularly if muscles are involved)
• point tenderness
• RICE & NSAIDs
• rest and decrease in activity

Question 16

Rib Fractures

Answer 16

• direct blow or result of violent muscular contraction
• can be caused by violent coughing and sneezing
• pain with inspiration, point tenderness and possible deformity with palpation
• refer x-rays
• support and rest, brace

Question 17

Flail chest

Answer 17

when 3+ consecutive ribs are fractured

Question 18

Costochondral Separation

Answer 18

• direct blow to the anterolateral aspect of the rib cage
• localized pain at costochondral junction
• pain with movement; difficulty breathing
• point tenderness and possible deformity
• rest and immobilization
• healing may take 1-2 months (very slow)

Question 19

Sternum Fractures

Answer 19

• high impact blow to the chest
• underlying cardiac muscle may also be contused
• point tenderness over sternum
• pain with deep inspiration and forceful expiration
• signs of shock, or weak rapid pulse may indicate more severe injuries
• refer for x-ray
• monitor athlete for signs of trauma to the heart

Question 20

Muscle Injuries

Answer 20

• direct blows or sudden torsion of the trunk
• pain with active motions
• pain with inspiration and expiration, coughing, sneezing or laughing
• immediate pressure
• application of cold
• immobilize the injury for athlete comfort

Question 21

Lung Injuries (Pneumothorax)

Answer 21

• pleural cavity becomes filled with air, negatively pressurizing the cavity, causing a lung to collapse
• pain, difficulty breathing and anoxia

Question 22

Lung Injuries (Tension Pneumothorax)

Answer 22

• pleural sac on one side fills with air displacing lung and heart, compressing the opposite lung
• may cause shortness of breath, chest pain, absence of breath sounds, cyanosis, distention of neck veins, deviated trachea

Question 23

Lung injuries (Hemothorax)

Answer 23

• blood in pleural cavity causes tearing or puncturing of the lungs or pleural tissue
• painful breathing, dyspnea, coughing up frothy blood and signs of shock

Question 24

Traumatic Asphyxia

Answer 24

• violent blow or compression of rib cage
• causes cessation of breathing
• signs include purple discoloration of the trunk and head and conjunctivas of the eye
• requires immediate mouth to mouth resuscitation
• medical emergency 9-1-1
• transport immediately

Question 25

Hyperventilation

Answer 25

• rapid rate of ventilation due to anxiety induced stress or asthma
• develop a decreased amount of carbon dioxide relative to oxygen
• difficulty inhaling and struggling to breathe
• gasping and wheezing
• breath into a bag
• should return within 1-2 minutes

Question 26

Sudden Cardiac Death Syndrome in Athletes

Answer 26

• hypertropic cardiomyopathy - thickening of cardiac muscle with no increase in chamber size
• other heart issues
• usually no signs
• may exhibit chest pain, palpitations, syncope, profuse sweating, shortness of breath
• cardiac screening - electrocardiograms and echocardiograms
• 75% of deaths in athletics

Question 27

Commotio Cordis

Answer 27

• syndrome resulting in cardaic arrest due to traumatic blunt impact to chest
• unfortunate timing relative to re-polarization phase of cardiac cycle
• ventricular fibrillation
• resuscitation of victim is seldom successful
• early defibrillation with AED and resuscitation is critical

Question 28

Heart Contusion

Answer 28

• compression between sternum and spine
• could cause aortic rupture
• severe shock and heart pain
• heart may exhibit arrhythmias chasing a decrease in cardiac output, followed by death if medical attention is not administered
• immediate referral to an emergency room
• CPR/treat for shock

Question 29

Kidney Contusion

Answer 29

• external force
• susceptible to injury due to normal distention of blood
• shock, nausea, vomiting, rigidity of back muscles
• referred pain (costovertebral angle posteriorly radiating forward around the trunk)
• 24 hour observation and gradual increase of fluid intake
• surgery required if hemorrhage fails to stop
• bed rest and close observation after activity resumes

Question 30

Kidney Contusion Management

Answer 30

• monitor urine for presence of blood
• refer if necessary
• 24 hour hospitalization and observation with gradual increase in fluid intake
• 2 weeks of rest
• close surveillance following initial return to activity

Question 31

Kidney Stones

Answer 31

• may remain in kidney and cause blockage and pressure in renal system
• very painful if stone dislodges and travels through urinary system
• sudden, sharp, severe pain, referred pain in low back, nausea, clammy, burning upon frequent urination, blood in urine
• Management: fluids, analgesics for pain, 80-85% of cases smaller stones move through ureter into bladder and excreted
• surgery if larger

Question 32

Contusion of Ureters, bladder and urethra

Answer 32

• blunt force to the lower abdomen may olives ureter or contuse/rupture bladder
• hematuria is often associated with contusion of bladder during running
• pain/discomfort in lower abdominal area/ridigity/bloody urine
• referred pain = anterior upper thigh and suprapubically, lower abdominals
• Management = monitor blood in urine/empty bladder prior to practice/wear protective equipment

Question 33

Gastrointestingal Bleeding

Answer 33

• distance running, gastritis, iron-deficiency, anemia, ingestion of aspirin or NSAIDs, stress
• blood in stool, abdominal pain, watery stool, dehydration, intermittent fever
• refer to physician

Question 34

Liver Contusion

Answer 34

• blunt trauma
• more susceptible if enlarged
• hemorrhaging and shock may present
• referred pain in right scapula, should and substernal area
• referral to a physicial

Question 35

Indigestion (Dyspepsia)

Answer 35

• food causing distress
• reaction before competition
• emotional stresses
• elimination of irritation foods, regular eating habits
• avoidance of anxiety

Question 36

Vomiting

Answer 36

• irritation, most often of the stomach
• antinausea medications
• fluids

Question 37

Food Poisoning (gastroenteritis)

Answer 37

• mild to severe reaction
• infectious microorganisms that contaminate food
• nausea, vomiting, cramps, diarrhea, subsides within 3-6 hours
• replacement of fluids
• best rest
• reintroduce tolerable, bland foods first

Question 38

Appendicitis

Answer 38

• mild to severe pain in lower abdomen
• nausea, vomiting, and low grade fever
• pain localized in lower right abdomen
• surgical intervention is often necessary

Question 39

Scrotal Contusion

Answer 39

• blunt trauma
• hemorrhaging, fluid effusion, muscle spasm, severe disabling pain
• reduction of testicular spasm (valsalva maneuver with knee to chest)
• application of cold pack
• unresolved pain after 15-20 minutes go to doctor

Question 40

Spermatic Cord Torsion

Answer 40

• testicle revolving in the scrotum following a direct blow or a result of coughing or vomiting
• acute testicular pain, nausea, vomiting, inflammation
• immediate referral to prevent irreparable damage

Question 41

Contusion of Female Genitalia

Answer 41

• lower incidence of injury in sports
• blunt trauma
• hematoma may form
• pubic symphsis
• osteitis pubis: inflammation

Question 42

Injury of the Spleen

Answer 42

• direct blow or infectious mononucleosis
• history of a direct blow, signs of shock, abdominal rigidity, nausea and vomiting
• Kehr’s signs: left shoulder
• conservative treatment involves 1 week of hospitalization and gradual return to activity
• surgery requires three months of recovery time
• removal of spleen requires 6 months of recovery time with no activity
• immune system

Question 43

Abdominal Muscle Strain

Answer 43

• sudden twisting or reaching with trunk
• severe pain and possible hematoma formation
• rectus abdominus most commonly injured
• ice and compression
• exercise with pain free limits

Question 44

Contusions of Abdominal Wall

Answer 44

• compressive force - collision sports
• extent of injury depends on whether force is bound or penetrating
• may cause a hematoma to develop under fascia of surrounding muscle tissue
• swelling may cause pain and tightness within the area
• cold pack and compression
• check and monitor for signs of internal injuries

Question 45

Hernia

Answer 45

• protrusion of abdominal viscera through portion of abdominal wall (congenital or acquired)
• inguinal vs. femoral hernias
• complications and strangulated hernias
• acquired hernia occurs when inherent weakness is further aggravated by a direct blow or strain
• pain increases with coughing, pulling sensation in groin area
• surgery

Question 46

Blow to Solar (Celiac) plexus

Answer 46

• transitory paralysis of the diaphragm due to direct blow
• stops respiration and causes anoxia
• overcome apprehension
• control breathing
• calm athletes, prevent hyperventilation
• check and monitor for internal injury

Question 47

Stitch in the Side

Answer 47

• idiopathic condition
• constipation, gas, overeating, diaphragm spasm, poor conditioning, distended spleen, breathing techniques
• cramp-like pain
• develops on right or left costal angle during hard physical activity
• stretch arm on affected side
• flex trunk
• monitor