Thorax and Abdomen Flashcards
1
Q
preventing injuries to the thorax/abdomen
A
- 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
2
Q
Assessment of the Thorax/Abdomen
A
- 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
3
Q
History
A
- what, where, how
- direct contact or blow
- position
- chest pain?
- blood or pain during urination
- family history?
4
Q
Observations
A
- 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
5
Q
Observations - visible changes
A
- 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
6
Q
Other observations
A
- 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
7
Q
Palpation (Thorax)
A
- check for symmetry of chest wall movement
- palpate for areas of tenderness
- palpate ribs and intercostal spaces and costochondral junctions
8
Q
Palpation (Abdomen)
A
- 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)
9
Q
Auscultation
A
- 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
10
Q
Heart Sounds
A
- lubbdubb (may hear third sound in children)
- listen for murmur (abnormal period due to valve insufficiency)
- listen at a variety of points
11
Q
Breath Sounds
A
- 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
12
Q
Bowel sounds
A
- liquid-like gurgling due to peristalsis
- diminished = paralytic milieus or peritonitis
- high pitched sounds = intestinal obstruction
13
Q
Percussion
A
- place fingers on abdomen and strike with other hand
- solid organ = dull sound
- hollow organ = tympanic or resonant sound
14
Q
Patterns of referred pain
A
- Heart/spleen = left thorax and inner left arm
- kidneys = back
15
Q
Rib Contusion
A
- blow to the rib cage
- painful breathing (particularly if muscles are involved)
- point tenderness
- RICE & NSAIDs
- rest and decrease in activity
16
Q
Rib Fractures
A
- 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
17
Q
Flail chest
A
when 3+ consecutive ribs are fractured
18
Q
Costochondral Separation
A
- 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)
19
Q
Sternum Fractures
A
- 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
20
Q
Muscle Injuries
A
- 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
21
Q
Lung Injuries (Pneumothorax)
A
- pleural cavity becomes filled with air, negatively pressurizing the cavity, causing a lung to collapse
- pain, difficulty breathing and anoxia
22
Q
Lung Injuries (Tension Pneumothorax)
A
- 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
23
Q
Lung injuries (Hemothorax)
A
- 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
24
Q
Traumatic Asphyxia
A
- 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
25
Q
Hyperventilation
A
- 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
26
Q
Sudden Cardiac Death Syndrome in Athletes
A
- 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
27
Q
Commotio Cordis
A
- 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
28
Q
Heart Contusion
A
- 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
29
Q
Kidney Contusion
A
- 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
30
Q
Kidney Contusion Management
A
- 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
31
Q
Kidney Stones
A
- 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
32
Q
Contusion of Ureters, bladder and urethra
A
- 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
33
Q
Gastrointestingal Bleeding
A
- 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
34
Q
Liver Contusion
A
- blunt trauma
- more susceptible if enlarged
- hemorrhaging and shock may present
- referred pain in right scapula, should and substernal area
- referral to a physicial
35
Q
Indigestion (Dyspepsia)
A
- food causing distress
- reaction before competition
- emotional stresses
- elimination of irritation foods, regular eating habits
- avoidance of anxiety
36
Q
Vomiting
A
- irritation, most often of the stomach
- antinausea medications
- fluids
37
Q
Food Poisoning (gastroenteritis)
A
- 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
38
Q
Appendicitis
A
- mild to severe pain in lower abdomen
- nausea, vomiting, and low grade fever
- pain localized in lower right abdomen
- surgical intervention is often necessary
39
Q
Scrotal Contusion
A
- 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
40
Q
Spermatic Cord Torsion
A
- 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
41
Q
Contusion of Female Genitalia
A
- lower incidence of injury in sports
- blunt trauma
- hematoma may form
- pubic symphsis
- osteitis pubis: inflammation
42
Q
Injury of the Spleen
A
- 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
43
Q
Abdominal Muscle Strain
A
- 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
44
Q
Contusions of Abdominal Wall
A
- 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
45
Q
Hernia
A
- 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
46
Q
Blow to Solar (Celiac) plexus
A
- 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
47
Q
Stitch in the Side
A
- 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
