(3) Lecture 16: Abdominal and Thoracic Injuries Flashcards
1
Q
Common causes of abdominal and thoracic injuries
A
- high-velocity sports
- being struck w/ an object
- inadequate protective equipment
2
Q
Thorax
A
- portion of the body btwn neck and diaphragm
- made up of spine posteriorly, ribs laterally and sternum anteriorly
FUNCTION: protect circulatory and resp. organs
3
Q
Ribs as a ring
A
Ribs wrap around thorax + attach at front
4
Q
Thoracic injuries
A
- most are due to BLUNT trauma but can happen due to forceful contractions
- RIB injuries are common - painful + debilitating
- heart + lung injuries are less common but serious
5
Q
Rib contusions
A
- blow to FRONT/SIDE = rib contusion
- blow to back, usually paraspinal contusion
- LOCALIZED PAIN (during inspiration + w/ palpation)
- manipulation of rib at distance/ “through the ring”
does NOT increase pain
6
Q
Rib Fractures
A
can be direct (fracture at site of trauma) or indirect (fracture way from impact due to COMPRESSION)
- Ribs 5-9 are MOST injured due to rigid fixation
- usually fractures at weakest point (posterior) angle of ribs
can be DISPLACED or UNDISPLACED
-if displaced (bone poking out), do an exam of internal structures – check ORGANS
- spleen trauma in 20% of lower L rib fracture (liver is less)
7
Q
Symptoms of rib fractures
A
- pain w/ coughing and/or deep inspiration
- trunk movements increase pain
8
Q
Signs of rib fractures
A
- may have visible contusion + palpable crepitus (creaking)
- athlete splints themselves/leans towards injured side
- pain w/ manipulation AWAY from injury, through ring
9
Q
Intercostal muscle strain
A
- most common strain is intercostal muscles
- usually violent exertional forces/trauma
- overstretching via ROTATION
10
Q
Symptoms of intercostal muscle strain
A
- pain over local area
- pain w/ inspiration and movement
11
Q
Signs of intercostal muscle strain
A
- NO pain w/ pressure through ring
- positive STTT
- findings for manual muscle testing
- tender on palpation btwn ribs over muscle
12
Q
Pain with fracture
A
indirect pressure causes pain w/ fracture
13
Q
Management of rib injuries
A
- send for imaging if fracture is suspected
- POLICE/PEACE & LOVE
- stabilize/wrap - may predispose to hypostatic pneumonia (can’t take full breath if splinted too tight)
- pad for return to play
- usually out 4-8 weeks
14
Q
Lung injuries
A
- NOT common but need to watch out for them
- pneumothorax
- tension pneumothorax
- hemothorax
15
Q
Pneumothorax
A
PARTIAL collapse (can happen +/- rib fracture)
- happens when air enters pleural cavity btwn chest wall and lung
- can progress to complete collapse (tension pneumothorax)
Signs and symptoms
- difficulty breathing (dyspnea)
- shortness of breath
- cyanosis (pale, blue lips)
16
Q
Tension pneumothorax
A
COMPLETE collapse
Pneumothorax PLUS
- pleural sac fills w/ air until lung collapses = DISPLACES lung and heart to other side
- TRACHEA MAY DEVIATE
CRITICAL
17
Q
Hemothorax
A
- presence of blood in pleural cavity
- can happen +/- rib fracture
- difficulty breathing, shortness, of breath, cyanosis
coughing up FROTHY BLOOD
18
Q
Commotio Cordis
A
Traumatic blunt trauma over heart = hit during narrow window of REPOLARIZATION
- results in cardiac arrest
- young athletes more at risk b/c of pliability of chest wall
- hockey, baseball, lacrosse, football
- get AED ASAP
- when defibrillation is delivered within ONE MIN, reported survival rate as high as 90%
19
Q
Abdomen
A
- lies btwn diaphragm and pelvis
- lined by PARIETAL PERITONEUM
- organs are covered by visceral peritoneum
- enough room btwn organs to bleed to death
- injury to abdominal wall produces LOCAL PAIN
- injury to viscera often initially causes localized pain that may spread to entire abdomen if INTRAPERITONEAL irritation develops
20
Q
Abdominal wall injuries
A
- muscular contusions
- abdominal muscle strain
- solar (celiac) plexus contusion
- intra-abdominal injuries (penetrating or blunt)
21
Q
Muscular contusions
A
- LOCALIZED area of tenderness
- increased pain on contraction/decreased on relaxation
- with internal bleeding, abdominal wall NOT relax
- no referred pain (only pain at affected place)
- treat w/ cold pack and compression
- position of comfort: on side, curled up
22
Q
Referred pain
A
NO pain @ affected organ BUT will feel pain elsewhere
- ex. during heart attack, feel pain in jaw or arm
23
Q
Abdominal muscle strain
A
RECTUS ABDOMINUS is most commonly injured
- lower rib origin or pubic insertion
- may pull periosteum of pubic rami = osteitis pubis
- may be seen w/ INTERNAL/EXTERNAL OBLIQUES
- MOI: violent contraction/twisting or recurrent mcirotrauma
- LOCALIZED pain + spasm at sight of injury
- STTT positive
- manual muscle testing positive
24
Q
Solar (Celiac) Plexus Contusion
A
- collection of nerves UNDER DIAPHRAGM
- trauma to relaxed abdominal wall or back
- “WIND KNOCKED OUT” = transitory paralysis of diaphragm
- make sure airway is clear
- loosen belt/restrictive clothing
- FLEX HIPS + BRING KNEES TO CHEST = take abs off stretch
- slow expiration, followed by short inspiration
25
Penetrating intra-abdominal injuries
- NOT COMMON
- usually superficial
- leave object in place unless ability to stop bleeding is compromised
- focus on CONTROLLING bleeding
26
Blunt intra-abdominal injuries
- MOST COMMON athletic trauma
- severity of symptoms varies
- possibility of PERITONEAL irritation from blood and/or bacterial/intra-abdominal contamination
27
Abdominal quadrants
RUQ, LUQ, RLQ, LLQ, Midline
28
RUQ abdominal quadrant
Liver
Right Kidney
Gall bladder
Colon
Pancreas
29
LUQ
Stomach
Left kidney
Spleen
Colon
Pancreas
30
RLQ
Appendix
Colon
Small intestine
Ureter
Major vein and artery to right leg
31
LLQ
Colon
Small Intestine
Ureter
Major vein and artery to left leg
32
Midline abdominal quadrants
Aorta
Pancrease
Small inetstine
Bladder
Spine
33
Signs of Peritoneal Irritation
aka PERITONEAL SIGNS = MEDICAL EMERGENCY
- abdominal rigidity (inability to relax muscles)
- guarding
- referred pain
- loss of bowel sounds
caused by BLOOD in peritoneal cavity/viscera
34
Heart and spleen referral
Left chest
35
Liver and gallbladder referral pattern
Right shoulder area and below left boob/chest
36
Pancreas referral pattern
Slightly left of stomach area and lower/to left of back middle
37
Stomach referral pattern
Middle of stomach on front and middle of bacl
38
Urinary bladder referral pattern
Above penis/ and btwn butt cheeks
39
Kidney referral pattern
Lower back and front area
40
Appendix referral pattern
Right area under stomach
41
Spleen
- deep to left 9-11 rib in LEFT UPPER quadrant (LUQ)
- injured w/ BLUNT trauma or primary to rib fracture
- spleen's capsule can bleed + signs of splenic injury are often delayed = physical exam is unreliable
42
Order of most common organ injuries
1. Spleen
2. Liver
3.Kidney
4. Bladder
43
Most frequently injured organ in sports
Spleen
Most common cause of death due to abdominal trauma in athletics
44
Symptoms of spleen injuries
- slow onset b/c symptoms develop SECONDARY to bleeding
- LUQ pain/left shoulder pain caused by diaphragmatic irritation = KEHR'S SIGN
MEDICAL EMERGENCY
45
Kehr's sign
LUQ pain/left shoulder pain due to diaphragmatic irritation
46
Liver
SECOND most commonly injured organ
- located in RUQ = RUQ pain
- REFERRED pain to RIGHT SHOULDER/SCAPULA
- occasional nausea + vomiting
Can be bruised or lacerated
- contusion: NO peritoneal signs
- lacerated: will SHOW peritoneal signs
MEDICAL EMERGENCY
47
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 w/ repetitive microtrauma (jostling)
MEDICAL EMERGENCY
48
Hematuria
blood in urine
49
Bladder
- protected by pelvic ring
- DECREASED trauma w/ 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
