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leccture 6- thorax Flashcards

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1
Q

3 respiratory muscles

A

-diaphragm
-intercostal muscles
-sternocleidomastoid

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2
Q

5 boundaries of the thorax

A

neck
diaphragm
thoracic vertebrae
ribs, sternum
muscles

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3
Q

Bones of the thorax

A

-12 thoracic vertebrae

-sternum
(manubrium, body, xiphoid process)

-12 pairs of ribs

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4
Q

Explain the attachments of the 12 thoracic ribs

A

1 to 7 attach to the sternum by individual cartilage (costochondral)

8, 9 and 10 share one attachment

11 and 12 are not attached to the sternum

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5
Q

contents of the thorax

A

lungs
heart
aorta and branches
superior vena cava
azygous vein
trachea
esophagus
vagus nerve

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6
Q

injuries: muscle strains

A

most common in running
intercostals, diaphragm and others

SSx:
-pain on deep inspriration, dypsnea
-tenderness

Tx:
rest, analgesics

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7
Q

injuries: rib fracture

A

direct blow, compression (tackle)

SSx:
severe inspiratory pain and dyspnea

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8
Q

costochondral sprain or dislocation

A

same Hx, Ssx, Tx as strain

plus crepitus deformity (surgery?)

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9
Q

life threatening injuries: pneumothorax (open vs closed)

A

open pneumothorax= air accumulates between chest wall and lung
**if open, there would be a puncture

closed= tear within lung
–> can happen spontaneously in very tall, skinny people

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10
Q

Pneumothorax SSx

A

severe dyspnea (running out of air), shock, cyanosis, rapid respiratory rate (RR)

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11
Q

life threatening injuries: flail chest

A

= multiple rib fractures

  • paradoxical motion of part of chest wall
    –> opposite motion of thoracic cage in place of injury!!! in and out in reverse of normal movement
  • SSx and Tx same as pneumothorax
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12
Q

Abdomen boundaries

A

diaphragm
pelvis
abdominal muscles
vertebrae
lower ribs
back muscles

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13
Q

abdomen quadrants

A

right upper quadrant/RUQ, LUQ, RLQ, LLQ

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14
Q

abdomen blood vessels

A

abdominal aorta, inferior vena cava

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15
Q

abdomen “visitors”

A

bladder if it is v full

uterus in pregnancy

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16
Q

Inguinal area contains

A

inguinal ligament
ASIS to pubic tubercle

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17
Q

What is above the inguinal ligament?

A

the inguinal canal!! which is the site of inguinal herniation

–> the inguinal ligament also has internal and external inguinal rings

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18
Q

The inguinal canal is a passage in the

A

lower part of the abdominal wall for spermatic cord in males or round ligament of uterus in females

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19
Q

What is below the inguinal ligament?

A

the femoral triangle!!!

–> femoral artery, nerve and vein
–> site of femoral herniation

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20
Q

Abdominal organs

A

liver RUQ
spleen LUQ
kidneys

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21
Q

abdominal intestines and glands

A

stomach, duodenum, ileum, jejunum, colon (appendix in RLQ)

pancreas, gallbladder

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22
Q

injuries: blow to coeliac (solar) plexus
(Hx, SSx, Tx)

A

Causes (Hx):
-trauma to central abdomen leads to nerve concussion

-transient paralysis (due to weakness, muscle control comes and goes periodically) of diaphragm

SSx:
Ache, shortness of breath/dyspnea, anxiety

Tx:
relaxation (short inhalation, long exhalation), reassurance, observe!!!

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23
Q

injuries: Side stretch
(Hx, SSx, Tx)

A

Hx:
strain or contusion of abdominal muslce

SSx: crampy pain, worse w inspiration

Tx: stretching, analgesics, rest

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24
Q

Injuries: herniae
definition and mechanism

A

= protrusion of abdominal contents through defect in muscle/fascia

mechanism:
-predisposition (weakness)
-valsalva or direct blow

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25
Degrees of herniae (3)
1. Reducible 2. Incarcerated 3. Strangulated
26
types of herniae
inguinal: mostly males femoral: uncommon, mostly females
27
herniae SSx
- "pull" or weakness - aching pain - swelling, tenderness above (inguinal) or below (femoral) ligament - pain swelling worse w valsalva or coughing?
28
herniae Tx
strengthen abdomen surgery
29
Strangulated herniae
is an emergency!!!! nausea, vomiting, intense pain NPO, transport to hospital!!!!
30
injuries: sports hernia/athletic pubalgia
not the same as herniae! same buildup as MTSS but occurring at the pubic bone SSx: chronic groin pain, pain w twisting, hip extension, possible pain into testicle AxL pt history, physical exam, MRI tear of abdominal muscles or tendon at attachment to pubic tubercle entrapment of inguinal or genitofemoral nerve often labral tear with adductor strain Tx: rest, surgery
31
mononucleosis
enlarged spleen not allowed to play contact sports to protect the area --> delayed abdominal pain after contusion to abdomen??? send to MD!!!!!
32
C spine anatomy
C1= altas (skull flexion/extension) C2= axis (rotation, C1 pivots on C2) C7= vertebra prominens
33
Spinal nerves
C1-C7 exit above the same vertebrae C8 exits between C7 and T1 C5-T1 form brachial plexus C3-C5 innervate diaphragm
34
facial bones are
Fragile (except mandible) TMJ (temporomandibular joint; hinge and gliding joint)
35
common mechanism of injuries for neck (neck strains and sprains Hx)
- flexion/extension - torsion - compression
36
Neck injury SSx
SSx: Pain, tenderness Muscle spasm Restricted ROM Headaches **check for neurological SSx
37
Neck injury management
- Stabilize - If neurologic or severe trauma assume fracture/nerve damage. May lead to permanent brachial plexus or spinal cord injury
38
Neck sprain or strain Tx
- Rest, NSAIDs, physio, massage, flexibility, strengthening - Recurrence is common
39
neck injury or concussion (what force?)
sprain or strain only require 4.5 G of force concussions need 70 to 120 G of force --> you CANNOT have a concussion without injuring your neck
40
concussion=
Immediate, transient, neurologic dysfunction due to trauma of the brain Mild traumatic brain injury
41
the spreading depression phase is an ---- problem
energetic management
42
Excitation phase (ca+, k+, glutamate, glucose and blood flow)
calcium is elevated 500% for up to 6 days potassium is elevated 400% within 12 minutes glutamate elevated 133% for 6 miniutes glucose elevated 200% of normal in first 20 min, then drops below normal for up to 10 days 40% decrease in cerebral blood flow
43
brain injury; grey and white matter
grey matter and white matter move at diff rates causes shearing/damage of axons
44
neurometabolic cascade
dramatic increase in neurotransmitters after a brain inury 1. excitation phase 2. spreading depression phase
45
explain spreading depression phase
Na+/K+ pump maintains balance of Na+, Ca+ inside cells and K+ outside cells requires ATP BUT high level of Ca+ is poisonous for mitochondria ENERGY crisis!!!! - increased ATP demand by Na+/K+ pump - decreased ATP production by mitochondria
46
why are people fatigued/not feeling good after a brain injury?
spreading depression phase results in decreased ATP production
47
3 categories of concussion SSx
1. Physical = headache, dizziness, ringing in ears, pressure in head, neck stiffness/pain, vision problems, balance problems, vomiting/nausea 2. Behavioural/emotional =personality changes, concentration problems, confusion, fatigue, irritable, emotional, anxious, depressed 3. Thinking/cognitive = memory, confusion, concentration, hard to find the words to say, slow to respond, disorientation, brain fog
48
SCAT 5
=sports concussion assessment tool
49
can we use imaging to determine if someone has had a concussion?
no
50
Concussion Tx:
Stabilize neck ABCDs serial assessment Rest High carb diet No absolute rest—light physical activity, gradually increase Limit screen time Don’t go in a dark room!
51
symptoms gone= recovered?!
we can indirectly measure ATP activity full ATP recovery in the brain is 30 days or longer return to sport before brain is metabolically recovered= inc risk of reinjury
52
FULL metabolic recovery from concussion takes
30 to 45 days!!!
53
concussion RTP
Absence of Sx before RTP Clearance from medical professional Physical testing (Buffalo treadmill test and Blackhawk test) gradually increasing intensity of exercise (walking on treadmill and using bike) - fatigue will show us when mitochondria production fails Return to school protocol before return to play protocol
54
concussion complications
- Epidural haematoa (arterial) - Subdural haematoma (venous) - Airway obstruction - Skull fracture (leads to infection --> Protein deposits in the brain (CTE) - impacts blood brain barrier, depression, mood disorders
55
most dangerous movement for brain
rotational deceleration
56
NFL RTP protocol: 5 phases
Phase 1: symptoms limited activity Phase 2: aerobic exercise Phase 3: football specific exercise Phase 4: club-based non-contact training drills Phase 5: full football activity clearance
57
Mandibular fracture and/or temporomandibular dislocation (Hx, SSx, Tx)
Hx: direct blow SSx: deformity, spasm (airway is threatened) Tx: ABCDs, stabilize, hospital ASAP
58
Nasal fracture
Hx: direct blow SSx: pain, swelling crepitus, deformity, epistaxis, uneven air entry Tx: cold compress, go to MD
59
Epistaxis
Hx: direct blow, sinusitis, “digital”= sticking finger up nose Tx: elevation, cold, pressure
60
External ear contusion
Hx: direct blow SSx: swelling, bruising, tenderness Conplication: deformity Tx: cold pack, compress Prevention: ear protection
61
Eye injuries
Contusion Foreign body, laceration, abrasion Infection go to MD
62
Tooth fracture
Save fragment (cold milk) Go to dentist within 2 hours

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