Thorax, abdomen, and pelvis injuries Flashcards
(87 cards)
1
Q
how many pairs of ribs do we have?
A
12
2
Q
what are the three rib classifications?
A
true ribs: 1-7
false ribs: 8-10
floating ribs: 11-12
3
Q
which muscle contribute to respiration?
A
main muscle is the diaphragm
-actively contracts during inhalation, flattens to decrease pressure and air enters
4
Q
what are the 4 main abdominal muscles?
A
transversus abdominis, rectus abdominis, external oblique, internal oblique
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
6
Q
which bones form the pelvic girdle?
A
2 innominate bones, and the sacrum in the middle
7
Q
which landmarks can you palpate on the innominate bones of the pelvis?
A
- ASIS
- iliac crest
- PSIS
- ischial tuberosity
- pubic tubercle
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
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)
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
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
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
13
Q
how can we identify a rib fracture via palpation?
A
A/P compression
14
Q
how can we identify a constochondral injury with palpation?
A
transverse compression
15
Q
in what order should the abdominal quadrants be palpated?
A
RUQ, LUQ, LLQ, RLQ
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)
17
Q
rib contusion & rib fracture: MOI
A
- direct blow/contact - compression force
- occasionally fracture due to a forceful muscle contraction (coughing/sneezing)
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)
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
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
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”
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
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
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
25
tension pneumothorax - def
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
26
hemothorax - def
- presence of blood within the pleural cavity
| - results from tearing or puncturing the lung or pleural tissue
27
pneumothorax and hemothorax - S&S
- 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
28
traumatic asphyxia - def
cessation of breathing due to violent blow of compression of rib cage
29
S&S of traumatic asphyxia
- purple discoloration of head and upper trunk
| - bright red eyes
30
lung injury: treatment
- 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
31
sternum fracture: MOI
- high impact to chest
- typically from MVA
- rib fracture and costochondral injuries are more common in athletics
32
S&S of sternum fracture
- point tenderness over sternum and pain on respiration
| - weak, rapid pulse or shock indicate internal injury
33
what is a secondary complication of a sternum fracture?
heart contusion
34
heart contusion - def
-heart compressed between the sternum and the spine
35
heart contusion: MOI
blow to the chest or barbell dropped on chest in bench press
- right ventricle affected
- violent impact can rupture aorta
36
S&S of heart contusion
- heart pain
| - arrythmias that decrease cardiac output
37
treatment of heart contusion
- immediate medical attention - 911
| - be prepared to start CPR and manage for shock
38
commotio cordis - def
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
S&S of commotio cordis
- cardiac arrest
| - immediate death in 50% of cases
40
management of commotio cordis
- immediate AED and CPR essential
| - resuscitation seldom successful
41
how common in sudden cardiac death in athletes?
- young individuals die for no apparent reason
| - 1 in 280,000 men under the age of 30 years
42
sudden cardiac death in athletes: S&S
- 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
what are the most common causes of sudden cardiac death in athletes?
- hypertrophic cardiomyopathy - thickened cardiac muscle
- anomalous origin of the coronary artery - obstructs flow
- Marfan's syndrome - weakened aorta and cardiac valves
44
how can we manage sudden cardiac death in athletes?
pre-participation examination and screening, not a lot can be done
45
abdominal contusion are common in which types of athletes?
contact or combative sports
46
how can abdominal contusions be prevented?
- good conditioning - tensed abdominal muscles provide protection
- proper protective equipment
- enforcing safety rules (esp. in sports with sticks)
47
superficial abdominal contusion - def
hematoma in fascia surrounding rectus abdominis muscles
- pain and tightness or muscle
- POLICE
48
deep abdominal contusion - def
visceral contusions
49
blow to the solar plexus - def
"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
management for blow to the solar plexus
- speak confidently to athletes to lower anxiety
| - controlled breathing - short inspirations and long expirations
51
kidney contusion - def
severe blow to abdomen or back can cause abnormal extension of an engorged kidney (RUQ/LUQ)
52
S&S of kidney contusion
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
management of kidney contusion
- hospital observation (24 hours) with possible surgery
| - 2 weeks of best rest and monitor when resumes activity
54
what is the second most common organ injury from blunt trauma?
liver contusion
55
liver contusion - etiology
-blow to the RUQ
56
liver contusion S&S
- 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
apendicitis: S&S
- 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
intercostal muscle strain - MOI
direct blow or sudden twisting of trunk
59
S&S of intercostal muscle strain
-pain on active movement, respiration, laughing, coughing, or sneezing
60
management of intercostal muscle strain
- POLICE
- cannot fully immobilize because of breathing
- R/O rib fracture (very similar pain)
61
abdominal muscle strain - MOI
- 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
S&S of abdominal muscle strain
- pain contracting muscle (trunk flexion or rotation)
- muscle spasm
- swelling and bruising less common
63
management of abdominal muscle strain
- 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
which abdominal muscle is most prone to strain? why?
rectus abdominis
- other abdominal muscles are more for stability, rotation
- rectus abdominis is the power muscle of the group
65
hernia - def
- protrusion of abdominal viscera through a portion of the abdominal wall
- acquired - heavy lifting (increase intra-abdominal pressure)
- congenital - born with it
66
S&S of hernia
- 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
which type of hernia is more common in males?
inguinal hernia
| -testicles have travelled through inguinal canal, more prone to viscera following the same path)
68
which type of hernia is more common in females?
femoral hernia
69
athletic pubalgia (sports hernia) - def
- 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
S&S of athletic pubalgia
- 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
management of athletic pubalgia
- 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
osteitis pubis - MOI
- stress on pubic symphysis from repetitive overload (distance running)
- restricted movement at SI joint and or hip flexors
73
S&S of osteitis pubis
- 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
management of osteitis pubis
- POLICE - prolonged rest, NSAIDs, and gradual return to activity
- increase mobility of surrounding joints
-need to find the cause, tight muscles, training, etc.
75
iliac crest contusion (hip pointer) MOI
direct blow to iliac crest
76
S&S of hip pointer
- 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
management of hip pointer
- 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
apophysitis - def
```
bony outgrowth (similar to growth plate in long bones)
-common injury in adolescent population (skeletally immature)
```
79
where are the common sites in the pelvis in which apophysitis/avulsion fracture occurs
- ischial tuberosity - attachment of hamstrings
- AIIS - attachment of rectus femoris
- ASIS - attachment of sartorius
80
pelvic avulsion fractures/apophysitis - MOI
sudden acceleration/deceleration
| -football, soccer, basketball
81
S&S of pelvic avulsion fracture/apophysitis
sudden localized pain and limited movement
82
management of pelvic avulsion fracture/apophysitis
- 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
stress fractures in the pelvis - S&S, management
- 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
stress fractures in the ribs - S&S, management
- 1st rib due to repetitive movements such as rowing or pitching
- repeated coughing or laughing
85
scrotal contusion - S&S and treatment
hemorrhage, fluid effusion and muscle spasm
| -Tx: comfortable position and ice
86
testicular torsion MOI
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
traumatic hydrocele - def
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
