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KIN 188 – Prevention and Care of Athletic Injuries Thoracic and Abdominal  Evaluation and Injuries
Anatomy
Bony Anatomy <ul><li>Thorax </li></ul><ul><ul><li>Anterior – sternum </li></ul></ul><ul><ul><li>Lateral – ribs </li></ul><...
Muscular Anatomy <ul><li>Muscles of inspiration </li></ul><ul><ul><li>Diaphragm </li></ul></ul><ul><ul><li>Intercostals </...
Respiratory Tract Anatomy <ul><li>Lungs </li></ul><ul><ul><li>Left – 2 lobes </li></ul></ul><ul><ul><li>Right – 3 lobes </...
Cardiovascular Anatomy <ul><li>Heart </li></ul><ul><ul><li>2 atria </li></ul></ul><ul><ul><li>2 ventricles </li></ul></ul>...
Digestive Tract/Lymphatic Anatomy <ul><li>Esophagus </li></ul><ul><li>Stomach </li></ul><ul><li>Small intestine </li></ul>...
Digestive Tract/Lymphatic Anatomy
Genitourinary Anatomy <ul><li>Urinary anatomy </li></ul><ul><ul><li>Kidneys, ureters, bladder, urethra </li></ul></ul><ul>...
Evaluation
History <ul><li>Mechanism of injury/etiology </li></ul><ul><ul><li>Almost all etiology associated with direct trauma to ab...
History <ul><li>Onset of symptoms </li></ul><ul><ul><li>If musculoskeletal, usually rapid onset </li></ul></ul><ul><ul><li...
Inspection/Observation <ul><li>Posture/guarding </li></ul><ul><ul><li>Often lean toward painful area for splinting </li></...
Inspection/Observation <ul><li>Muscle tone </li></ul><ul><ul><li>Tension due to spasm/guarding or internal bleeding </li><...
Palpation <ul><li>Abdominal quadrants </li></ul><ul><ul><li>Upper left </li></ul></ul><ul><ul><li>Upper right </li></ul></...
Palpation <ul><li>Positioning </li></ul><ul><ul><li>Best done in “hook laying” position </li></ul></ul><ul><li>Rigidity </...
Special Tests <ul><li>Vital sign assessment for shock secondary to internal bleeding </li></ul><ul><ul><li>Increased heart...
Injuries
Thoracic Injuries <ul><li>Bony injuries </li></ul><ul><ul><li>Rib fracture </li></ul></ul><ul><ul><ul><li>Most common to a...
Thoracic Injuries <ul><li>Pneumothorax </li></ul><ul><ul><li>Accumulation of air in pleural cavity that affects ability of...
Thoracic Injuries <ul><li>Hemothorax </li></ul><ul><ul><li>Accumulation of blood in the pleural cavity </li></ul></ul><ul>...
Abdominal Injuries <ul><li>Liver injury </li></ul><ul><ul><li>Typically associated with blunt force trauma to upper right ...
Organ Injuries
Abdominal Injuries <ul><li>Appendix injuries </li></ul><ul><ul><li>Appendicitis </li></ul></ul><ul><ul><ul><li>Initial gen...
Appendicitis
Abdominal Injuries <ul><li>Male reproductive injuries/conditions </li></ul><ul><ul><li>More common than in women due to ex...
Testicular Torsion
Abdominal Injuries <ul><li>Female reproductive injuries/conditions </li></ul><ul><ul><li>Less common due to protection aff...
Abdominal Injuries <ul><li>Female reproductive injuries/conditions </li></ul><ul><ul><li>Dysmenorrhea </li></ul></ul><ul><...
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Kin 188 Thoracic And Abdominal Evaluation And Injuries

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Transcript of "Kin 188 Thoracic And Abdominal Evaluation And Injuries"

  1. 1. KIN 188 – Prevention and Care of Athletic Injuries Thoracic and Abdominal Evaluation and Injuries
  2. 2. Anatomy
  3. 3. Bony Anatomy <ul><li>Thorax </li></ul><ul><ul><li>Anterior – sternum </li></ul></ul><ul><ul><li>Lateral – ribs </li></ul></ul><ul><ul><li>Posterior - vertebrae </li></ul></ul><ul><li>Abdomen </li></ul><ul><ul><li>Posterior – vertebrae </li></ul></ul><ul><ul><li>Lateral – ribs (lesser extent) </li></ul></ul>
  4. 4. Muscular Anatomy <ul><li>Muscles of inspiration </li></ul><ul><ul><li>Diaphragm </li></ul></ul><ul><ul><li>Intercostals </li></ul></ul><ul><li>Muscles of expiration </li></ul><ul><ul><li>Abdominal muscles </li></ul></ul><ul><ul><ul><li>Rectus abdominus </li></ul></ul></ul><ul><ul><ul><li>Internal/external obliques </li></ul></ul></ul><ul><ul><ul><li>Transversus abdominus </li></ul></ul></ul>
  5. 5. Respiratory Tract Anatomy <ul><li>Lungs </li></ul><ul><ul><li>Left – 2 lobes </li></ul></ul><ul><ul><li>Right – 3 lobes </li></ul></ul><ul><li>Trachea </li></ul><ul><ul><li>Divides into bronchi </li></ul></ul><ul><li>Pleural linings </li></ul><ul><ul><li>Parietal – lines cavity </li></ul></ul><ul><ul><li>Visceral – lines lungs </li></ul></ul><ul><ul><li>Creates potential space </li></ul></ul>
  6. 6. Cardiovascular Anatomy <ul><li>Heart </li></ul><ul><ul><li>2 atria </li></ul></ul><ul><ul><li>2 ventricles </li></ul></ul><ul><li>Vascular structures </li></ul><ul><ul><li>Aorta </li></ul></ul><ul><ul><li>Inferior/superior vena cava </li></ul></ul><ul><ul><li>Pulmonary arteries/veins </li></ul></ul>
  7. 7. Digestive Tract/Lymphatic Anatomy <ul><li>Esophagus </li></ul><ul><li>Stomach </li></ul><ul><li>Small intestine </li></ul><ul><ul><li>Duodenum, jejunum, ileum </li></ul></ul><ul><li>Large intestine (colon) </li></ul><ul><ul><li>Cecum (appendix), ascending/transverse/descending, sigmoid, rectum, anus </li></ul></ul><ul><li>Liver/gall bladder </li></ul><ul><li>Spleen </li></ul>
  8. 8. Digestive Tract/Lymphatic Anatomy
  9. 9. Genitourinary Anatomy <ul><li>Urinary anatomy </li></ul><ul><ul><li>Kidneys, ureters, bladder, urethra </li></ul></ul><ul><li>Male reproductive anatomy </li></ul><ul><ul><li>Testes, epididymis, penis </li></ul></ul><ul><li>Female reproductive anatomy </li></ul><ul><ul><li>Ovaries, fallopian tubes, uterus, vagina </li></ul></ul>
  10. 10. Evaluation
  11. 11. History <ul><li>Mechanism of injury/etiology </li></ul><ul><ul><li>Almost all etiology associated with direct trauma to abdomen/thorax </li></ul></ul><ul><ul><ul><li>Another competitor </li></ul></ul></ul><ul><ul><ul><li>Equipment </li></ul></ul></ul><ul><ul><ul><li>Ground </li></ul></ul></ul><ul><ul><ul><li>Increased incidence with trauma to unprotected areas </li></ul></ul></ul><ul><li>Location of pain </li></ul><ul><ul><li>Must know anatomy </li></ul></ul>
  12. 12. History <ul><li>Onset of symptoms </li></ul><ul><ul><li>If musculoskeletal, usually rapid onset </li></ul></ul><ul><ul><li>If organ related, may have quick or slow onset depending upon structure and amount/rate of bleeding </li></ul></ul><ul><li>Symptoms/chief complaint/s </li></ul><ul><ul><li>Dyspnea, abdominal pain, nausea/vomiting (appearance), dizziness, hematuria, blood in stool </li></ul></ul><ul><li>Medical history </li></ul><ul><ul><li>Any prior thoracic/abdominal injuries? </li></ul></ul>
  13. 13. Inspection/Observation <ul><li>Posture/guarding </li></ul><ul><ul><li>Often lean toward painful area for splinting </li></ul></ul><ul><li>Breathing pattern </li></ul><ul><ul><li>Rate/depth/quality of breaths </li></ul></ul><ul><li>Capillary refill </li></ul><ul><ul><li>Best done at fingers for cursory vascular evaluation </li></ul></ul>
  14. 14. Inspection/Observation <ul><li>Muscle tone </li></ul><ul><ul><li>Tension due to spasm/guarding or internal bleeding </li></ul></ul><ul><li>Discoloration/ecchymosis </li></ul><ul><ul><li>Typically not visible, abrasions/etc. indicative of potential underlying trauma </li></ul></ul><ul><li>Vomiting </li></ul><ul><ul><li>“ Coffee grounds” if blood in it </li></ul></ul><ul><li>Hematuria </li></ul><ul><ul><li>If visible, significant for genitourinary conditions </li></ul></ul><ul><ul><li>May need urinalysis for ultimate determination </li></ul></ul>
  15. 15. Palpation <ul><li>Abdominal quadrants </li></ul><ul><ul><li>Upper left </li></ul></ul><ul><ul><li>Upper right </li></ul></ul><ul><ul><li>Lower left </li></ul></ul><ul><ul><li>Lower right </li></ul></ul>
  16. 16. Palpation <ul><li>Positioning </li></ul><ul><ul><li>Best done in “hook laying” position </li></ul></ul><ul><li>Rigidity </li></ul><ul><ul><li>Guarding/spasm vs. internal bleeding </li></ul></ul><ul><li>Rebound tenderness </li></ul><ul><ul><li>Tension on peritoneum (lining of abdominal cavity) </li></ul></ul><ul><li>Percussion </li></ul><ul><ul><li>Hollow vs. solid organs </li></ul></ul><ul><li>Auscultation </li></ul><ul><ul><li>Listen for bowel sounds (“gurgling”) </li></ul></ul>
  17. 17. Special Tests <ul><li>Vital sign assessment for shock secondary to internal bleeding </li></ul><ul><ul><li>Increased heart/respiratory rates, decreased blood pressure </li></ul></ul><ul><li>Neurological signs – referred pain sites </li></ul><ul><ul><li>L shoulder – spleen (Kerr’s sign) </li></ul></ul><ul><ul><li>R shoulder – liver </li></ul></ul><ul><ul><li>Flanks – kidneys </li></ul></ul><ul><ul><li>Groin – gonads </li></ul></ul><ul><ul><li>Medial thigh - bladder </li></ul></ul>
  18. 18. Injuries
  19. 19. Thoracic Injuries <ul><li>Bony injuries </li></ul><ul><ul><li>Rib fracture </li></ul></ul><ul><ul><ul><li>Most common to anterior/lateral aspect of 5 th -9 th ribs </li></ul></ul></ul><ul><ul><li>Flail chest </li></ul></ul><ul><ul><ul><li>4 or more ribs fractured in 2 or more places </li></ul></ul></ul><ul><ul><li>Sternum fracture </li></ul></ul><ul><ul><ul><li>Potential for significant injury if posterior displacement </li></ul></ul></ul>
  20. 20. Thoracic Injuries <ul><li>Pneumothorax </li></ul><ul><ul><li>Accumulation of air in pleural cavity that affects ability of lung to expand </li></ul></ul><ul><ul><ul><li>Decreased oxygen, hypoxia, respiratory distress </li></ul></ul></ul><ul><ul><li>Dyspnea, pain with respirations, guarding or splinting of affected area, possible cyanosis </li></ul></ul><ul><ul><li>Decreased or absent breath sounds on auscultation of affected lung </li></ul></ul>
  21. 21. Thoracic Injuries <ul><li>Hemothorax </li></ul><ul><ul><li>Accumulation of blood in the pleural cavity </li></ul></ul><ul><ul><ul><li>Bleeding from lacerated lung and/or rupture of blood vessel within thoracic cavity </li></ul></ul></ul><ul><ul><ul><li>May be from penetrating injury </li></ul></ul></ul><ul><ul><li>Often occurs simultaneously with pneumothorax </li></ul></ul>
  22. 22. Abdominal Injuries <ul><li>Liver injury </li></ul><ul><ul><li>Typically associated with blunt force trauma to upper right quadrant – contusion vs. laceration </li></ul></ul><ul><li>Splenic injury </li></ul><ul><ul><li>Typically associated with blunt force trauma to upper left quadrant – may be atraumatic </li></ul></ul><ul><ul><li>Risk is higher if spleen enlarged due to systemic condition (mono, pneumonia, etc.) </li></ul></ul><ul><li>Kidney injury </li></ul><ul><ul><li>Well protected anatomically by rib cage, vertebrae and spinal musculature </li></ul></ul><ul><ul><li>Typically associated with blunt force trauma to “flank” region </li></ul></ul>
  23. 23. Organ Injuries
  24. 24. Abdominal Injuries <ul><li>Appendix injuries </li></ul><ul><ul><li>Appendicitis </li></ul></ul><ul><ul><ul><li>Initial general systemic symptoms </li></ul></ul></ul><ul><ul><ul><li>Initial tenderness in lower right quadrant (McBurney’s point) – rebound tenderness </li></ul></ul></ul><ul><ul><ul><li>May have referred pain to right chest, upper trap and/or umbilicus </li></ul></ul></ul><ul><li>Appendix rupture </li></ul><ul><ul><li>May be more risk with blunt force trauma to lower right quadrant if appendix is inflamed </li></ul></ul>
  25. 25. Appendicitis
  26. 26. Abdominal Injuries <ul><li>Male reproductive injuries/conditions </li></ul><ul><ul><li>More common than in women due to external location of male genitalia </li></ul></ul><ul><ul><li>Testicular contusion </li></ul></ul><ul><ul><ul><li>Etiology is direct trauma </li></ul></ul></ul><ul><ul><ul><li>Calm injured person </li></ul></ul></ul><ul><ul><ul><li>Signs and symptoms (localized pain, often severe, nausea/vomiting </li></ul></ul></ul><ul><ul><ul><li>Must inspect for abnormalities (self-exam unless unable) once symptoms minimize (swelling, abnormal tissue density) </li></ul></ul></ul><ul><ul><li>Testicular torsion </li></ul></ul><ul><ul><ul><li>Twisting of spermatic cord within scrotum </li></ul></ul></ul><ul><ul><ul><li>Signs and symptoms (intense pain, nausea/vomiting, swelling and/or mass in scrotum from occlusion of vascular structures </li></ul></ul></ul>
  27. 27. Testicular Torsion
  28. 28. Abdominal Injuries <ul><li>Female reproductive injuries/conditions </li></ul><ul><ul><li>Less common due to protection afforded by abdomen/anatomical location </li></ul></ul><ul><ul><li>Amenorrhea </li></ul></ul><ul><ul><ul><li>Primary vs. secondary </li></ul></ul></ul><ul><ul><ul><ul><li>Primary – absence of onset of menstruation by age 16 </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Secondary – cessation of menstruation for 6+ months </li></ul></ul></ul></ul><ul><ul><ul><li>Contributing factors </li></ul></ul></ul><ul><ul><ul><ul><li>Exercise, weight loss, stress, anxiety </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Body image, societal pressures </li></ul></ul></ul></ul>
  29. 29. Abdominal Injuries <ul><li>Female reproductive injuries/conditions </li></ul><ul><ul><li>Dysmenorrhea </li></ul></ul><ul><ul><ul><li>Pain and/or cramping in lower abdomen and pelvis prior to menstruation </li></ul></ul></ul><ul><ul><ul><li>Signs and symptoms (nausea/vomiting, diarrhea or constipation, bloating) </li></ul></ul></ul><ul><ul><li>Female athlete triad </li></ul></ul><ul><ul><ul><li>Comprised of three elements </li></ul></ul></ul><ul><ul><ul><ul><li>Amenorrhea, disordered eating, osteoporosis </li></ul></ul></ul></ul><ul><ul><ul><li>Presence of one component requires screening for the others </li></ul></ul></ul><ul><ul><ul><ul><li>In combination, can be life threatening </li></ul></ul></ul></ul><ul><ul><ul><li>Best treatment is prevention (screening) and education </li></ul></ul></ul><ul><ul><ul><ul><li>Team approach to clinical treatment – physiological and psychological </li></ul></ul></ul></ul>
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