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KIN 191B – Advanced Assessment of Upper Extremity Injuries Abdomen and Thorax Anatomy and Evaluation
Review Bony Anatomy <ul><li>Thorax </li></ul><ul><ul><li>Anterior: sternum </li></ul></ul><ul><ul><li>Posterior: vertebrae...
Muscular Anatomy <ul><li>Focus on function relative to internal organs vs. movement/strength </li></ul><ul><li>Muscles of ...
Muscles of Inspiration
Muscles of Expiration
Respiratory Tract Anatomy <ul><li>Lungs </li></ul><ul><ul><li>Left, 2 lobes: upper and lower </li></ul></ul><ul><ul><li>Ri...
Respiratory Tract
Cardiovascular Anatomy <ul><li>Heart </li></ul><ul><ul><li>Four chambers </li></ul></ul><ul><ul><ul><li>Right atrium – rec...
Heart Chambers
Cardiovascular Anatomy <ul><li>Arterial structures </li></ul><ul><ul><li>Aortic arch forms soon after aorta leaves heart <...
Venous Structures <ul><li>Superior vena cava </li></ul><ul><ul><li>Delivers deoxygenated blood to right atrium from head, ...
Great Vessels off Heart
Digestive Tract Anatomy <ul><li>Esophagus </li></ul><ul><li>Stomach </li></ul><ul><li>Small intestine </li></ul><ul><ul><l...
Digestive Tract and Small Intestine
Large Intestine and Liver
Lymphatic Anatomy <ul><li>Spleen </li></ul>
Urinary Tract Anatomy <ul><li>Kidneys </li></ul><ul><li>Ureters </li></ul><ul><li>Bladder </li></ul><ul><li>Urethra </li><...
Reproductive Tract Anatomy <ul><li>Male </li></ul><ul><ul><li>Testes </li></ul></ul><ul><ul><li>Epididymis </li></ul></ul>...
Male Reproductive Anatomy
Female Reproductive Anatomy
Abdomen and Thorax Evaluation
History
History <ul><li>Location of pain </li></ul><ul><li>Onset of symptoms </li></ul><ul><li>Mechanism of injury </li></ul><ul><...
Location of Pain <ul><li>Musculoskeletal injuries typically present with pain at site of injury </li></ul><ul><li>Internal...
Onset of Symptoms <ul><li>Musculoskeletal injuries </li></ul><ul><ul><li>Pain exacerbated by sneezing, breathing or coughi...
Mechanism of Injury <ul><li>Almost all etiology associated with direct trauma to abdomen/thorax </li></ul><ul><ul><li>Anot...
Symptoms/Chief Complaint/s <ul><li>Dyspnea, pain with inspiration/expiration </li></ul><ul><li>Generalized abdominal pain ...
Medical History <ul><li>Most abdominal and thoracic injuries acute in nature and typically have no associated prior histor...
Inspection
Inspection <ul><li>Posture/guarding </li></ul><ul><li>Breathing pattern </li></ul><ul><li>Capillary refill </li></ul><ul><...
Posture/Guarding <ul><li>Be aware of trunk positioning – is posture abnormal in effort to minimize pain </li></ul><ul><ul>...
Breathing Pattern <ul><li>Observe rate, depth and quality of breaths </li></ul><ul><li>Observe chest wall movements for ab...
Capillary Refill <ul><li>Quick evaluation of nail beds can be assistive in r/o cardiac and/or lung injuries </li></ul><ul>...
Muscle Tone <ul><li>Tension or distension in abdominal muscles may be indicative of internal bleeding </li></ul><ul><li>Ty...
Discoloration/Ecchymosis <ul><li>Contusions generally not acutely visible </li></ul><ul><li>Presence of wounds and abrasio...
Vomiting <ul><li>Presence of vomiting is indication of likely internal injury, with or without associated bleeding </li></...
Hematuria <ul><li>At minimum, question individual about appearance of urine </li></ul><ul><li>If blood present, indicative...
Palpation
Abdominal Quadrants
Quadrants <ul><li>Upper left </li></ul><ul><ul><li>Stomach, spleen, L kidney, gut, ½ pancreas </li></ul></ul><ul><li>Lower...
Palpation <ul><li>Positioning </li></ul><ul><li>Quadrant analysis </li></ul><ul><li>Rigidity </li></ul><ul><li>Rebound ten...
Positioning <ul><li>“ Hook-laying” position allows for relaxation of abdominal musculature and promotes ease of palpation ...
Quadrant Analysis <ul><li>Tenderness associated with palpation of quadrant generally indicative of injury to contents of t...
Rigidity <ul><li>Abdominal rigidity may occur due to </li></ul><ul><ul><li>Muscle guarding due to musculoskeletal and/or i...
Rebound Tenderness <ul><li>Peritoneum is lining of abdominal cavity – extremely well innervated and sensitive to tension, ...
Tissue Density <ul><li>Percussion </li></ul><ul><ul><li>Hollow (stomach, gut) vs. solid (liver, spleen) organs </li></ul><...
Percussion
Special Tests
Auscultation <ul><li>Utilizes stethoscope to assess for internal injury </li></ul><ul><li>For thorax, listen for normal he...
Vital Signs <ul><li>Used to assess function of thoracic and abdominal structures </li></ul><ul><li>Heart rate – assesses c...
Vital Signs <ul><li>Blood pressure </li></ul><ul><ul><li>Pressure exerted on arterial walls of circulatory system </li></u...
Neurological Signs <ul><li>Referred pain is most common neurological sign of abdominal and thoracic injury </li></ul><ul><...
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Kin 191 B – Abdomen And Thorax Anatomy And Evaluation

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Kin 191 B – Abdomen And Thorax Anatomy And Evaluation

  1. 1. KIN 191B – Advanced Assessment of Upper Extremity Injuries Abdomen and Thorax Anatomy and Evaluation
  2. 2. Review Bony Anatomy <ul><li>Thorax </li></ul><ul><ul><li>Anterior: sternum </li></ul></ul><ul><ul><li>Posterior: vertebrae </li></ul></ul><ul><ul><li>Connecting: ribs </li></ul></ul><ul><ul><ul><li>True vs. false </li></ul></ul></ul><ul><ul><ul><li>Costal cartilages </li></ul></ul></ul><ul><li>Abdomen </li></ul><ul><ul><li>Posterior: vertebrae </li></ul></ul><ul><ul><li>Lateral: floating ribs </li></ul></ul><ul><ul><li>Inferior: sacrum and ilia (pelvis) </li></ul></ul>
  3. 3. Muscular Anatomy <ul><li>Focus on function relative to internal organs vs. movement/strength </li></ul><ul><li>Muscles of inspiration </li></ul><ul><ul><li>Diaphragm </li></ul></ul><ul><ul><li>Intercostal muscles </li></ul></ul><ul><ul><li>Scalene muscles </li></ul></ul><ul><li>Muscles of expiration </li></ul><ul><ul><li>“ Traditional” abdominal muscles (IO, EO, RA, TA) </li></ul></ul>
  4. 4. Muscles of Inspiration
  5. 5. Muscles of Expiration
  6. 6. Respiratory Tract Anatomy <ul><li>Lungs </li></ul><ul><ul><li>Left, 2 lobes: upper and lower </li></ul></ul><ul><ul><li>Right, 3 lobes: upper, middle and lower </li></ul></ul><ul><li>Trachea </li></ul><ul><ul><li>Divides into bronchi (2), segmental bronchi (2 left and 3 right), bronchioles and alveoli (exchange of gases) </li></ul></ul><ul><li>Pleural linings </li></ul><ul><ul><li>Parietal pleura: lines thoracic cavity walls </li></ul></ul><ul><ul><li>Visceral pleura: surrounds lungs </li></ul></ul><ul><ul><li>Creates potential space (pleural cavity) – important for injury classification/evaluation </li></ul></ul>
  7. 7. Respiratory Tract
  8. 8. Cardiovascular Anatomy <ul><li>Heart </li></ul><ul><ul><li>Four chambers </li></ul></ul><ul><ul><ul><li>Right atrium – receives deoxygenated blood from body via superior/inferior vena cava, delivers deoxygenated blood to right ventricle </li></ul></ul></ul><ul><ul><ul><li>Right ventricle – receives deoxygenated blood from right atrium, delivers deoxygenated blood to lungs via pulmonary arteries </li></ul></ul></ul><ul><ul><ul><li>Left atrium – receives oxygenated blood from lungs via pulmonary veins, delivers oxygenated blood to left ventricle </li></ul></ul></ul><ul><ul><ul><li>Left ventricle – receives oxygenated blood from left atrium, delivers oxygenated blood to body via aorta and its branches </li></ul></ul></ul>
  9. 9. Heart Chambers
  10. 10. Cardiovascular Anatomy <ul><li>Arterial structures </li></ul><ul><ul><li>Aortic arch forms soon after aorta leaves heart </li></ul></ul><ul><ul><li>On R, brachiocephalic trunk arises and branches into R subclavian and R common carotid arteries </li></ul></ul><ul><ul><li>On L, left subclavian and L common carotid arteries arise individually from aortic arch </li></ul></ul><ul><ul><li>Destinations? </li></ul></ul><ul><ul><li>Aorta travels inferiorly from arch as thoracic and abdominal aortas before branching into LE </li></ul></ul>
  11. 11. Venous Structures <ul><li>Superior vena cava </li></ul><ul><ul><li>Delivers deoxygenated blood to right atrium from head, neck and upper extremities </li></ul></ul><ul><li>Inferior vena cava </li></ul><ul><ul><li>Delivers deoxygenated blood to right atrium from trunk and lower extremities </li></ul></ul>
  12. 12. Great Vessels off Heart
  13. 13. Digestive Tract Anatomy <ul><li>Esophagus </li></ul><ul><li>Stomach </li></ul><ul><li>Small intestine </li></ul><ul><ul><li>Duodenum, jejunum and ileum </li></ul></ul><ul><li>Large intestine (colon) </li></ul><ul><ul><li>Cecum (appendix), ascending-transverse-descending colon, sigmoid colon, rectum, anus </li></ul></ul><ul><li>Liver (R and L lobes, ligamentum teres), gall bladder, common bile duct </li></ul>
  14. 14. Digestive Tract and Small Intestine
  15. 15. Large Intestine and Liver
  16. 16. Lymphatic Anatomy <ul><li>Spleen </li></ul>
  17. 17. Urinary Tract Anatomy <ul><li>Kidneys </li></ul><ul><li>Ureters </li></ul><ul><li>Bladder </li></ul><ul><li>Urethra </li></ul>
  18. 18. Reproductive Tract Anatomy <ul><li>Male </li></ul><ul><ul><li>Testes </li></ul></ul><ul><ul><li>Epididymis </li></ul></ul><ul><ul><li>Penis </li></ul></ul><ul><li>Female </li></ul><ul><ul><li>Ovaries </li></ul></ul><ul><ul><li>Fallopian tubes </li></ul></ul><ul><ul><li>Uterus </li></ul></ul><ul><ul><li>Vagina </li></ul></ul>
  19. 19. Male Reproductive Anatomy
  20. 20. Female Reproductive Anatomy
  21. 21. Abdomen and Thorax Evaluation
  22. 22. History
  23. 23. History <ul><li>Location of pain </li></ul><ul><li>Onset of symptoms </li></ul><ul><li>Mechanism of injury </li></ul><ul><li>Symptoms/chief complaint/s </li></ul><ul><li>Medical history </li></ul><ul><li>General health </li></ul>
  24. 24. Location of Pain <ul><li>Musculoskeletal injuries typically present with pain at site of injury </li></ul><ul><li>Internal organ injuries often more difficult to localize </li></ul><ul><li>Must appreciate anatomical locations </li></ul><ul><li>Must be mindful of referred pain from organ injury </li></ul>
  25. 25. Onset of Symptoms <ul><li>Musculoskeletal injuries </li></ul><ul><ul><li>Pain exacerbated by sneezing, breathing or coughing </li></ul></ul><ul><ul><li>Symptoms usually present immediately, but often overlooked </li></ul></ul><ul><li>Internal injuries </li></ul><ul><ul><li>Symptoms may present gradually, especially with internal bleeding – depends on damaged organ and extent of damage </li></ul></ul>
  26. 26. Mechanism of Injury <ul><li>Almost all etiology associated with direct trauma to abdomen/thorax </li></ul><ul><ul><li>Another competitor </li></ul></ul><ul><ul><li>Equipment </li></ul></ul><ul><ul><li>Ground </li></ul></ul><ul><ul><li>Increased incidence with trauma to unprotected areas </li></ul></ul>
  27. 27. Symptoms/Chief Complaint/s <ul><li>Dyspnea, pain with inspiration/expiration </li></ul><ul><li>Generalized abdominal pain </li></ul><ul><li>Nausea </li></ul><ul><li>Vomiting (if blood – coffee grounds) </li></ul><ul><li>Dizziness </li></ul><ul><li>Hematuria </li></ul><ul><li>Blood in stool </li></ul>
  28. 28. Medical History <ul><li>Most abdominal and thoracic injuries acute in nature and typically have no associated prior history of similar problems </li></ul><ul><li>Other health concerns may increase risk of abdominal or thoracic injury </li></ul><ul><ul><li>Mononucleosis/spleen </li></ul></ul>
  29. 29. Inspection
  30. 30. Inspection <ul><li>Posture/guarding </li></ul><ul><li>Breathing pattern </li></ul><ul><li>Capillary refill </li></ul><ul><li>Muscle tone </li></ul><ul><li>Discoloration, ecchymosis </li></ul><ul><li>Vomiting </li></ul><ul><li>Hematuria </li></ul>
  31. 31. Posture/Guarding <ul><li>Be aware of trunk positioning – is posture abnormal in effort to minimize pain </li></ul><ul><ul><li>Often lean toward pain as opposed to away from it </li></ul></ul><ul><li>Anatomical alignment </li></ul><ul><ul><li>Trachea positioned in midline? </li></ul></ul><ul><ul><li>If not, may be indicative of tracheal injury or tension pneumothorax </li></ul></ul>
  32. 32. Breathing Pattern <ul><li>Observe rate, depth and quality of breaths </li></ul><ul><li>Observe chest wall movements for abnormalities (flail segment, rib fracture/s) </li></ul><ul><li>Subcutaneous emphysema = “rice crispies” under skin – indicative of lung injury </li></ul><ul><li>Dyspnea – identify source </li></ul>
  33. 33. Capillary Refill <ul><li>Quick evaluation of nail beds can be assistive in r/o cardiac and/or lung injuries </li></ul><ul><li>Fingers often best site due to relative proximity to torso </li></ul>
  34. 34. Muscle Tone <ul><li>Tension or distension in abdominal muscles may be indicative of internal bleeding </li></ul><ul><li>Typically requires some time for this to occur </li></ul>
  35. 35. Discoloration/Ecchymosis <ul><li>Contusions generally not acutely visible </li></ul><ul><li>Presence of wounds and abrasions indicative of trauma and increases suspicion of injury to underlying structures </li></ul>
  36. 36. Vomiting <ul><li>Presence of vomiting is indication of likely internal injury, with or without associated bleeding </li></ul><ul><li>Blood in vomit often indicative of GI and/or respiratory injury </li></ul><ul><ul><li>If partially digested, appears as coffee grounds </li></ul></ul>
  37. 37. Hematuria <ul><li>At minimum, question individual about appearance of urine </li></ul><ul><li>If blood present, indicative of kidney and/or genitourinary injury in need of immediate attention </li></ul><ul><li>If able, perform dipstick urinalysis to evaluate for presence of blood otherwise not seen </li></ul>
  38. 38. Palpation
  39. 39. Abdominal Quadrants
  40. 40. Quadrants <ul><li>Upper left </li></ul><ul><ul><li>Stomach, spleen, L kidney, gut, ½ pancreas </li></ul></ul><ul><li>Lower left </li></ul><ul><ul><li>Gut, ureter, ½ bladder, L ovary (female) </li></ul></ul><ul><li>Upper right </li></ul><ul><ul><li>Liver, gall bladder, R kidney, gut, ½ pancreas </li></ul></ul><ul><li>Lower right </li></ul><ul><ul><li>Gut, ureter, ½ bladder, appendix, R ovary (female) </li></ul></ul>
  41. 41. Palpation <ul><li>Positioning </li></ul><ul><li>Quadrant analysis </li></ul><ul><li>Rigidity </li></ul><ul><li>Rebound tenderness </li></ul><ul><li>Tissue density </li></ul><ul><li>Auscultation </li></ul>
  42. 42. Positioning <ul><li>“ Hook-laying” position allows for relaxation of abdominal musculature and promotes ease of palpation of abdominal structures </li></ul>
  43. 43. Quadrant Analysis <ul><li>Tenderness associated with palpation of quadrant generally indicative of injury to contents of that quadrant </li></ul><ul><li>Must have perspective on underlying tissue – anatomy!!! </li></ul>
  44. 44. Rigidity <ul><li>Abdominal rigidity may occur due to </li></ul><ul><ul><li>Muscle guarding due to musculoskeletal and/or internal injury </li></ul></ul><ul><ul><li>Internal bleeding – actual accumulation of blood in abdominal cavity </li></ul></ul>
  45. 45. Rebound Tenderness <ul><li>Peritoneum is lining of abdominal cavity – extremely well innervated and sensitive to tension, especially when inflamed secondary to internal injury </li></ul><ul><li>When pressure applied to injured site, stretch is typically gradual and non-irritating </li></ul><ul><li>When pressure released, stretch is typically quick and pain results </li></ul>
  46. 46. Tissue Density <ul><li>Percussion </li></ul><ul><ul><li>Hollow (stomach, gut) vs. solid (liver, spleen) organs </li></ul></ul><ul><ul><li>Analogize to finding stud in wall behind drywall </li></ul></ul><ul><ul><li>Typically percussion done by placing fingers of one hand over area and tapping with other hand </li></ul></ul>
  47. 47. Percussion
  48. 48. Special Tests
  49. 49. Auscultation <ul><li>Utilizes stethoscope to assess for internal injury </li></ul><ul><li>For thorax, listen for normal heart “lub-dub” </li></ul><ul><ul><li>r/o presence of murmurs </li></ul></ul><ul><li>For thorax, listen for breath sounds in all lobes of lungs </li></ul><ul><ul><li>If absent, may indicate lung injury </li></ul></ul><ul><ul><li>Rales – fluid in lung (pneumonia, etc.) </li></ul></ul><ul><li>For abdomen, listen for “gurgling” indicative of peristalsis </li></ul><ul><ul><li>If absent, may indicate intra-abdominal injury </li></ul></ul>
  50. 50. Vital Signs <ul><li>Used to assess function of thoracic and abdominal structures </li></ul><ul><li>Heart rate – assesses cardiovascular function </li></ul><ul><ul><li>Rate and quality </li></ul></ul><ul><li>Respiratory rate – assesses respiratory function </li></ul><ul><ul><li>Rate, depth and quality </li></ul></ul>
  51. 51. Vital Signs <ul><li>Blood pressure </li></ul><ul><ul><li>Pressure exerted on arterial walls of circulatory system </li></ul></ul><ul><ul><li>Decreased blood pressure may be indicative of shock, decreased blood volume and/or decreased ability of heart to pump and deliver blood </li></ul></ul>
  52. 52. Neurological Signs <ul><li>Referred pain is most common neurological sign of abdominal and thoracic injury </li></ul><ul><li>L shoulder – spleen (Kehr’s sign) </li></ul><ul><li>R shoulder – liver </li></ul><ul><li>Flanks – kidney </li></ul><ul><li>Groin – gonads </li></ul><ul><li>Medial thigh - bladder </li></ul>

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