Kin 191 B – Abdomen And Thorax Injuries


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Kin 191 B – Abdomen And Thorax Injuries

  1. 1. KIN 191B – Advanced Assessment of Upper Extremity Injuries Abdomen and Thorax Injuries
  2. 2. Pathologies <ul><li>Thoracic Injuries </li></ul><ul><ul><li>Review bony injuries </li></ul></ul><ul><ul><li>Pneumothorax </li></ul></ul><ul><ul><li>Hemothorax </li></ul></ul><ul><ul><li>Solar plexus contusions </li></ul></ul><ul><ul><li>Heart contusion </li></ul></ul><ul><li>Abdominal Injuries </li></ul><ul><ul><li>Liver Injury </li></ul></ul><ul><ul><li>Splenic injury </li></ul></ul><ul><ul><li>Kidney/urinary pathologies </li></ul></ul><ul><ul><li>Appendix pathologies </li></ul></ul><ul><ul><li>Hollow organ injury </li></ul></ul><ul><ul><li>General medical issues </li></ul></ul><ul><ul><li>Male/female reproductive system pathologies </li></ul></ul>
  3. 3. Thoracic Injuries
  4. 4. Review Bony Injuries <ul><li>Rib fractures </li></ul><ul><ul><li>Common fracture sites </li></ul></ul><ul><ul><li>Why? </li></ul></ul><ul><li>Flail chest </li></ul><ul><ul><li>Definition </li></ul></ul><ul><ul><li>Classic presentation </li></ul></ul><ul><li>Costochondral/chondrosternal injuries </li></ul><ul><ul><li>Types of injury </li></ul></ul><ul><ul><li>Nature of articulation </li></ul></ul>
  5. 5. Flail Chest
  6. 6. Pneumothorax <ul><li>Accumulation of air in pleural cavity that affects ability of lung to expand </li></ul><ul><ul><li>Decreased oxygen, hypoxia, respiratory distress </li></ul></ul><ul><li>Open vs. closed presentation </li></ul><ul><ul><li>Closed = spontaneous pneumothorax </li></ul></ul><ul><ul><ul><li>Air leaks into cavity </li></ul></ul></ul><ul><ul><ul><li>With/without trauma, post-op, poor breathing during strenuous exercise </li></ul></ul></ul><ul><ul><li>Open pneumothorax </li></ul></ul><ul><ul><ul><li>Penetrating wound from rib fracture and/or foreign object </li></ul></ul></ul><ul><ul><ul><li>“ Sucking chest wound” – cover with nonporous material to prevent passage of air </li></ul></ul></ul>
  7. 7. Pneumothorax
  8. 8. Pneumothorax <ul><li>Tension pneumothorax </li></ul><ul><ul><li>If left untreated, spontaneous pneumo may progress to tension pneumo = “collapsed lung” </li></ul></ul><ul><ul><li>If tension pneumo untreated, pressure continues to build ultimately affecting other lung, heart and great vessels </li></ul></ul><ul><ul><li>Tracheal shift and JVD </li></ul></ul>
  9. 9. Tension Pneumothorax
  10. 10. Pneumothorax <ul><li>Signs and symptoms </li></ul><ul><ul><li>Dyspnea, pain with respirations, guarding or splinting of affected area, possible cyanosis </li></ul></ul><ul><ul><li>If associated with trauma, pain at site of impact, rib fracture or foreign object </li></ul></ul><ul><ul><li>Decreased or absent breath sounds on auscultation of affected lung </li></ul></ul><ul><ul><li>Vitals – signs of shock </li></ul></ul><ul><ul><ul><li>Heart rate, respirations </li></ul></ul></ul><ul><ul><ul><li>Blood pressure </li></ul></ul></ul>
  11. 11. Hemothorax <ul><li>Accumulation of blood in the pleural cavity </li></ul><ul><ul><li>Bleeding from lacerated lung and/or rupture of blood vessel within thoracic cavity </li></ul></ul><ul><ul><li>May be from penetrating injury </li></ul></ul><ul><li>Often occurs simultaneously with pneumothorax </li></ul><ul><li>Essential signs and symptoms identical </li></ul><ul><ul><li>Also may present with coughing up of bloody sputum </li></ul></ul>
  12. 12. Hemothorax
  13. 13. Solar Plexus Contusion <ul><li>Solar (celiac) plexus is large network of nerves associated with abdomen/thorax </li></ul><ul><li>Blunt force trauma can cause contusion which causes transient paralysis of diaphragm leading to breathing difficulties </li></ul><ul><li>Condition is self-limiting and breathing will return – must minimize panic </li></ul><ul><li>Deep breaths, pant, loosen clothing </li></ul><ul><li>Must rule out other abdominal injury </li></ul>
  14. 14. Heart Contusion <ul><li>Uncommon due to anatomical location and bony protection </li></ul><ul><li>May be affected by forceful trauma to anterior chest/sternal region </li></ul><ul><li>Signs and symptoms </li></ul><ul><ul><li>Chest pain </li></ul></ul><ul><ul><li>JVD </li></ul></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Vitals – signs of shock </li></ul></ul><ul><li>Can cause immediate death due to interruption of normal cardiac rhythm </li></ul>
  15. 15. Abdominal Injuries
  16. 16. Liver Injury <ul><li>Typically associated with blunt force trauma to upper right quadrant – contusion vs. laceration </li></ul><ul><li>Risk is higher if liver is enlarged (hepatitis) from viral infection or alcohol consumption </li></ul><ul><li>Generally have acute onset of symptoms, but may have delayed onset depending on severity of injury </li></ul>
  17. 17. Liver Injury <ul><li>Signs and symptoms </li></ul><ul><ul><li>Pain at site of injury (upper right quadrant) </li></ul></ul><ul><ul><li>Referred pain to right shoulder/scapula </li></ul></ul><ul><ul><li>Nausea and/or vomiting (appearance) </li></ul></ul><ul><ul><li>Significant bleeding may present with abdominal rigidity and/or rebound tenderness </li></ul></ul><ul><ul><li>Vitals – signs of shock </li></ul></ul><ul><ul><ul><li>Heart rate/respirations </li></ul></ul></ul><ul><ul><ul><li>Blood pressure </li></ul></ul></ul><ul><ul><ul><li>Due to internal bleeding (hypovolemic) </li></ul></ul></ul>
  18. 18. Liver Laceration
  19. 19. Splenic Injury <ul><li>Typically associated with blunt force trauma to upper left quadrant – may be atraumatic </li></ul><ul><li>Risk is higher if spleen enlarged due to systemic condition (mono, pneumonia, etc.) </li></ul><ul><li>Generally have acute onset of symptoms, but may have delayed onset depending on severity of injury </li></ul>
  20. 20. Splenic Injury <ul><li>Signs and symptoms </li></ul><ul><ul><li>Pain at site of injury (upper left quadrant) </li></ul></ul><ul><ul><li>Referred pain to left shoulder (Kehr’s sign) </li></ul></ul><ul><ul><li>Nausea and/or vomiting (appearance) </li></ul></ul><ul><ul><li>Significant bleeding may present with abdominal rigidity and/or rebound tenderness </li></ul></ul><ul><ul><li>Vitals – signs of shock </li></ul></ul><ul><ul><ul><li>Heart rate/respirations </li></ul></ul></ul><ul><ul><ul><li>Blood pressure </li></ul></ul></ul><ul><ul><ul><li>Due to internal bleeding (hypovolemic) </li></ul></ul></ul>
  21. 21. Splenic Injury
  22. 22. Kidney Contusion/Laceration <ul><li>Well protected anatomically by rib cage, vertebrae and spinal musculature </li></ul><ul><li>Typically associated with blunt force trauma to “flank” region </li></ul><ul><li>Contusion generally isolated injury while laceration generally associated with rib fracture displacement </li></ul>
  23. 23. Kidney Contusion/Laceration <ul><li>Signs and symptoms </li></ul><ul><ul><li>Pain to “flank” region at site of trauma </li></ul></ul><ul><ul><li>Referred pain around thoracoabdominal region </li></ul></ul><ul><ul><li>Associated symptoms of rib fracture </li></ul></ul><ul><ul><li>Significant bleeding may present with abdominal rigidity and/or rebound tenderness </li></ul></ul><ul><ul><li>Hematuria </li></ul></ul><ul><ul><ul><li>If significant - easily seen, but if minor – requires further analysis to rule out or verify </li></ul></ul></ul><ul><ul><li>Vitals – signs of shock </li></ul></ul>
  24. 24. Kidney Laceration
  25. 25. Kidney Stones <ul><li>Result from collection of incomplete kidney filtration </li></ul><ul><li>Family history, stress, hypertension, high salt intake increase risk </li></ul><ul><li>Other foods may decrease risk </li></ul><ul><ul><li>Apple/grapefruit juice </li></ul></ul><ul><ul><li>Coffee/tea/beer/wine </li></ul></ul><ul><ul><li>Potassium rich foods (bananas, tomatoes) </li></ul></ul>
  26. 26. Kidney Stones <ul><li>Signs and symptoms </li></ul><ul><ul><li>Pain in affected side </li></ul></ul><ul><ul><li>Pain on urination </li></ul></ul><ul><ul><li>May feel larger stones move through ureter and ultimately urethra (most pain) </li></ul></ul><ul><ul><li>If on right side, must differentiate from appendix pathology </li></ul></ul>
  27. 27. Kidney Stones
  28. 28. Urinary Tract Infections (UTI) <ul><li>Caused by bacterial infections of the bladder and/or urethra – may spread to ureter/kidney </li></ul><ul><ul><li>If urethritis, must consider STDs </li></ul></ul><ul><li>Must differentiate from kidney stones </li></ul><ul><li>Signs and symptoms </li></ul><ul><ul><li>Dysuria – frequent need to urinate </li></ul></ul><ul><ul><li>Abnormal appearance/odor of urine </li></ul></ul><ul><ul><li>Other systemic symptoms (fever, etc.) </li></ul></ul>
  29. 29. Appendix Pathologies <ul><li>Appendicitis </li></ul><ul><ul><li>Initial general systemic symptoms </li></ul></ul><ul><ul><li>Initial tenderness in lower right quadrant (McBurney’s point) – rebound tenderness </li></ul></ul><ul><ul><li>May have referred pain to right chest, upper trap and/or umbilicus </li></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 inflame d </li></ul></ul>
  30. 30. Appendicitis
  31. 31. Hollow Organ Rupture <ul><li>Uncommon due to ability to deform when impacted and absorb forces </li></ul><ul><li>Signs and symptoms </li></ul><ul><ul><li>Abdominal pain at site of injury (trauma) </li></ul></ul><ul><ul><li>Nausea/vomiting </li></ul></ul><ul><ul><li>Abdominal rigidity and/or rebound tenderness </li></ul></ul><ul><ul><li>Absence of bowel sounds on auscultation </li></ul></ul><ul><ul><li>Blood in stool </li></ul></ul><ul><ul><li>Vitals –signs of shock </li></ul></ul>
  32. 32. Stomach Rupture
  33. 33. General Medical Conditions <ul><li>Gastritis </li></ul><ul><ul><li>Inflammation of lining of stomach </li></ul></ul><ul><ul><ul><li>NSAIDs, alcohol, bile </li></ul></ul></ul><ul><ul><li>Heartburn/indigestion </li></ul></ul><ul><li>Ulcer </li></ul><ul><ul><li>Irritation of duodenum (proximal small intestine) </li></ul></ul><ul><ul><li>Most are bacterial but may be due to long term use of some meds </li></ul></ul><ul><li>Gastroenteritis </li></ul><ul><ul><li>Inflammation of the small intestine </li></ul></ul><ul><ul><li>Nausea/vomiting/diarrhea </li></ul></ul><ul><ul><li>Often attributable to “food poisoning” </li></ul></ul>
  34. 34. Peptic Ulcer
  35. 35. General Medical Conditions <ul><li>Colitis </li></ul><ul><ul><li>Inflammation of the large intestine </li></ul></ul><ul><ul><li>Frequent diarrhea, blood if ulcerative colitis </li></ul></ul><ul><li>Regional enteritis (Crohn’s disease) </li></ul><ul><ul><li>Primarily affects ileum </li></ul></ul><ul><ul><li>Cramping, incontinence, constipation </li></ul></ul><ul><ul><li>Requires diet modification </li></ul></ul><ul><li>Irritable bowel syndrome (IBS) </li></ul><ul><ul><li>Altered motility of large intestine </li></ul></ul><ul><ul><li>Diarrhea/constipation, gas, nausea/vomiting, abdominal pain </li></ul></ul><ul><ul><li>Requires stress reduction and diet modification </li></ul></ul>
  36. 36. Colitis
  37. 37. Male Reproductive System Pathologies <ul><li>More common than in women due to external location of male genitalia </li></ul><ul><li>Pathologies </li></ul><ul><ul><li>Testicular contusion </li></ul></ul><ul><ul><li>Testicular torsion </li></ul></ul><ul><ul><li>Testicular dysfunction </li></ul></ul><ul><ul><li>Testicular cancer </li></ul></ul>
  38. 38. Testicular Contusion <ul><li>Etiology is direct trauma </li></ul><ul><li>Calm injured person </li></ul><ul><li>Signs and symptoms </li></ul><ul><ul><li>Localized pain, often severe </li></ul></ul><ul><ul><li>Nausea/vomiting </li></ul></ul><ul><li>Must inspect for abnormalities (self-exam unless unable) once symptoms minimize </li></ul><ul><ul><li>Swelling, abnormal tissue density </li></ul></ul>
  39. 39. Testicular Torsion <ul><li>Twisting of spermatic cord within scrotum </li></ul><ul><li>Higher risk if undescended testicle and lower risk if athletic supporter worn </li></ul><ul><li>Signs and symptoms </li></ul><ul><ul><li>Intense pain </li></ul></ul><ul><ul><li>Nausea/vomiting </li></ul></ul><ul><ul><li>Swelling and/or mass in scrotum from occlusion of vascular structures </li></ul></ul>
  40. 40. Testicular Torsion
  41. 41. Testicular Dysfunction <ul><li>Hydrocele </li></ul><ul><ul><li>Fluid filled “sac” into testicle </li></ul></ul><ul><ul><li>Multiple causes – often associated with inguinal herni a </li></ul></ul><ul><li>Varicocele </li></ul><ul><ul><li>Varicose veins within scrotum – alters blood flow </li></ul></ul><ul><ul><li>“ Bag of worms” on palpation </li></ul></ul><ul><li>Epididymitis </li></ul><ul><ul><li>Typically associated with UTIs/STDs </li></ul></ul><ul><ul><li>Inflammation of epididymis </li></ul></ul><ul><ul><li>Pain with urination/ejaculation/bowel movements </li></ul></ul>
  42. 42. Varicocele and Hydrocele
  43. 43. Testicular Cancer <ul><li>If detected early by self-exam, often respond well to treatment </li></ul><ul><li>Definitive diagnosis via advanced studies and/or biopsy </li></ul><ul><li>Hardening and/or enlarging of affected testicle is most common symptom </li></ul><ul><li>May present with referred pain to low back or inguinal area in addition to localized pain </li></ul>
  44. 44. Female Reproductive System Pathologies <ul><li>Less common due to protection afforded by abdomen/anatomical location </li></ul><ul><li>Pathologies </li></ul><ul><ul><li>Amenorrhea </li></ul></ul><ul><ul><li>Dysmenorrhea </li></ul></ul><ul><ul><li>Female athlete triad </li></ul></ul><ul><ul><li>Vaginitis </li></ul></ul><ul><ul><li>Pelvic inflammatory disease </li></ul></ul>
  45. 45. Amenorrhea <ul><li>Primary vs. secondary </li></ul><ul><ul><li>Primary – absence of onset of menstruation by age 16 </li></ul></ul><ul><ul><li>Secondary – cessation of menstruation for 6+ months </li></ul></ul><ul><li>Contributing factors </li></ul><ul><ul><li>Exercise, weight loss, stress, anxiety </li></ul></ul><ul><ul><li>Body image, societal pressures </li></ul></ul><ul><li>Contributing component of female athlete triad </li></ul>
  46. 46. Dysmenorrhea <ul><li>Pain and/or cramping in lower abdomen and pelvis prior to menstruation </li></ul><ul><li>Signs and symptoms </li></ul><ul><ul><li>Nausea/vomiting </li></ul></ul><ul><ul><li>Diarrhea or constipation </li></ul></ul><ul><ul><li>Bloating </li></ul></ul><ul><li>May be related to other conditions (PID, endometriosis, etc.) </li></ul>
  47. 47. Female Athlete Triad <ul><li>Comprised of three elements </li></ul><ul><ul><li>Amenorrhea, disordered eating, osteoporosis </li></ul></ul><ul><li>Presence of one component requires screening for the others </li></ul><ul><ul><li>In combination, can be life threatening </li></ul></ul><ul><li>Best treatment is prevention (screening) and education </li></ul><ul><ul><li>Team approach to clinical treatment – physiological and psychological </li></ul></ul>
  48. 48. Vaginitis <ul><li>Bacterial vaginosis </li></ul><ul><ul><li>Bacterial imbalance in vagina </li></ul></ul><ul><li>Trichomoniasis </li></ul><ul><ul><li>Most commonly affects vagina but also may involve urethra </li></ul></ul><ul><li>Vulvovaginal candidiasis (“yeast infection”) </li></ul><ul><ul><li>Overgrowth of normally present yeast cells </li></ul></ul><ul><li>Signs and symptoms </li></ul><ul><ul><li>Abnormal odor and/or discharge </li></ul></ul><ul><ul><li>Pain with urination and/or intercourse </li></ul></ul>
  49. 49. Pelvic Inflammatory Disease (PID) <ul><li>Inflammation or infection of the uterus, ovaries or fallopian tubes </li></ul><ul><li>Often related to STDs </li></ul><ul><li>Signs and symptoms </li></ul><ul><ul><li>Vaginal discharge </li></ul></ul><ul><ul><li>Menstrual irregularities </li></ul></ul><ul><ul><li>Low back/abdominal pain </li></ul></ul><ul><ul><li>Dysuria/frequent urination </li></ul></ul><ul><ul><li>Fever </li></ul></ul>
  50. 50. Pelvic Inflammatory Disease