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The Thorax and Abdomen

The Thorax and Abdomen. Chapter 26. Anatomy of Thorax. Thoracic Cavity Contains lungs, heart and thymus Ribs (12), Costal Cartilage, and Sternum Thoracic Muscles External intercostals-elevate diaphragm Internal intercostals-depress rib cage Lungs

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The Thorax and Abdomen

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  1. The Thorax and Abdomen Chapter 26

  2. Anatomy ofThorax • Thoracic Cavity • Contains lungs, heart and thymus • Ribs (12), Costal Cartilage, and Sternum • Thoracic Muscles • External intercostals-elevate diaphragm • Internal intercostals-depress rib cage • Lungs • - trachea, R & L primary bronchi… aveoli (O2 – CO2 exchange) • Respiratory Muscles • Diaphragm; contraction-increases thorax volume = inspiration

  3. Blood Supply • Pulmonary artery (CO2) & vein (O2) • Heart – 4 chambers • blood supply – de O2 blood to R atrium-tricuspid-R ventricle-pulmonary valve-pulmonary artery-lungs-O2 blood returns via pulmonary vein-L atrium-mitral valve-L ventricle – ejected thru aortic valve • Heartbeat = contraction of atrium followed by ventricles (systole) and relaxation (diastole) • Thymus • Produce lymphocytes – respond to foreign substances • Abdominal Muscles • rectus abdominis, external oblique, internal oblique, transverse abdominis

  4. Abdominal Viscera • Urinary System • Kidneys-filter wastes • Adrenal glands- secrete hormones (epi, norepi, cortosol, estrogen, aldosterone, androgen) • Ureters / urinary bladder • Digestive System • Liver-digestive & excretory • Gallbladder- bile storage • Pancreas -digestion • Stomach-storage &mixing food • Small intestines-digestion and absorption • Large intestines – waste

  5. Lymphatic System • Spleen –reservoir of RBCs, destroy ineffective RBCs, produces antibodies = immunity; produces lymphocytes • Reproductive System • Female • Uterus& vagina (main supporting ligament – broad lig.), ovaries, tubes • Internal and protected by pelvis • Male • Prostate (internal behind pubic symphysis) • More external : testes, series of ducts, penis (both urine and semen exit thru urethra)

  6. Prevention of Injury • Protective equipment • Core muscle strength • Ensure hollow organs are empty when participating (stomach and bladder)

  7. Assessing Injuries to Thorax and Abdomen • History • Observation • Palpation • Abdomen - ausculation and percussion (solid organ = dull sound; hollow organ = resonant sound) • Palpation • Special Tests • Anterior-posterior compression – fx • Transverse compression – costochondral defect

  8. Recognition and Management of Specific Injuries • Rib Contusion • Etiology- direct blow • Symptoms and Signs- pain with breathing, point tender • Management-RICE, NSAIDs, self limiting • Rib Fracture • Etiology-direct blow; forced cough/sneeze • Symptoms and Signs-sharp pain, crepitus, point tender • Management-referred; brace • Costochondral Separation and Dislocations • Etiology-direct blow, fall on object • Symptoms and Signs- pain local to junction, difficulty breathing, crepitus • Management-refer for X-ray and monitor

  9. Sternum Fracture • Etiology- high impact blow to chest • Symptoms and Signs-point tender, pain with breathing, LOOK FOR SIGNS OF SHOCK!!! • Management-refer for X-ray and monitor • Muscle Injuries • Etiology- direct blow or sudden torsion • Symptoms and Signs-pain with active motion, laugh, cough, etc • Management-pressure and cold; possible immobilization • Breast Injury • Etiology-violent up and down and lateral motions = bruise or strain (Cooper’s ligament) • Symptoms and Signs - pain • Management – proper support

  10. Injuries to the Lungs • Pneumothorax (pleural cavity fills with air; lung collapses) Hemothorax ( blood in pleural cavity), Traumatic Asphyxias(violent blow to chest causes breathing to stop), Tension pnemothorax (pleural sac fills with air and lung displaces) • Etiology • Symptoms and Signs • Management – medical emergency =TRANSPORT • Heart Contusion • Etiology-direct force • Symptoms and Signs-severe shock and heart pain; arrhythmias • Management – be prepared for CPR and transport

  11. Sudden Death Syndrome • Three prevalent conditions • Others (CAD, R ventricular dysplasis (enlarged R ventricle, cardiac conducton problems, aortic stenosis, Wolff-Parkinson-White syndrome (abnormality = ventricular tachycardia), myocarditis • Marfan’s Syndrome • Weakened aorta and cardiac valves • HCM (hypertrophic cardiomyopathy) • Thicken cardiac muscle, no enlarged chamber, myocardial scarring

  12. Prevention • Counseling, screening, early ID of disorders • Etiology • Congenital, Non-cariad (alcohol, drug abuse, vascular event, obstrutcive respiratory disease • Symptoms and Signs • Cardiac causes: chest pain, heart palpatations,syncope, profuse sweating, SOB, general malaise, fever, etc • Management • Of death? Survivors…

  13. Abdominal Injuries • Kidney Contusions • Etiology – back blows • Symptoms and Signs- signs of shock, nausea, vomitting, rigidity of back muscles, hematuria • Management • Kidney Stones • Unknown cause • Management – must be passed

  14. Contusion of Ureters, Bladder, and Urethera • Prevention – empty bladder • Etiology – direct blow • Symptoms and Signs – pain lower ab, rigidity, nausea, vomitting, shocky, passing blood (if bladder is ruptured, cannot urinate) • Management – referral and manage • Cystitis • Etiology- inflammation caused by urinary tract infection • Symptoms and Signs- frequent urination, pain, chills, fever, • Management - antibiotics • Hernia • Etiology- congentital or acqurired (blow or strain) • Symptoms and Signs- history, protrusion increased by coughing, weakness or pulling sensation in groin area • Management- referral

  15. Urinary Tract Infection • Etiology – staph bacteria; more common in females • Symptoms and Signs –frequent, urination • Management • Urethritis • Etiology- STD (gonorrhea) or nongonococcal organisms • Symptoms and Signs – painfull urination, urethral discharge • Management- antibiotics • Contusion of Abdominal Wall • Etiology – severe blow to region • Symptoms and Signs – pain, nausea, rigidity, etc • Management- r/o severe internal injury & monitor

  16. Recognition and Management of Specific Injuries of the Abdomen • Gastrointestinal Bleeding • Etiology-gastritis, iron deficient anemia, ingestion of asprin or NSAIDs, stress, bowel irritation, colitis • Symptoms and Signs- bloody stool; discomfort • Management - refer • Liver Contusion • Etiology blunt trauma • Symptoms and Signs- hemorrhage, shock, pain below scapula and right shoulder and sometimes substernal and anterior left chest, rigid to palpation • Management – surgical intervention (if severe); referral always • Pancreatitis • Etiology obstruction of pancretic duct; scar tissue • Symptoms and Signs- vomitting,m belching, constipation, shock, tender and rigid to palpation, pain radiates to back • Management- rehydration, referral, manage shock

  17. Indigestion (Dyspepsia) • Etiology- emotional stress, esophageal and stomach spasm, inflammation of lining • Symptoms and Signs-sour stomach, gas, and nausea • Management- eliminate source of irritation, avoid anxiety, referral possible • Solar Plexus / “stitch in side” • Etiology- direct blow- “wind knocked out” • Symptoms and Signs-respiration stops/ cramplike pain • Management- calm athlete, loosen clothing • Food Poisoning • Etiology- consuming bad food • Symptoms and Signs-nausea, vomitting, cramps, diarrhea • Management- replace lost fluids

  18. Peptic Ulcer • Etiology- acid from stomach destroys mucousal lining • Symptoms and Signs- gnawing pain 1-3 hrs following meal • Management- may disappear, antacids • Diarrhea • Etiology diet, inflammation or intestinal lining, GI infection, consuming drugs • Symptoms and Signs- ab cramps, nausea, lose and frequent stools • Management-knowledge of the cause is required, ; replace lost fluid • Hemorrhoids • Etiology-constipation or straining • Symptoms and Signs- bleeding and itching • Management- make comfortable and allow healing

  19. Constipation • Etiology-lack ab muscle tone, insufficient moisture in feces • Symptoms and Signs-full feeling, cramping, lower abd pain • Management-regulate eating; avoid laxative useless prescribed • Appendicitis • Etiology-fecal obstruction, lymph swelling, tumors • Symptoms and Signs- pain in lower R quad; fever, nausea, vomitting • Management-referral • Spleen Contusion • Etiology-direct blow • Symptoms and Signs- pain, hemorrhage, shock • Management- referral

  20. Recognition and Management of Specific Injuries of Reproductive Organs • Scrotal Contusion • Etiology- trauma • Symptoms and Signs- hemorrhage, fluid effusion, muscle spasm, pain, nausea, disabling • Management-lift few inches form ground; cold pack; possible referral (>15mins painful) • Spermatic Cord Torsion • Etiology-direct blow, coughing • Symptoms and Signs-pain, nausea, vomitting, local inflmmation • Management-IMMEDIATE REFERRAL • Traumatic Hydrocele of Tunica Vaginalis • Etiology- severe blow results in fluid accumulation • Symptoms and Signs-pain, large amounts of swelling • Management-cold pack, referral

  21. Contusion of Female Genitalia • Etiology- direct blow • Symptoms and Signs- pain, hemorrhage to external surface; possible damage to pubic symphisis • Management- cold pack, referral if necessary • Vaginitis • Etiology-STDs, bacterial infection, chemicals, tampons, poor hygeine • Symptoms and Signs- red, painful to touch, strong odor and itching, urination frequent and painful • Management- if STD, treat that; education

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