chapter 11 throat, thorax, and visceral conditions
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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 11
Throat, Thorax, and Visceral Conditions
Chapter 11
Throat, Thorax, and Visceral Conditions
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Throat AnatomyThroat Anatomy
Throat region
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Throat Anatomy (cont’d)Throat Anatomy (cont’d)
• Pharynx, larynx, esophagus
– “Adam’s” apple
– Epiglottis
– Vocal cords
– Hyoid bone
– Esophageal sphincters
• Trachea
– Divides into right and left bronchial tubes
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Throat Anatomy (cont’d)Throat Anatomy (cont’d)
• Blood vessels
– Common carotid arteries
Arterial supply to the neck and throat region
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Thoracic CageThoracic Cage
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Thorax AnatomyThorax Anatomy
• Thoracic cage and pleura
– Sternum, ribs, costal cartilage, thoracic vertebrae
– Cage around heart and lungs
– Pleura and pleural cavity
• Bronchial tree and lungs
– Bronchial tubes → terminal bronchioles
– Alveoli
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Visceral Region AnatomyVisceral Region Anatomy
• Pelvic girdle
– Sacrum, ilium, ischium, pubis
– Functions
• Visceral organs
– Stomach
– Liver
– Spleen
– Kidneys
Anterior view of the visceral organs
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Visceral Region Anatomy (cont’d)Visceral Region Anatomy (cont’d)
• Blood vessels
– Aorta
• Numerous branches
Arterial system of the trunk
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Anterior Muscles of TrunkAnterior Muscles of Trunk
Muscles of the trunk. A. Anterior
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Posterior Muscles of TrunkPosterior Muscles of Trunk
Muscles of the trunk. B. Posterior
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Injury PreventionInjury Prevention
• Protective equipment
– Variety of equipment available
– Concern: adolescent rib cage – less rigid
• Physical conditioning
– Flexibility
– Strength
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Throat ConditionsThroat Conditions
• Neck laceration
– Uncommon; severe bleeding
– Management:
• Activate emergency plan, including summoning EMS
• Control hemorrhage – apply firm, direct pressure over the wound
• Assess vitals and treat as necessary
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Throat Conditions (cont’d)Throat Conditions (cont’d)
• Contusions and fractures
– Trachea, larynx, and hyoid bone
• Occur during hyperextension of the neck
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Throat Conditions (cont’d)Throat Conditions (cont’d)
• Contusions and fractures (cont’d)
– S&S
• Hoarseness
• Dyspnea
• Difficulty swallowing
• Coughing
• Significant – severe pain, laryngospasm, acute respiratory distress
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Throat Conditions (cont’d)Throat Conditions (cont’d)
• Contusions and fractures (cont’d)
– Management:
• Calm individual; help individual focus on their breathing rate
• Significant trauma
• Activate emergency plan, including summoning EMS
• Assess vitals and treat as necessary
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Thoracic ConditionsThoracic Conditions
• Sudden deceleration and impact → compression and deformation of rib cage
• “Red Flags”
– Shortness of breath or difficulty in breathing
– Deviated trachea or trachea that moves during breathing
– Anxiety, fear, confusion, or restlessness
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• “Red Flags” (cont’d)
– Distended neck veins
– Bulging or bloodshot eyes
– Suspected rib or sternal fracture
– Severe chest pain aggravated by deep inspiration
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• “Red Flags” (cont’d)
– Abnormal chest movement on affected side
– Coughing up bright red or frothy blood
– Abnormal or absent breath sounds
– Rapid, weak pulse
– Low blood pressure
– Cyanosis
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• “Stitch in the Side”
– Sharp pain or spasm in chest wall (lower) during exertion
– Etiology: varies
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• “Stitch in the Side” (cont’d)
– Management: Most individuals can run through the sharp pain by:
• Forcibly exhaling through pursed lips
• Breathing deeply and regularly
• Leaning away from the affected side
• Stretching the arm on the affected side over the head as high as possible
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Breast conditions
– Contusions
• Can produce fat necrosis or hematoma formation → ↑ pain
• Management: standard acute and external support
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Breast conditions (cont’d)
– Nipple irritation
• Runner’s nipples
• Friction → abrasions, blisters, or bleeding
• Management: advise individual to cleanse and cover the wound; if infection is a concern, physician referral
• Prevention: petroleum-based product
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Breast conditions (cont’d)
• Cyclist’s nipples
• Perspiration + wind chill → ↑ pain
• Management: warm the area after the event to prevent irritation
• Prevention: wind-proof jacket
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Strain of pectoralis major
– MOI: active contraction; overburdened by excessive load or extrinsic force
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Strain of pectoralis major (cont’d)
– S&S
• Sound: pop or tearing
• Immediate pain and weakness; aching or fatigue-like rather than sharp pain
• Deformity – muscle retracts
• Swelling and ecchymosis
• Limited shoulder motion due to pain
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Strain of pectoralis major
– Management:
• Grade 1 – standard acute; if the condition does not resolve in 2-3 days, physician approval prior to return to activity
• Grade 2 or 3 – physician referral
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Costochondral sprain
– Etiology:
• Collision force
• Severe twisting of thorax
– Result: separates cartilage at attachment to rib or sternum
Undisplaced costochondral separation
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Costochondral sprain (cont’d)
– S&S
• Hear or feel a “pop”
• Localized sharp pain; changes to intermittent stabbing pain
• Visible deformity
• Severe: pain with deep inhalation
– Management: standard acute; physician referral
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Sternal fracture
– Rare; requires high impact
– S&S
• Immediate loss of breath
• Pain, especially with deep inspiration
– Suspected fracture – assess for underlying injury
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Sternal fracture (cont’d)
– Management:
• Activate emergency plan, including summoning EMS
• Assess vitals and treat as necessary
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Rib fracture
– Stress fracture – indirect force (muscle contraction)
– Acute
• Direct blow or compression
• Ribs 5-9
– Most minor – undisplaced; if displaced, suspect internal injury
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Rib fracture (cont’d)
– S&S
• Pain at site with deep inspiration or coughing
• Individual will take shallow breaths and lean toward fracture site
• Localized swelling, discoloration, crepitus
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Rib fracture (cont’d)
– S&S (cont’d)
• Check for:
• Coughing up of blood
• Abnormal breath sounds
• Rate and depth of respiration
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Thoracic Conditions (cont’d)Thoracic Conditions (cont’d)
• Rib fracture (cont’d)
– Management:
• Standard acute; immobilize chest
• Severe: immediate referral to emergency care facility
• Internal injury suspected: activate emergency plan, including summoning of EMS
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Internal ComplicationsInternal Complications
• Hyperventilation
– Etiology: pain, stress, trauma
– Rapid, deep inhalation – more O2
long exhalation – excessive CO2 loss
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Internal Complications (cont’d)Internal Complications (cont’d)
• Hyperventilation (cont’d)
– S&S
• Inability to catch breath
• Numbness in lips and hands
• Spasm of hands
• Chest pain
• Dry mouth
• Dizziness
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Internal Complications (cont’d)Internal Complications (cont’d)
• Hyperventilation (cont’d)
– Management:
• Calm individual
• Slowly inhale through nose and exhale through mouth
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Internal Complications (cont’d)Internal Complications (cont’d)
• Pneumothorax
– Air trapped in pleural space, causing portion of lung to collapse; lung can’t fully expand
– Etiology
• Traumatic – penetrating wound
• Spontaneous – unexpectedly without underlying disease
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Internal Complications (cont’d)Internal Complications (cont’d)
Internal complication to the lungs. A. Pneumothorax
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Internal Complications (cont’d)Internal Complications (cont’d)
• Hemothorax
– Loss of blood into pleural cavity
– Etiology: fracture of rib could tear lung tissue or blood vessels in chest
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Internal Complications (cont’d)Internal Complications (cont’d)
Internal complications to the lungs. B. Hemothorax
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Internal Complications (cont’d)Internal Complications (cont’d)
• Tension pneumothorax
– Air accumulates in pleural space during inspiration and cannot escape on exhalation; expansion compresses heart and lung
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Internal Complications (cont’d)Internal Complications (cont’d)
Internal complications to the lungs. C. Tension pneumothorax
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Internal Complications (cont’d)Internal Complications (cont’d)
• Pneumothorax, hemothorax, tension pneumothorax (cont’d)
– S&S
• Severe pain during breathing
• Hypoxia
• Cyanosis
• Signs of shock
• Hemothorax – coughing up frothy blood may also be seen
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Internal Complications (cont’d)Internal Complications (cont’d)
• Pneumothorax, hemothorax, tension pneumothorax (cont’d)
– Management:
• Activate emergency plan, including summoning EMS
• Assess vitals and treat as necessary
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Internal Complications (cont’d)Internal Complications (cont’d)
• Heart injuries
– Blunt cardiac injury
• Leads to localized damage and necrosis of heart tissue
• Concern: decreased cardiac output secondary to arrhythmias
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Internal Complications (cont’d)Internal Complications (cont’d)
• Heart injuries (cont’d)
– Blunt cardiac injury (cont’d)
• Cardiac tamponade
• Ruptures myocardium or lacerates coronary artery; ↑ fluid in pericardium; compresses venous return to heart
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Internal Complications (cont’d)Internal Complications (cont’d)
• Heart injuries (cont’d)
– Blunt cardiac injury (cont’d)
• S&S
• Jugular venous distention
• Collapse within seconds and respiratory arrest
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Internal Complications (cont’d)Internal Complications (cont’d)
• Heart injuries (cont’d)
– Blunt cardiac injury (cont’d)
• Management
• activate emergency plan, including summoning EMS
• Initiate breathing and chest compressions
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Internal Complications (cont’d)Internal Complications (cont’d)
• Sudden Death in Athletes
– Sudden death – an event that is non-traumatic, unexpected, and occurs instantaneously or within minutes of an abrupt change in an individual’s previous clinical state
– Causes: hypertrophic cardiomyopathy; abnormalities in the coronary arteries; aortic rupture associated with Marfan’s syndrome; and mitral valve prolapse
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Internal Complications (cont’d)Internal Complications (cont’d)
• Sudden Death in Athletes (cont’d)
– S&S
• Unexplained chest pain, sudden onset of fatigue, heartburn or indigestion, and excessive breathlessness during exercise
– Management:
• Activate emergency plan, including summoning EMS
• Initiate breathing and chest compressions
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Abdominal Wall ConditionsAbdominal Wall Conditions
• Muscle strains
– MOI: sudden twisting or sudden hyperextension of spine
– Most common – rectus abdominis
– S&S
• Localized pain and spasm in the involved muscle may be present.
• Increased pain with straight leg raising, performing a sit-up, or hyperextension of the back
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Abdominal Wall Conditions (cont’d)Abdominal Wall Conditions (cont’d)
• Muscle strains (cont’d)
– Management
• Grade 1 – standard acute; if the condition does not resolve in 2-3 days, physician approval prior to return to activity
• Grade 2 or 3 – physician referral
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Abdominal Wall Conditions (cont’d)Abdominal Wall Conditions (cont’d)
• Solar plexus contusion (“wind knocked out”)
– S&S
• Dyspnea
• Complicated by fear and anxiety
– Management:
• Flex the knees toward the chest
• Have athlete take a deep breath and hold it; repeat several times
• Have the athlete whistle
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Abdominal Wall Conditions (cont’d)Abdominal Wall Conditions (cont’d)
• Hernia
– Protrusion of abdominal viscera through weakened portion of abdominal wall
– Congenital or acquired
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Abdominal Wall Conditions (cont’d)Abdominal Wall Conditions (cont’d)
• Hernia (cont’d)
– S&S:
• Visible, tender swelling and an aching feeling in the groin
• If ruptures – a sharp, stinging pain or a feeling of something giving way at the site of the rupture, nausea and vomiting.
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Abdominal Wall Conditions (cont’d)Abdominal Wall Conditions (cont’d)
Hernias
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Abdominal Wall Conditions (cont’d)Abdominal Wall Conditions (cont’d)
• Hernia (cont’d)
– Management of suspected ruptured hernia
• Activate emergency plan, including summoning EMS
• Position the individual on their back; place a rolled blanket under the knees to reduce abdominal tension
• Monitor vitals and treat as necessary
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Intra-abdominal ConditionsIntra-abdominal Conditions
• Trauma to abdomen: potential for severe internal hemorrhage
• “Red flags”
– Abdominal pain
– Nausea
– Thirst
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Intra-abdominal Conditions (cont’d)Intra-abdominal Conditions (cont’d)
• “Red flags” (cont’d)
– Localized tenderness and rigidity
– Cramps or muscle guarding
– Rebound pain
– Referred pain
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Intra-abdominal Conditions (cont’d)Intra-abdominal Conditions (cont’d)
• Trauma to abdomen (cont’d)
– Management:
• Activate emergency plan, may require summoning EMS
• Waiting for EMS
• Position individual supine with the knees flexed to relax the low back and abdominal muscles
• Assess vitals and treat as necessary
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Intra-abdominal Conditions (cont’d)Intra-abdominal Conditions (cont’d)
• Splenic rupture
– Enlarged spleen: increases susceptibility
– Most frequent cause of death from abdominal blunt trauma in sport
– Ability to splint itself
– Individual with mononucleosis should be disqualified from contact & strenuous non-contact activities
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Intra-abdominal Conditions (cont’d)Intra-abdominal Conditions (cont’d)
• Splenic rupture (cont’d)
– S&S
• Trauma to left upper quadrant
• Kehr’s sign
• Signs of shock at time of injury
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Intra-abdominal Conditions (cont’d)Intra-abdominal Conditions (cont’d)
• Liver contusion and rupture
– Direct blow to right upper quadrant
– S&S
• Palpable pain
• Hypotension
• S&S of shock
• Referred pain to inferior angle of right scapula
– Enlarged liver: avoid contact sports
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Intra-abdominal Conditions (cont’d)Intra-abdominal Conditions (cont’d)
• Kidney contusion
– Mechanism: direct blow or contrecoup injury from a high-speed collision
– S&S
• Pain, tenderness
• Hematuria
• Pain referred posteriorly to low back region, sides of the buttocks, and anteriorly to lower abdomen
• Hypovolemic shock is possible
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Coach and On-site Assessment of Throat, Thorax, and Abdominal Regions
Coach and On-site Assessment of Throat, Thorax, and Abdominal Regions
• Assessment should focus on:
– Primary survey, history, and assessment of vital signs
– Caution:
• Trauma may appear superficial and minor, but mask internal hemorrhage
• Condition can slowly deteriorate into a life-threatening status
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Coach and On-site Assessment of Throat, Thorax, and Abdominal Regions
Coach and On-site Assessment of Throat, Thorax, and Abdominal Regions
• Assessment should focus on:
– Observation while approaching
• Overall presentation and attitude; willingness to move
• Body position – may indicate site, nature. and severity of injury
– Primary survey → assessment of vitals → history
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Coach and On-site Assessment of Throat, Thorax, and Abdominal Regions
Coach and On-site Assessment of Throat, Thorax, and Abdominal Regions
• Assessment should focus on:
– If any S&S suggest potentially life threatening condition, activate emergency plan, including summoning EMS
• Refer to Application Strategy 11.1
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