chapter 11 throat, thorax, and visceral conditions

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 11

Throat, Thorax, and Visceral Conditions

Chapter 11

Throat, Thorax, and Visceral Conditions


Throat AnatomyThroat Anatomy

Throat region


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


Throat Anatomy (cont’d)Throat Anatomy (cont’d)

• Blood vessels

– Common carotid arteries

Arterial supply to the neck and throat region


Thoracic CageThoracic Cage


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


Visceral Region AnatomyVisceral Region Anatomy

• Pelvic girdle

– Sacrum, ilium, ischium, pubis

– Functions

• Visceral organs

– Stomach

– Liver

– Spleen

– Kidneys

Anterior view of the visceral organs


Visceral Region Anatomy (cont’d)Visceral Region Anatomy (cont’d)

• Blood vessels

– Aorta

• Numerous branches

Arterial system of the trunk


Anterior Muscles of TrunkAnterior Muscles of Trunk

Muscles of the trunk. A. Anterior


Posterior Muscles of TrunkPosterior Muscles of Trunk

Muscles of the trunk. B. Posterior


Injury PreventionInjury Prevention

• Protective equipment

– Variety of equipment available

– Concern: adolescent rib cage – less rigid

• Physical conditioning

– Flexibility

– Strength


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


Throat Conditions (cont’d)Throat Conditions (cont’d)

• Contusions and fractures

– Trachea, larynx, and hyoid bone

• Occur during hyperextension of the neck



• Contusions and fractures (cont’d)

– S&S

• Hoarseness

• Dyspnea

• Difficulty swallowing

• Coughing

• Significant – severe pain, laryngospasm, acute respiratory distress



• Contusions and fractures (cont’d)

– Management:

• Calm individual; help individual focus on their breathing rate

• Significant trauma




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


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



• “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



• “Stitch in the Side”

– Sharp pain or spasm in chest wall (lower) during exertion

– Etiology: varies



• “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



• Breast conditions

– Contusions

• Can produce fat necrosis or hematoma formation → ↑ pain

• Management: standard acute and external support



• 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



• 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



• Strain of pectoralis major

– MOI: active contraction; overburdened by excessive load or extrinsic force



• 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



• 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



• Costochondral sprain

– Etiology:

• Collision force

• Severe twisting of thorax

– Result: separates cartilage at attachment to rib or sternum

Undisplaced costochondral separation



• 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



• Sternal fracture

– Rare; requires high impact

– S&S

• Immediate loss of breath

• Pain, especially with deep inspiration

– Suspected fracture – assess for underlying injury



• Sternal fracture (cont’d)

– Management:





• Rib fracture

– Stress fracture – indirect force (muscle contraction)

– Acute

• Direct blow or compression

• Ribs 5-9

– Most minor – undisplaced; if displaced, suspect internal injury



• 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




– S&S (cont’d)

• Check for:

• Coughing up of blood

• Abnormal breath sounds

• Rate and depth of respiration




– Management:

• Standard acute; immobilize chest

• Severe: immediate referral to emergency care facility

• Internal injury suspected: activate emergency plan, including summoning of EMS


Internal ComplicationsInternal Complications

• Hyperventilation

– Etiology: pain, stress, trauma

– Rapid, deep inhalation – more O2

long exhalation – excessive CO2 loss


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



• Hyperventilation (cont’d)

– Management:

• Calm individual

• Slowly inhale through nose and exhale through mouth



• 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



Internal complication to the lungs. A. Pneumothorax



• Hemothorax

– Loss of blood into pleural cavity

– Etiology: fracture of rib could tear lung tissue or blood vessels in chest



Internal complications to the lungs. B. Hemothorax



• Tension pneumothorax

– Air accumulates in pleural space during inspiration and cannot escape on exhalation; expansion compresses heart and lung



Internal complications to the lungs. C. Tension pneumothorax



• 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



• Pneumothorax, hemothorax, tension pneumothorax (cont’d)

– Management:





• Heart injuries

– Blunt cardiac injury

• Leads to localized damage and necrosis of heart tissue

• Concern: decreased cardiac output secondary to arrhythmias



• 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





• S&S

• Jugular venous distention

• Collapse within seconds and respiratory arrest





• Management

• activate emergency plan, including summoning EMS

• Initiate breathing and chest compressions



• 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



• Sudden Death in Athletes (cont’d)

– S&S

• Unexplained chest pain, sudden onset of fatigue, heartburn or indigestion, and excessive breathlessness during exercise

– Management:


• Initiate breathing and chest compressions


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


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



• 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



• Hernia

– Protrusion of abdominal viscera through weakened portion of abdominal wall

– Congenital or acquired



• 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.



Hernias



• Hernia (cont’d)

– Management of suspected ruptured hernia


• Position the individual on their back; place a rolled blanket under the knees to reduce abdominal tension

• Monitor vitals and treat as necessary


Intra-abdominal ConditionsIntra-abdominal Conditions

• Trauma to abdomen: potential for severe internal hemorrhage

• “Red flags”

– Abdominal pain

– Nausea

– Thirst


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



• 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




• 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



• Splenic rupture (cont’d)

– S&S

• Trauma to left upper quadrant

• Kehr’s sign

• Signs of shock at time of injury



• 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



• 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


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





– 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





– If any S&S suggest potentially life threatening condition, activate emergency plan, including summoning EMS

• Refer to Application Strategy 11.1

chapter 11 throat, thorax, and visceral conditions

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