Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Thoracic, Abdominal, and Cardiopulmonary Pathologies.

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Clinical Anatomy  Sternum  Manubrium  Xiphoid process  True ribs  False ribs  Floating ribs  Cervical rib  Thoracic outlet syndrome  Costal cartilages

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Clinical Anatomy  Respiratory tract  Trachea  Bronchi  Segmental bronchi  Bronchioles  Parietal pleura  Visceral pleura  Pleural cavity  Alveoli  Pulmonary arteries  Pulmonary veins  Mucosal cells  Ciliary cells

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Clinical Anatomy  Cardiovascular  Fibrous pericardium  Serous pericardium  Parietal layer  Chordinae tendinae  Papillary muscles  Right atrium  Superior vena cava  Inferior vena cava Valves controlling blood entering and exiting the heart.

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Clinical Anatomy Anterior view of the heart. Blood supply to the body is delivered through the aorta. The left atrium is hidden in this view.  Cardiovascular  Right and left atrium  Right and left ventricle  Superior and inferior vena cava  Tricuspid valve  Mitral valve  Semilunar valves  Pulmonary arteries and veins  Aorta  Aortic arch  Brachiocephalic trunk  Right and left common carotid  Abdominal aorta  Coronary arteries

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company This structure is supported by ligaments arising from the inferior surface of the diaphragm. Anterior View of the Liver

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Clinical Anatomy  Lymphatic organ  Spleen (left side of the body, level of 9 – 11th ribs)  Solid, fragile organ  Produces and destroys blood cells during infection  Mononucleosis — spleen becomes engorged with blood  Trauma may result in the removal of the spleen Spleen. During illness the spleen may become enlarged, causing it to become vulnerable to injury.

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Clinical Anatomy  Urinary tract  Kidneys (bilaterally at the level of T12 – L3; right kidney is slightly lower)  Regulate body’s electrolyte levels; filtrate urine  Ureters  Urinary bladder  Urethra  Trauma: blow to the low back Relative location of the kidneys.

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Clinical Anatomy  Reproductive tract  Testes  Epididymis  Ovaries  Fallopian tubes Male reproductive system. Female reproductive system.

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Past medical history  General medical history  Family medial history  Medication and drugs  General medical health  Cystic fibrosis  Crohn’s disease History of present condition  Location of pain  MOI  Onset of symptoms  Dysmenorrhea  Arrhythmias  Complaints  Syncope  Palpations  Respiratory  Chest pain Clinical Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Clinical Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies  Inspection  Sweating  Profuse sweating is a sign of cardiac arrest  Throat  Deviations can indicate a pneumothorax  Muscle tone  Observe contour of abdominal muscles  Distended area may indicate bleeding  Skin features  Note contusion, wounds, or abrasions  Possible injury to underlying organs

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Palpation 1. Sternum 2. Sternal body 3. Xiphoid process 4. Costal cartilage and rib 5. Spleen 6. Kidneys 7. McBurney’s point Clinical Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company The sagittal quadrants are relative to the patient. Therefore, the right kidney is on the person’s right-hand side. Abdominal Quadrant Reference System

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company This point becomes tender in the presence of appendicitis. McBurney’s Point, Located Approximately One-Third of the Way Between the ASIS and the Umbilicus

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Palpation of the abdomen  Rigidity  Areas of pain  Rebound tenderness  Tissue density  Quadrant analysis Positioning of the patient during palpation of the abdomen. Clinical Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Clinical Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies  Review of systems  Cardiovascular  Heart rate  Blood pressure (BP)  Heart auscultation  Capillary refill  Respiratory  Breath sounds  Respiratory rate and pattern  Respiratory flow  Gastrointestinal  Vomiting  Auscultation of the abdomen  Genitourinary  Urinalysis  Neurologic

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Injuries to the thorax  Rib fractures  Costochondral injury  Pneumothorax  Hemothorax Pathologies of the Thorax and Abdomen and Related Special Tests

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Pathologies of the abdominal and urinary organs  Splenic injury  MOI: blunt trauma to the abdomen  Causes: contusion or laceration  Inflamed due to infectious disease  Kehr’s sign — telltale sign of a ruptured spleen; pain in the ULQ and left shoulder  Vital sign are indicators of hemodynamic (process of blood circulating through the body) changes  MRI and CT scans identify splenic trauma Pathologies of the Thorax and Abdomen and Related Special Tests

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Kidney pathologies  Area over kidneys may become TTP or reveal crepitus  Rib fracture  Kidney stones  Urinary tract infection Palpation of the right kidney. Pathologies of the Thorax and Abdomen and Related Special Tests

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company The stone is approximately 14 mm (0.55 in.) long. A Superior-Inferior View of the Thorax Demonstrating a Stone Located Within the Left Kidney (arrow)

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Appendicitis and appendix rupture  Common in 15 – 25 year olds (men > women)  Signs and symptoms  Lower abdominal tenderness  Fever  Nausea  Vomiting  Prefer lying supine with right leg flexed at hip  Immediate referral, and no eating or drinking! Pathologies of the Thorax and Abdomen and Related Special Tests

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Hollow organ rupture  MOI: blow to the abdomen  Signs and symptoms  Pain  Nausea  Muscle guarding/rigidity  Tenderness  Absent bowel sounds  Bloody stool  Immediate referral, and no eating or drinking! Pathologies of the Thorax and Abdomen and Related Special Tests

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Male reproductive system pathologies  Testicular contusion  Testicular torsion  Testicular dysfunction  Testicular cancer Female reproductive system pathologies  Menstrual irregularities Associated with physical activity  Female athlete triad  Pelvic inflammatory disease Pathology of the Reproductive Organs

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Cardiopulmonary Pathologies  Commotion cordis  “Cardiac concussion”  Instantaneous cardiac arrest caused by a nonpenetrating blow to the chest  Cardiac contusions  MOI: Direct blow or compression to sternum  Contusion to pericardial lining, ventricular contusion, or aortic rupture Electrocardiogram demonstrating ventricular fibrillation caused by a blunt impact to the chest wall during vulnerable zone of repolarization (10 — 30 ms prior to the T wave peak).

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Cardiopulmonary Pathologies  Syncope  Cause  Cardiac abnormality  Symptom of heat illness  Benign  Always warrants further exam  Especially exertional syncope (after exercise)

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Cardiopulmonary Pathologies  Hypertrophic cardiomyopathy  Myocardial infarction  Arrhythmias  Tachycardia  Athlete’s heart  Mitral valve prolapse  Hypertension

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Examination of the unconscious athlete  Cervical stabilization  Airway  Look, listen, and feel  Breathing  Bradypnea (< 10 breaths per minute)  Tachypnea (> 30 breaths per minute)  Dyspnea (labored quick breathing pattern)  Circulation  Carotid pulse Management of sudden cardiac arrest. On-Field Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Inspection and palpation of the conscious athlete  Position of the athlete  Skin color  Airway  Breathing  Circulation  Sweating  Responsiveness  Nausea and vomiting On-Field Examination of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Rib fractures  Rule out pneumothorax or hemothorax  Stabilize injury  Rib belt  Wrap arm to side of athlete  Transport athlete for further medical evaluation Immobilization of the rib cage through the use of a swath. On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Pneumothorax and hemothorax  Monitor vital signs  Treat for shock  Place athlete on affected side in semi-reclined position  Give oxygen if available  Activate EMS On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Open pneumothorax  Activate EMS  Do not remove object  Cover opening with a sterile dressing  Seal opening with nonporous material  Transport athlete to emergency room On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Hollow organ injuries  Activate EMS  Treat for shock  Monitor vital signs  Record and give to medical transport team  Don’t give anything by mouth  Transport athlete to emergency room On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Solar plexus injury  MOI: direct blow to abdomen or falls on an object  Transitory paralysis of diaphragm  “Have the wind knocked out of you”  Management  Loosen clothing  Calm athlete  Instructions for long inspirations, short expirations€ On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Asthma  Have athlete’s medication on hand and marked  Move athlete to sideline  If no inhaler is available  Pulmonary emergency  Sit athlete down with hands on knees  Assist in slow controlled diaphragmatic breathing  Hard part is to breath out On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Hyperventilation  Control the rate at which CO 2 is lost from the body  Breathe into paper bag  Breathe through only one nostril Controlling hyperventilation. On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company  Sudden cardiac arrest  Activate EMS  Early defibrillation  For every minute that defibrillation is delayed, chance of survival decreases by 10% On-Field Management of Thoracic, Abdominal, and Cardiopulmonary Pathologies

Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Thoracic, Abdominal, and Cardiopulmonary Pathologies.

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Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Thoracic, Abdominal, and Cardiopulmonary Pathologies.

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Presentation on theme: "Examination of Orthopedic and Athletic Injuries, 3rd Edition Copyright © 2010. F.A. Davis Company Thoracic, Abdominal, and Cardiopulmonary Pathologies."— Presentation transcript:

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