Thorax and Abdomen Injuries

Injuries to the Lungs MOI Pneumothorax Pleural cavity surrounding the lung becomes filled with air that enters through a hole in the chest Lung on that side collapses Tension Pneumothorax Pleural cavity on one side fills with air – displacing lung and heart toward opp. side Compresses opposite lung Hemothorax Blood within pleural cavity Tearing or puncturing the lung or pleural tissue Traumatic Asphyxia Violent blow to or compression of rib cage – cessation of breathing

Lung Injuries continued Signs and Symptoms Difficulty breathing, shortness of breath, chest pain, coughing up blood, cyanosis, potential shock Treatment Medical emergency – immediate referral Traumatic asphyxia Rescue breaths

Sudden Death Syndrome MOI Hypertrophic cardiomyopathy (HCM) Thickened cardiac muscle with no evidence of chamber enlargement Extensive myocardial scarring Commotio Cordis Sudden, blunt, non-penetrating trauma to anterior chest causes ventricular fibrillation Predominantly in young males Marfan syndrome Abnormality of connective tissue – weakens aorta and cardiac valves Can lead to rupture Classic presentation Coronary Artery Disease (CAD) Atherosclerosis

Sudden Death continued MOI continued Non cardiac related Drugs – alcohol, cocaine, amphetamines, erythropoietin Brain bleed Obstructive respiratory disease Signs and Symptoms Chest pain/discomfort, heart palpitations/flutters, syncope, nausea, profuse sweating, heart murmurs, shortness of breath, general malaise, fever Treatment Medical emergency, immediate referral Prevention?

Hernia MOI Protrusion of abdominal viscera through a portion of the abdominal wall Inguinal More common in men Abnormal enlargement of opening of inguinal canal Femoral More common in female Found in femoral triangle

Hernia continued Signs and Symptoms Previous history of a blow or strain to the groin area that produced pain and prolonged discomfort Superficial protrusion in the groin area Pain, increased by coughing Weakness and pulling sensation in groin area Treatment Referral, surgery

Injuries to the Spleen MOI Fall or direct blow to ULQ + existing medical condition has caused enlargement Most likely infectious mononucleosis Signs and Symptoms Shock, abdominal rigidity, nausea, vomiting Kehr’s sign Profuse hemorrhage into abdominal cavity Treatment Hospitalization, no surgery – RTP in 4 weeks Surgical repair? RTP in 3 months Surgical removal? RTP in 6 months Athletes with an enlarged spleen should sit out for 3 weeks after onset until swelling, pain, and fever are gone

Kidney Contusion MOI Direct blow to the lower back Signs and Symptoms Shock, nausea, vomiting, rigidity of the back muscles, hematuria Radiating pain to lower abdominals Treatment Monitor urine – hematuria warrants an immediate referral Bed rest

Liver Contusion MOI Extreme blow to the right side of rib cage Predisposed if they have hepatitis Signs and Symptoms Hemorrhage, shock, immense pain Referred pain below right scapula, right shoulder, anterior left side of chest Treatment Immediate referral for diagnosis and surgery

Appendicitis MOI Caused by a variety of factors Often confused for other conditions Signs and Symptoms Mild to severe pain in lower abdomen Nausea, vomiting, low-grade fever Pain will progressively get worse and more localized Rigidity and rebound tenderness at McBurney’s point Treatment Referral, surgical removal Rupture – life-threatening