The document discusses assessment and types of thoracic injuries. It describes assessing the athlete's mental status, vital signs, breathing sounds and quality, chest examination for injuries. Key injuries include fractures, pneumothorax, hemothorax, open pneumothorax, and pulmonary embolism. Pneumothorax can become life-threatening as a tension pneumothorax and requires needle decompression. Treatment depends on injury but may include oxygen, ventilation support, intravenous fluids, and rapid transport to a trauma center.
The document discusses assessment and types of thoracic injuries. It describes assessing the athlete's mental status, vital signs, breathing sounds and quality, chest examination for injuries. Key injuries include fractures, pneumothorax, hemothorax, open pneumothorax, and pulmonary embolism. Pneumothorax can become life-threatening as a tension pneumothorax and requires needle decompression. Treatment depends on injury but may include oxygen, ventilation support, intravenous fluids, and rapid transport to a trauma center.
The document discusses assessment and types of thoracic injuries. It describes assessing the athlete's mental status, vital signs, breathing sounds and quality, chest examination for injuries. Key injuries include fractures, pneumothorax, hemothorax, open pneumothorax, and pulmonary embolism. Pneumothorax can become life-threatening as a tension pneumothorax and requires needle decompression. Treatment depends on injury but may include oxygen, ventilation support, intravenous fluids, and rapid transport to a trauma center.
The document discusses assessment and types of thoracic injuries. It describes assessing the athlete's mental status, vital signs, breathing sounds and quality, chest examination for injuries. Key injuries include fractures, pneumothorax, hemothorax, open pneumothorax, and pulmonary embolism. Pneumothorax can become life-threatening as a tension pneumothorax and requires needle decompression. Treatment depends on injury but may include oxygen, ventilation support, intravenous fluids, and rapid transport to a trauma center.
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Thoracic Injuries
The vital organs of the thoracic cavity
Heart
Lungs
Major vessels
Well protected by the rib cage
Takes high energy and velocity forces to cause injury
Anatomy Assessment Must be thorough, efficient, and focused on the mechanism of injury. Observe general appearance while determining level of consciousness Evaluating the ABCs (airway, breathing, circulation). Valuable information regarding the severity of the condition by: Level of anxiety Ability to speak in full sentences Assessment The mental status of the athlete is also important to
determine because alterations in mental status are the
first signs of hypoxia. Any athlete with difficulty breathing and who is
unable to speak in full sentences needs emergent
referral to a hospital. Assessment Vital signs, including: Blood pressure
Pulse oximetry
Pulse rate and quality
Skin color
Temperature
Quality and frequency of respirations
Assessment Evaluating the quality of respirations; be alert for the following: Nasal flaring: the nostrils opening wide on inhalation Tracheal tugging: the Adam’s apple is pulled upward on inhalation Retraction of the intercostal muscles on inhalation Use of the diaphragm and neck muscles to assist inhalation Use of abdominal muscles on exhalation Cyanosis Assessment Auscultation of the lungs will determine the quality of
respirations and efficiency of air movement.
Should listen at each site during expiration and
inspiration for air movement.
Sites of auscultation Assessment Palpate the chest by gently placing hands on the rib cage and feel for the rise and fall during breathing Should be equal in motion, rate, and rhythm
Palpate the bony structures, looking for:
Deformity of the ribs Unstable segments Congruency of the sternoclavicular and costosternal joints Presence of swelling, crepitus, or crackling of subcutaneous emphysema Assessment Pain elicited by compressing the thorax front to back or inward from the sides indicates the possibility of a fracture to the ribs • Percuss the chest, indicate the density of the underlying tissue Normal: a resonant sound equal bilaterally Hyperresonant: excessive air accumulating in the thorax as would be present in the case of a pneumothorax Dull: the presence of fluid in the lung such as in the case of a hemothorax Percussion Assessment Notice should be taken to: Erythema
Ecchymosis
Deformity
Paradoxical movement
Alignment of the trachea
Assessment In the case of an open wound, determine if air
movement in and out of the wound is present
Determining the presence of an exit wound would
Any injury to the thoracic cavity may lead to shock
either acutely or over time.
Observation of the skin color may be informative in
identifying the onset of shock
Assessment Pale, ashen, or cyanotic coloring would be indicative
of respiratory collapse Red, dark-red, or blue coloring of the head and neck
would be indicative of traumatic asphyxia
Types of Injuries Fractures Dislocation Types of Injuries Pneumothorax Types of Injuries The athlete will present with a sudden onset of a sharp chest pain and difficulty breathing after exercising, strenuous coughing, or even air travel. Tension Pneumothorax A pneumothorax that expands to the point where it compresses on the aorta, heart, and superior and inferior vena cava is called a tension pneumothorax and is a life-threatening injury Types of Injuries If breathing sounds are absent on the affected side and severe dyspnea and jugular vein distension are present, then a tension pneumothorax should be immediately suspected. Affected athletes will appear anxious and restless, hypotensive with a rapid and thready pulse, and on the verge of circulatory collapse. Percussion will result in hyperresonanceon the affected side. Types of Injuries If the athlete is unconscious or unable to breathe adequately, then assist respirations with a bag-valve mask. If the symptoms still do not improve, needle decompression must be performed rapidly Types of Injuries Open Pneumothorax The severity of this condition is dependent on the size of the opening in the chest wall and the causative agent such as a bullet, knife, or javelin. Management of an open pneumothorax includes administration of high-flow oxygen and monitoring of vital signs, especially respiratory effort and efficiency. Open Pneumothorax Treatment of an open pneumothorax involves creating a one-way valve with a dressing. Covering the opening with a sterile occlusive dressing. If significant improvement is not seen, endotracheal intubation is indicated. Hemothorax Blood entering the pleural cavity results in a hemothorax, and the mechanism is the same as a pneumothorax. If the lungs become compromised, the athlete will develop dyspnea and chest pain and the jugular veins will become distended Effective treatment of a hemothorax includes oxygen supplementation and respiratory support. Intravenous fluid resuscitation is undertaken with great care because an overload of fluid may result in significant pulmonary edema and difficulty in ventilation during the hospital course of treatment. Rapid transport to a trauma center is essential. Pulmonary Embolism A blood clot that enters the venous system and lodges in the lung results in a pulmonary embolism. The clot blocks pulmonary circulation, and dead space in the lung increases. Symptoms of an acute pulmonary embolism include a sudden onset of chest pain, dyspnea, tachycardia, and bloody sputum. Treatment includes early recognition, oxygen administration, and rapid transport to the hospital
