12

Thorax and Abdomen

Observe surroundings and athlete.

On-Field Assessment: On-Field Assessment: Primary SurveyPrimary Survey

Establish consciousness.

Assess vitals early (pulse, respirations, blood pressure).

Check airway, breathing, and circulation.

Nausea

On-Field Assessment: On-Field Assessment: Secondary SurveySecondary Survey

Chest or abdominal pain

Respiratory or cardiac distress

History—note symptoms:

Difficulty breathing

Pain increase on inspiration

Observation—note overall response:

Pain

Shock

Chest wall (tenderness, deformity, swelling, asymmetry)

On-Field Assessment: On-Field Assessment: Secondary SurveySecondary Survey

Bony and soft tissue landmarks

Palpate to assess potential structures involved:

Abdomen (distension, guarding, rebound tenderness)

Pulse

Decreased blood pressure

Cardinal Signs Cardinal Signs of Internal Injuryof Internal Injury

Rapid and weak pulse

Wet, white, and weak appearance

Rapid and shallow respirations

Chief complaint

Sideline and Off-Field Sideline and Off-Field Assessment: HistoryAssessment: History

Mechanism of injury

Onset, duration, and change in symptoms

Pain profile

Presence and location of referred pain

(continued)

Nausea, vomiting, difficulty breathing

Sideline and Off-Field Sideline and Off-Field Assessment: HistoryAssessment: History

Presence of hematuria

General health and previous injury history

Response, position and posture

Sideline and Off-Field Sideline and Off-Field Assessment: ObservationAssessment: Observation

Skin coloration and moisture

Abdomen (rigidity, guarding, distension)

Thorax (breathing pattern, signs of cardiac distress)

(continued)

Genitalia (swelling or abnormal appearance)

Sideline and Off-Field Sideline and Off-Field Assessment: ObservationAssessment: Observation

Hematuria and hemoptysis

Vital signs

Swelling, discoloration, lacerations, deformity, asymmetry

Pulse

Sideline and Off-Field Sideline and Off-Field Assessment: PalpationAssessment: Palpation

Chest (tenderness, deformity, crepitus, asymmetry)

Soft tissue

Bony landmarks

(continued)

Abdomen

Sideline and Off-Field Sideline and Off-Field Assessment: PalpationAssessment: Palpation

Muscle guarding

Deep organ palpation (liver, spleen, kidney)

Rebound tenderness

Ridigity and distension

Testicles (swelling, tenderness, masses, abnormalities)

Abdominal quadrantsAbdominal quadrants

anterior view

posterior view

Liver palpationLiver palpation

Spleen palpationSpleen palpation

Anatomical position Anatomical position of the kidneysof the kidneys

Kidney palpationKidney palpation

Anterior-posterior rib compression

Abdominal Sideline and Abdominal Sideline and Off-Field Assessment: Off-Field Assessment: Special TestsSpecial Tests

Lateral rib compression

Auscultation (heart, lungs, bowel)

Anterior-posterior Anterior-posterior rib compressionrib compression

Lateral rib Lateral rib compressioncompression

AuscultationAuscultation

Active for trunk, scapular, and shoulder motions

Sideline and Off-Field Sideline and Off-Field Assessment: Assessment: ROM and StrengthROM and Strength

Bilateral comparisons

Range of motion

Same motions as for ROM

Note weaknesses and bilateral differences

Strength

Thoracic dermatomes

Sideline and Off-Field Sideline and Off-Field Assessment: Assessment: Neurological TestsNeurological Tests

Visceral pain referral patterns

Neurological assessment is primarily sensory.

Cardiorespiratory (aerobic exercise)

Functional AssessmentFunctional Assessment

Musculoskeletal (active sport-related movements)

Reassess signs and symptoms during and after each functional activity.

Follow-Up AssessmentFollow-Up Assessment

Signs and symptoms may not be present until hours or days postinjury. Ongoing follow-up care is important along with frequent evaluation and instruction.