Chapter 9

THE THORAX AND ABDOMEN

ANATOMY

Bones

Sternum & Manubrium Ribs - 12

– Costocartilage Vertebrae

– Thoracic -12– Lumbar - 5– Sacral - 5– Coccyx - 4 (fused)

ORGANS

Heart Lungs Abdomen

– 4 Quadrants • Right Upper Quadrant (RUQ)• Left Upper Quadrant (LUQ)• Right Lower Quadrant (RLQ)• Left Lower Quadrant (LLQ)

Right Upper Quadrant

Liver ** Adrenal Gland Gallbladder ** Stomach Pancreas Kidney Small Intestine Colon

Left Upper Quadrant

Stomach Spleen ** Adrenal gland Pancreas Colon Small intestine Kidney

Right Lower Quadrant

Appendix ** Small intestine Large intestine Colon Urinary and reproductive organs

Left Lower Quadrant

Small intestine Large intestine Colon Urinary and reproductive organs

Normal Abdomen

http://health.allrefer.com/pictures-images/normal-abdominal-anatomy-1.html

Evaluation of Thorax and Abdomen Slightly varies from HOPS assessment. Follow Primary and Secondary survey

Primary Survey

Check ABC’s Assist athlete in maintaining an open

airway by removing any blood or vomit from the airway.

Secondary Survey

History and Physical Examination History:

– MOI– Location of inj– Onset of s/s– PQRST– Nausea– Weakness– Dyspnea– Movements that make the s/s better or worse.

Physical Examination– VITAL SIGNS

VITAL SIGNS Abnormal nerve

response BP Movement Pulse Respiration Skin Color Level of consciousness Temperature

After you check the vital signs progress to: – Inspection– Auscultation– Percussion– Palpation and Special Tests

INSPECTION

Cyanosis Flail chest Tracheal deviation Jugular vein

distension PEARL Vomiting

Position Respiratory

rate/rhythm Chest appearance Hemoptysis Hematemesis Ecchymosis

Auscultation

Listening for sounds determined in the thoracic and abdominal cavities

Completed by a medical professional Used to determine:

– Normal/abnormal chest sounds– Breathing equality– Depth of breaths

Percussion

Tapping on various parts of the body and noting the sound it produces

Requires extensive training

Palpation

Looking for…– Areas of tenderness– Deformities– Swelling– Air Crepitus - air caught in subcutaneous

tissue– Bony Crepitus - bones rubbing together– Asymmetry

– Muscle Rigidity– Abdominal Rebound Tenderness

• Tender when you “let go”

Inspiration/Expiration Test

Instruct the athlete to breathe in as much air as possible; hold inspiration.

Then, expire as much as possible; hold expiration.

Observe:– Inability to fully inspire– Pain during breathing– Guarding or apprehension with respirations

Chest Compression Tests

A test for fractures to the ribs, sternum, or costocartilages.

Anterior/Posterior and Lateral Compression Test– Have athlete sit or stand– Compress on the ant and post aspect of chest– + Test = pain or bony crepitus– - Test = may indicate a contusion or muscle

spasm

Pancreas

Gallbladder

Spleen

Large/Small Intestine

Stomach