Kine 318 Ex

thoracic cavity

the thoracic cavity is divided into three sections/spaces: two separate pleural cavities which house the right and left lungs and the mediastinum which houses the heart, thoracic parts of the great vessels, the trachea, the left and right bronchi, and other structure

*important organs - if damaged could result in death (the heart and lungs)

pleural space in thoracic cavity

inner and outer linnings
-blood can get in between that can cause problems

thoracic

there is also the thoracic vertebrae and the twelve pair of ribs housed withn the thoracic cavity
-main functions are to protect the vital respiratory and circulatory organs and assist the lungs in inspiration and expiration
-first 7 ribs (sternal or true ribs) are attached to the sternum by separate costal cartilage
-the 8th, 9th and 10th ribs (false ribs) have cartilages that join each other and the 7th rib, while the 11th and 12th ribs (floating ribs) remain unattached to the sternum but do have muscle attachments

1st group of ribs

sternal or true ribs that have a direct contact to sternum with cartilage

2nd group of ribs

7th, 8th, 9th, 10th
-connect to each other

3rd group of ribs

11th and 12th
-floating not attached
-blow to bottom = no fracture because give with blow

ribs that come out (dislocated)

Is uncomfortable and hard to breath
-chiropractor to pop back in

boundaries of the thoracic cavity

-posterior = mid spine
-superior = shoulder girdle (clavicle area)
-lateral = rib cage
-anterior = ribs/ sternum
-inferior = diaphragm

abdomen

lies between the diagram and the pelvis and is bounded by the margin of the lower ribs
-superior border is the base of the ribs and the inferior border is the pelvic area (iliac spine)
-the abdomen is divided into four quadrants

abdominal muscles

-rectus abdominis
-external oblique
-internal oblique
-each is involved in trunk flexion, rotation, and lateral flexion
-transverse abominis = hold the abdominal contents in place and aids in forced expiration (blow out candles)
*external on one side works with internal on opposite side for bending and turning

abdominal viscera

made up of hollow and solid organs

hollow organs

stomach
-intestines
-gallbladder
-urinary bladder

solid organs

*more at jeopardy from an injury bc don't give in and are easily ruptured - expect urinary bladder (minimize solid organ and ruptures if hit directly - should empty few hours on long drive in case in car accident
-kidneys
-speen
-liver
-pancreas

upper right of abdomen

liver
gallbladder
stomach
large intestine
small intestine

upper left of abdomen

stomach
pancreas
spleen

lower right of abdomen

large intestine
small intestine
ascending colon
appendix

lower left of abdomen

large intestine
small intestine
descending colon

pelvic cavity

lies next to the abdominal cavity includes the reproductive system, urinary tract and parts of the low digestive system

rib contusion

-MOI= blow to the rib cage
-S/S = pain while breathing, point tenderness, pain
-TX = PRICEMM and NSAIDs
**hard to tell apart from fracture - need an x-ray b/c both cause pain and point tenderness

rib fractures

-MOI = direct or indirect trauma
-S/S = point tender, pain while breathing, sharp pain
-TX = refer to MD, x-ray
*can break rib with a sneeze
* elderly pt kept in hospital to make sure don't develop pneumonia bc air isn't passing through correctly
* put in flat jacket to defer blow if participating in sports again

costochondral separation

-MOT = direct blow to the anterolateral aspect of the thorax
-Example: land on side when sliding into base
-S/S= pain during sudden movement (breathing, talk, walking, sneezing, and coughing), point tender, swelling, possible deformity (can feel when sternum and coastal cartilage connects)
-TX = rest, refer to MD (need good pain medication - take exactly as medication states and pain ends in about 48 hours), immobilization

sternum fracture

-MOI = high impact blow to the chest
-S/S = point tenderness, pain while breathing
-TX: refer to MD, X-ray
*not overly common - but occurs when doing chest chest compressions in CPR - if hands are too long can push down and cause zyphode process to break off

pneumothorax definition

the pleural cavity becomes filled with air
-air coming out of lung which can collapse the lung - air continues in and fills around heart and then goes around to lung
-if can feel between ribs on opp side of blow the other lung is about to collapse and need to be at hospital

pneumothorax MOI, S/S, and TX

-MOI: may be spontaneous, appearing following activity or after a cough or traumatic due to punctured lung from rib fracture
-S/S: pain, difficulty breathing (air isn't coming in), cyanosis (blue around lips or nail beds)
-TX: medical emergency = transport pt on injured side bc need opposite lung to work best that it can (doing double duty)
*not common to be spontaneous - usually blow or stabbing

Hemothorax definition

presence of blood in the pleural cavity

hemothorax MOI, S/S, and TX

-MOI = laceration of lung tissue, intercostals artery secondary to a penetrating rib fracture or knife
-S/S: pain, difficulty breathing, cyanosis, may cough up blood
-TX: medical emergency

traumatic asphyxia

-MOI: violent blow
-S/S: purple discoloration in upper half of body, conjunctivas (whites) of the eyes are bright red, may have subcutaneous emphysema - may have been run over by car and the lower pressure causes bursting of blood vessels
*subcutaneous emphysema from scuba diving - around neck felt like bubbles underneath
-TX: medical emergency, mouth to mouth

commotio cordis

-DEF: cardiac arrest
-MOI: blunt impact to the chest during repolarization phase i cardiac cycle
-S/S: arrhythmia (quivering), death (flat line)
-TX: medical emergency, defibrillation (AED = specifically for this arrhythmia to get back in this rhythm) , cardiopulmonary resuscitation
**common in baseball and softball when ball hits you directly in the chest

kidney contusion

-MOI: direct. blow to the back
-S/S: signs of shock, nausea, vomiting blood in the urine (hematuria)
-TX: refer to MD (urologist) - must determine if able to go play
**give pt cup to catch pee in cup if visible blood must go to dr and continue catching urine for next few days to look for urine

liver contusion

-MOI: blunt trauma
-S/S: hemorrhage, shock, referred pain (goes all over the place) just below the right scapula, shoulder and substernal area, referred pain anterior left side of the chest (larger referral pattern)
-TX: refer to MD

appendicitis

-MOI: inflammation of the vermiform appendix
-S/S: pain in the lower abdomen, McBurney's pain (specifically where pain is) 1/3 of the distance between the anterosuperior illiac spine and the umbilicus - lower right - look for rebound pain when push down there is no pain and when comes out there is pain - not definite
-TX: refer to MD (make decision on exactly what is happening)

scrotal contusion

moi= direct blow
-S/S = pain, hemorrhage, fluid effusion, muscle spasms, nausea
-TX = put at ease, reduce testicular spasm, ice, refer to MD, have pt sit up with legs fully extended and go behind pt and pick up butt underneath airs and drop back down - sometimes relieves pain

traumatic hydrocele of the tunic vaginalis definition

excess of fluid accumulation in the testicular area

traumatic hydocele of the tunica vaginalis. MOI, S/S, and TX

-MOI = severe blow, possible side effect of testicular surgery
-S/S = pain, swelling in the scrotum
-TX = ice, refer to MD

torsion of the spermatic cord

-MOI = possible complication of testicular trauma, spontaneous in absence of trauma (and immediate pain - occasionally gradually pain)
-S/S = immediate or gradual onset of groin pain, heaviness in scrotum, change in normal appearance of the testicle
-TX = medical emergency, refer to MD
**twisting of balls = compression of blood vessels

**testicle can die if blood vessel compressed long enough and must be removed surgically

injury of the spleen

-MOI = direct blow, fall
-S/S = signs of shock, abdominal rigidity, nausea, vomiting
-TX = refer to MD
-DIAG = kehr's sign: reflex pain that radiates to the left shoulder and down the left arm

contusion of the abdominal wall

-MOI = direct blow
-S/S = hematoma, pain, tightness
-TX = pricemm, nsaids

inguinal hernia definition

protrusion of the abdominal viscera through a portion of the abdominal wall, maybe congenital or acquired, groin area, more common in men

inguinal hernia MOI, S/S, and TX

-MOI = strain, direct blow
-S/S = pain, prolonged discomfort, superficial protrusion, weak, pulling sensation
-TX = refer to MD, surgery

femoral hernia definition

protrusion of the abdominal viscera through a portion of the abdominal wall, maybe congenital or acquired femoral area, more common in women

femoral hernia MOI, S/S, TX

-MOI = strain, direct blow
-S/S = pain, prolonged discomfort, superficial protrusion, weak pulling sensation
-TX = refer to MD, surgery

blow to the solar plexus definition

"wind knocked out", brief paralysis of the diaphragm

blow of the solar plexus MOI, S/S and TX

-MOI - direct blow
-S/S = lack of oxygen, inability to inhale, may cause hysteria
-TX = reassuring athlete, loosening clothing, bending knees to chest, encouraging the athlete to initiate short inspirations and long expirations

side stitch definition

an idiopathic condition described as a cramp like pain

side stitch MOI

usually develops during physical activity, can be caused y: constipation, intestinal gas, diaphragmatic spasm as a result of poor conditioning, or lack of oxygen, ischemia of either the diaphragm of the intercostals, lack of visceral support because of weak abdominal muscles, distended spleen, overreacting

side stitch S/S and TX

-S/S = cramp, sharp pain
-TX = relaxation of the spasm, by stretching the arm on the affected side, flexing the trunk forward on the thighs

hyperventilation

-MOI = anxiety induced stress, asthma
-S/S = difficulty breathing, panic state, gasping, wheezing
-TX = decrease the rate of carbon dioxide loss

breast injury

-MOI = vertical and horizontal movement, direct blow
-S/S = bruising, stretch of the cooper's ligament, which may cause premature sagging of the breast
-TX = wear well designed bra that has minimal elasticity and allow little vertical or horizontal movement, as well as appropriate protective padding

Dyspepsia

*indigestion*
-MOI = emotional stress, esophageal and stomach spasms, inflammation of the mucous lining of the esophagus and stomach
-S/S = nausea, flatulence (gas), increased secretion of hydrochloric acid
-TX = eliminate irritating food, regular eating habits, refer to MD if worse

peptic ulcer

-MOI = acids secreted in the stomach destroys the mucous lining of the stomach or small intestine, sever anxiety
-S/S = gnawing pain, dyspepsia, heartburn, nausea, vomiting
-TX = antacids, altering the diet

gastresophageal reflux definition

a condition occurs when there is a reflux or backwards flow of the acidic gastric contents into the esophagus

gastroesophageal reflux MOI, S/S, and TX

-MOI = malfunction of the lower esophageal sphincter, hiatal hernia
-S/S heartburn retrosternal pain, burning feeling, sour liquid taste, difficulty swallowing
-TX = medication, refer to MD

skull fracture

-MOI = blunt trauma
-S/S = (may show up a day later especially ecchymosis) severe headache, nausea, blood in the middle ear or ear canal, bleeding through nose, ecchymosis around the eyes (raccoon eyes) , ecchymosis fluid (typically clear but may be pink bc mixed with red blood) may appear in the ear canal (don't put direct pressure - let drip on gauze pad) and nose
-TX = immediate hospitalization, referral to neurosurgeon

concussion MOI

MOI = agitation or shaking from being hit, direct or indirect blow (brain free floating like in jello - brain then with indirect blow hits the side of the skull)

concussion old info

-250,000 in high school football per year with several deaths per year
-4 to 6 greater risk for a second concussion after the first one (more susceptible)
-many different ways to classify (don't classify anymore)
-area that has changed the most over the years in relatively short period of time

up to date sports concussion stats

-3,800,000 concussions reported in 2012- double what was reported in 2002 - not more concussions now just understand that they need to be reported if suspect athlete has a concussion
-33% of all sports concussions happen at practice (more in game)
-39% the amount by which cumulative concussions are shown to increase catastrophic head injury leading to permanent neurologic disability (really bad things can occur = permeant disability and death)
-47% of all reported sports concussions occur during high school football
-1 in 5 high school athletes will sustain a sports concussion during the season
-33% of high school athletes who have a sports concussion report two or more in the same year (doubling up increases problems )
-4 to 5 million concussion occur annually, with rising numbers among middle school athletes (even lower ages)
-90% of most diagnosed concussions do not involve a loss of consciousness (significant change) - in 2009 guidelines used grading and grade I = no loss of consciousness (no longer used)
-an estimated 5.3 million Americans live with a traumatic brain injury related disability (CDC)

heath care providers of concussions

-team physician (resent concussion training needed)
-athletic trainers (have authority to determine if safe to return to play) - physician makes overall call for clearance
-have unchallengeable authority to determine and manage the treatment and the return to play of any ill or injured athlete
- return to play following a concussion will be made by the team physical or his/her designate

education of concussions

-coaches must acknowledge that have been educated and understand the concussion management plan (must be updated and aware of why)
-they are presented education and they answer basic questions
-athletes must receive documentation and sign an acknowledgement form
-athletes must agree to report if they feel they have an injury or suspect someone else

neurocognitive testing

-IMPACT training - a computer program in which symptoms checklist, concussion history and neuropsychological testing
-C3 logix
-sports tested for baseline (in past = baseball, basketball, diving, equestrian, football, pole vaulting, soccerm and softball - used to be sports that were tested - now all athletes are tested to get baseline so don't have to guess)
-all sports tested now
**testing involves memory and coordination when athlete is healthy to get a baseline and redo testing to be cleared for play after injury

mild traumatic brain injury (MTBI)

*event occurs (athletic trainer evaluates - symptoms checklist = (+) symptoms, refer if physician is present
-headache
-nausea
-vomiting
-balance problems
-dizziness
-fatigue
-drowsiness
-visual problems
-sensitivity to light
-sensitivity to noise
-irritable
-sadness (mood swings)
-nervousness (CNS may be affected)
-numbness or tingling
-feeling "foggy"
-difficulty in concentration

evaluations

-short term memory evaluation
-long term memory evaluation
-processing functions
-balance testing

short term memory evaluations

-how injury occurred
- 3 word memory (color, object and shape and asked to repeat 5 mins late)

long term memory evaluation

-day of week
-what did you eat for lunch

processing functions

-subtract from 100 by 7s (may get to 97 or 86 but then can't remember the last number)
-months of year backwards (can't remember where they stopped - no processing function)

balance testing

-double leg stance
-single leg stance
-tandem or heel to toe

decisions for concussions

-if team physician is NOT present - remove from all activities - not coming back on the same day at all
-if a concussion is suspected, do not return them that day!!
- used to go bac to play i 15 mins if showed no symptoms and just looked at them every few mins
-observe for minimum of 15 minutes (observe them - could be bleeding or swelling in brain)
-athletic trainer reevaluates
-if athlete is completely asymptomatic - normal neurological exam including balance testing and perform functional testing
-if still symptomatic the athlete does not return that day and remains in observation and arrange for physician evaluation

functional testing for concussions

-progressive = walk then jog then sprint
-running up/downs
-bear crawls
-observe for symptoms
-"do you feel like normal .. (name)? - if yes, allow return and if no hold them
**these exercises may increase symptoms - look at symptoms again the next day but stop they second symptoms are present

diagnosed concussions using physical evaluations

*ASAP
-sport concussion assessment tool 3 (SCAT3) - appropriate for persons age 10 and above
-admitted or released
-transportation arranged (don't drive alone) - athlete given head injury handout, athlete instructed to follow-up with their staff athletic trainer daily and if roommate seeing any signs on give list call 911
**refrain from cognitive and physical activity (don't text or watch video - may need to be excused from school

immediate concussion treatment

-tylenol only for pain
-refrain from physical activity, texting and emailing, playing video games, watching TV/Videos, consider excusing from all academics

daily concussion follow up

-symptom score (if below 10 may need baseline testing)
-determine athletes best interest depending on symptoms and academic demands
-refer to nutritionist to be placed on DHA Omega 3 - has been shown to aid the brain tissue
-if symptom score is less than 10 - setup IMPACT testing

when to athletes become active after concussion?

-at or near NO symptoms
-at or near return to baseline on IMPACT

graduated return to play after concussion

-light aerobic exercise - goal = increase heart rate (walking, stationary bike, swimming, 70% max)
-sport specific exercise - goal = add movement (running drills, jogging to sprinting)
-training drills - goal = add coordination and cognitive function (up/downs, bear crawls, pass catching)

*gradually increase unless symptoms increase then stop

final clearance

-athlete is completely asymptomatic
-athlete returns to baseline on IMPACT
-athlete can accomplish all return to play activities with no onset of symptoms
-athlete is referred to physician for final clearance

ultimate return to play after concussion

*upon medical clearance:
-athlete is released to coaches for normal training exercises including contact drills if appropriate to restore athletes confidence and to determine if athlete is ready to participate
-put them out there when they are 100% ready - no limitations

concussions norms

-typical recovery is 5-7 days (simple)
-complex concussions take much longer - weeks to years
-everyone is different - some can be a lot longer (weeks, years or may never fully recover)

NCAA Concussion Policy

-required concussion management plan on file
-student athletes must sign a statement agreeing to report all injuries and illnesses
-student athletes should be present with educational material on concussions
-all student athletes with suspected head injuries MUST be removed and evaluated
-student athletes diagnosed with a concussion shall not return to activity for the remainder of the day (NO EXPECTATIONS)
-medical clearance determined by team physician (must have concussion training)

concussion related laws

-as of October 25, 2011 - 33 states have enacted youth sports concussion related laws
-all states have laws now - some laws aren't great and some are really good

house bill 2038 - Natasha's Law

-signed into law May 17, 2011
- requirements = every school district that competes on interscholatic athletic activity must establish a concussion oversight team (COT) - members include physician, athletic trainer and one other
-all suspected head injures must be evaluated by a physician - in small town can be done over zoom
- a 5 step return to play (RTP) protocol must be followed by all high schoolers
-must obtain a written release by a physician or health care provider prior to an athlete's RTP (must be from physician on oversight team) - good investment bc parents would think they are fine and find a doctor that would sign off on them and get in an argument with team doctor

concussion management

-recognize (train athletes, coaches, parents, school staff - involved education of athletes, coaches, parents, and other school educators)
- remove (develop and implement a sounds concussion management policy (at tamu mandated by NCAA)
-refer (athlete must be seen by a physician (must be dr that is recently trained in concussion management)
-return (stepwise progression (prague guidelines and NATA position statement )

postconcussion syndrome

-MOI = occurs following a concussion
-S/S = headache, impaired memory, lack of concentration, anxiety, irritability, giddiness, fatigue, depression, visual disturbances
-TX = treat symptoms, not allowed to return to play until ALL symptoms have resolved
**repeat of all previous symptoms - why not allowed to return until all protocols are met

second impact syndrome

-MOI = rapid swelling and herniation of brain after a second head injury that occurs before the symptoms of a previous head injury has resolved (blow on top of a blow)
=S/S = dilated pupils, loss of eye movement, loss of consciousness leading to coma, respiratory failure (could be permanent and result in death)
-TX = medical emergency

epidural hematoma MOI

-MOI = blow to head or skill fracture that tears the meningeal arteries - must be diagnosed at hospital
-could tear meningeal arteries and bleed into brain

Epidural hematoma S/S and TX

-S/S = loss of consciousness, head pains, dizziness, nausea, dilation of one pupil (usually on the same side of the injury), sleepiness (medical emergency and assume c-spine
-TX = CT scan, surgery (may need to relieve pressure on the brain)

subdural hematoma MOI

MOI = acceleration/deceleration forces that tear vessels that bridge the dura mater and the brain

subdural hematoma S/S and TX

- S/S = unconsciousness, dilation of one pupil, headache, dizziness, nausea, sleepiness (can't tell apart in field)
-TX = immediate medical attention, CT scan, MRI

mandible fracture MOI

MOI = direct blow
-multiple fractures can occur - need to be seen by physician
-jaw fracture

mandible fracture S/S and TX

-S/S = deformity, loss of normal occlusion of the teeth (bottom teeth stick out further normally), pain when biting (bite test - tough depressor with tape around and bite down on) , bleeding around teeth, lower lip anesthesia
-TX = temporary immobilization (tell not to move), reduction and fixation of the jaw (done by MD - "jaw sown shut"

mandibular dislocation

-MOI = side blow to the open mouth
-S/S = locked open position bc out of place, no jaw movement, overriding malocclusion of teeth (bottom part is sticking way out)
-TX = PRICEMM, refer to MD

temporomandibular joint dysfunction MOI

-MOI = disk condyle derangement which the disk is positioned anteriorly with respect to the condyle when the jaw is closed - pain when talking or chewing

temporomandibular joint dysfunction S/S and TX

-S/S = severe headache on regular basis earache, vertigo (dizziness), inflammation, neck pain
-TX = address the causes of the problem - not a good treatment just find what works for you (EX: dentist, chiropractor, or acupuncturist)
-popping sensation in jaw = lots of pain

zygomatic complex (cheekbone) fracture

-MOI = direct blow to the cheek
-S/S = deformity (not always, bony discrepancy can be felt, nosebleed, seeing double, numbness in that area
-TX = ice, not a lot of pressure, refer to MD (determine if need surgery or heal on its own)

maxillary fractures

-MOI = severe blow to upper jaw
-S/S = pain while chewing, malocclusion, nosebleed, double vision, numbness
-TX = maintain, airway (true in all facial injuries - prepare for an issue), transport to hospital

Tooth Fractures

-MOI = high impact to the upper or lower jaw, direct trauma
-S/S = part of the tooth is missing, possible bleeding, pain
-TX = refer to dentist (not a time frame), x-ray, brace (not normally)
**can do things late - dentist can rebuild tooth and have perfect smile
-get x-ray to ensure no fracture

tooth subluxation, luxation, avulsion

-MOI = high impact to the upper or lower jaw, direct trauma
-S/S = loose or completely out of socket, pain, tooth moved forward or backward, possible tooth missing
-TX = refer to dentist within 48 hours (usually can save tooth if done rapidly - work in immediately
*take care of tooth correctly- the least amound of thing you can do to the tooth the better
** NEVER touch the root
*don't worry about rinsing it off or putting it in a solution
*take care of pt and quickly get to dentist

nasal fractures

-MOI = direct blow to the nose
-S/S = hemorrhage (bleeding) , swelling (could be difficult to breath), deformity, pain
-TX = control the bleeding, refer to MD, x-ray (make decision with pt what they need to do and when they need to do it)

**location!!
-high above the eye is bone and if deviates must be felt with immediately (quickly)
-lower down = cartilage and can be dealt with at any time ( normally no difficulty in breathing) - deviated are fine to fix later (after season) with a simple surgery

deviated spetum

-MOI = compression, lateral trauma
-S/S = bleeding, septal hematoma, pain
-TX = compression to the site of hematoma, refer to the MD (decide about surgery - can pt breath normally??) = snoring

*some people are born with with - fracture can also result in this

epistaxis

*nosebleed
-MOI = direct blow
-S/S = hemorrhage
-TX = apply pressure to the affected nostril for five minutes (if let loose after a few seconds the clot that is trying to form will break)
-use afrin (nose spray) normally use when congested - vasoconstriction of blood vessels = beneficial!!) - controls bleeding and if use afrin for congestion don't use for more than 2 days in a row bc addictive and nose craves it

**can have spontaneous nosebleeds expecially at different times of the year like this week when cooler and drier air 0 those with allergies and blow nose often = nosebleed

auricular hematoma

**cauliflower ear
-MOI = compression, shearing to the auricle that causes subcutaneous bleeding
-S/S = hemorrhage, fluid accumulation, keloid that appears elevated (temporary or permeant)
**seen in African Americans that had surgery = fluid build up
-TX = ear guards (more preventative), ice, aspiration by MD (may need to drain - don't want to unless necessary bc open wound = infection

**bleeding = swelling build up - common in wrestling = helmets

rupture of the tympanic membrane

-MOI = fall or slap to the unprotected ear, sudden underwater variation (ear drum pops bc of air variation)
-S/S = loud pop (notice), pain, nausea, vomiting (from pain), dizziness (inability to stand bc where balance comes from)
-TX = heal spontaneously (not a whole lot need to do - heal on its own), monitor for infections (keep water out of it especially from river or lake) - normally put something in ear to keep from getting in there
*scar tissue might form too much - hearing = muffled = rare

otitis externa

*swimmer's ear (common)
-MOI = infection in the ear canal caused by Pseudomona aeriginosa, a type of gram negative bacteria
-S/S = pain, dizziness, itching, discharge (possible), partial hearing loss (doesn't last)
-TX = ear drops (rubbing alcohol - also prevention), refer to MD (not normally recommend unless extreme)

*preventative to put ear drops in after swimming - evaporates quickly and dries ear out