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Chapter 11 Throat, Thorax, and Visceral Conditions

Chapter 11 Throat, Thorax, and Visceral Conditions. Throat Anatomy. Throat region. Throat Anatomy (cont’d). Pharynx, larynx, esophagus “Adam’s” apple Epiglottis Vocal cords Hyoid bone Esophageal sphincters Trachea Divides into right and left bronchial tubes. Throat Anatomy (cont’d).

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Chapter 11 Throat, Thorax, and Visceral Conditions

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  1. Chapter 11 Throat, Thorax, and Visceral Conditions

  2. Throat Anatomy Throat region

  3. Throat Anatomy (cont’d) • Pharynx, larynx, esophagus • “Adam’s” apple • Epiglottis • Vocal cords • Hyoid bone • Esophageal sphincters • Trachea • Divides into right and left bronchial tubes

  4. Throat Anatomy (cont’d) • Arterial supply to the neck and throat region • Blood vessels • Common carotid arteries

  5. Thoracic Cage

  6. Thorax Anatomy • Thoracic cage and pleura • Sternum, ribs, costal cartilage, thoracic vertebrae • Cage around heart and lungs • Pleura and pleural cavity • Bronchial tree and lungs • Bronchial tubes → terminal bronchioles • Alveoli

  7. Visceral Region Anatomy • Pelvic girdle • Sacrum, ilium, ischium, pubis • Functions • Visceral organs • Stomach • Liver • Spleen • Kidneys Anterior view of the visceral organs

  8. Visceral Region Anatomy (cont’d) • Blood vessels • Aorta • Numerous branches Arterial system of the trunk

  9. Anterior Muscles of Trunk Muscles of the trunk. A. Anterior

  10. Posterior Muscles of Trunk Muscles of the trunk. B. Posterior

  11. Injury Prevention • Protective equipment • Variety of equipment available • Concern: adolescent rib cage – less rigid • Physical conditioning • Flexibility • Strength

  12. Throat Conditions • Neck laceration • Uncommon; severe bleeding • Management: • Activate emergency plan, including summoning EMS • Control hemorrhage – apply firm, direct pressure over the wound • Assess vitals and treat as necessary

  13. Throat Conditions (cont’d) • Contusions and fractures • Trachea, larynx, and hyoid bone • Occur during hyperextension of the neck

  14. Throat Conditions (cont’d) • Contusions and fractures (cont’d) • S&S • Hoarseness • Dyspnea • Difficulty swallowing • Coughing • Significant – severe pain, laryngospasm, acute respiratory distress

  15. Throat Conditions (cont’d) • Contusions and fractures (cont’d) • Management: • Calm individual; help individual focus on their breathing rate • Significant trauma • Activate emergency plan, including summoning EMS • Assess vitals and treat as necessary

  16. Thoracic Conditions • Sudden deceleration and impact → compression and deformation of rib cage • “Red Flags” • Shortness of breath or difficulty in breathing • Deviated trachea or trachea that moves during breathing • Anxiety, fear, confusion, or restlessness

  17. Thoracic Conditions (cont’d) • “Red Flags” (cont’d) • Distended neck veins • Bulging or bloodshot eyes • Suspected rib or sternal fracture • Severe chest pain aggravated by deep inspiration

  18. Thoracic Conditions (cont’d) • “Red Flags” (cont’d) • Abnormal chest movement on affected side • Coughing up bright red or frothy blood • Abnormal or absent breath sounds • Rapid, weak pulse • Low blood pressure • Cyanosis

  19. Thoracic Conditions (cont’d) • “Stitch in the Side” • Sharp pain or spasm in chest wall (lower) during exertion • Etiology: varies

  20. Thoracic Conditions (cont’d) • “Stitch in the Side” (cont’d) • Management: Most individuals can run through the sharp pain by: • Forcibly exhaling through pursed lips • Breathing deeply and regularly • Leaning away from the affected side • Stretching the arm on the affected side over the head as high as possible

  21. Thoracic Conditions (cont’d) • Breast conditions • Contusions • Can produce fat necrosis or hematoma formation → ↑ pain • Management: standard acute and external support

  22. Thoracic Conditions (cont’d) • Breast conditions (cont’d) • Nipple irritation • Runner’s nipples • Friction → abrasions, blisters, or bleeding • Management: advise individual to cleanse and cover the wound; if infection is a concern, physician referral • Prevention: petroleum-based product

  23. Thoracic Conditions (cont’d) • Breast conditions (cont’d) • Cyclist’s nipples • Perspiration + wind chill → ↑ pain • Management: warm the area after the event to prevent irritation • Prevention: wind-proof jacket

  24. Thoracic Conditions (cont’d) • Strain of pectoralis major • MOI: active contraction; overburdened by excessive load or extrinsic force

  25. Thoracic Conditions (cont’d) • Strain of pectoralis major (cont’d) • S&S • Sound: pop or tearing • Immediate pain and weakness; aching or fatigue-like rather than sharp pain • Deformity – muscle retracts • Swelling and ecchymosis • Limited shoulder motion due to pain

  26. Thoracic Conditions (cont’d) • Strain of pectoralis major • Management: • Grade 1 – standard acute; if the condition does not resolve in 2-3 days, physician approval prior to return to activity • Grade 2 or 3 – physician referral

  27. Thoracic Conditions (cont’d) • Costochondral sprain • Etiology: • Collision force • Severe twisting of thorax • Result: separates cartilage at attachment to rib or sternum Undisplaced costochondral separation

  28. Thoracic Conditions (cont’d) • Costochondral sprain (cont’d) • S&S • Hear or feel a “pop” • Localized sharp pain; changes to intermittent stabbing pain • Visible deformity • Severe: pain with deep inhalation • Management: standard acute; physician referral

  29. Thoracic Conditions (cont’d) • Sternal fracture • Rare; requires high impact • S&S • Immediate loss of breath • Pain, especially with deep inspiration • Suspected fracture – assess for underlying injury

  30. Thoracic Conditions (cont’d) • Sternal fracture (cont’d) • Management: • Activate emergency plan, including summoning EMS • Assess vitals and treat as necessary

  31. Thoracic Conditions (cont’d) • Rib fracture • Stress fracture – indirect force (muscle contraction) • Acute • Direct blow or compression • Ribs 5-9 • Most minor – undisplaced; if displaced, suspect internal injury

  32. Thoracic Conditions (cont’d) • Rib fracture (cont’d) • S&S • Pain at site with deep inspiration or coughing • Individual will take shallow breaths and lean toward fracture site • Localized swelling, discoloration, crepitus

  33. Thoracic Conditions (cont’d) • Rib fracture (cont’d) • S&S (cont’d) • Check for: • Coughing up of blood • Abnormal breath sounds • Rate and depth of respiration

  34. Thoracic Conditions (cont’d) • Rib fracture (cont’d) • Management: • Standard acute; immobilize chest • Severe: immediate referral to emergency care facility • Internal injury suspected: activate emergency plan, including summoning of EMS

  35. Internal Complications • Hyperventilation • Etiology: pain, stress, trauma • Rapid, deep inhalation – more O2long exhalation – excessive CO2 loss

  36. Internal Complications (cont’d) • Hyperventilation (cont’d) • S&S • Inability to catch breath • Numbness in lips and hands • Spasm of hands • Chest pain • Dry mouth • Dizziness

  37. Internal Complications (cont’d) • Hyperventilation (cont’d) • Management: • Calm individual • Slowly inhale through nose and exhale through mouth

  38. Internal Complications (cont’d) • Pneumothorax • Air trapped in pleural space, causing portion of lung to collapse; lung can’t fully expand • Etiology • Traumatic – penetrating wound • Spontaneous – unexpectedly without underlying disease

  39. Internal Complications (cont’d) Internal complication to the lungs. A. Pneumothorax

  40. Internal Complications (cont’d) • Hemothorax • Loss of blood into pleural cavity • Etiology: fracture of rib could tear lung tissue or blood vessels in chest

  41. Internal Complications (cont’d) Internal complications to the lungs. B. Hemothorax

  42. Internal Complications (cont’d) • Tension pneumothorax • Air accumulates in pleural space during inspiration and cannot escape on exhalation; expansion compresses heart and lung

  43. Internal Complications (cont’d) Internal complications to the lungs. C. Tension pneumothorax

  44. Internal Complications (cont’d) • Pneumothorax, hemothorax, tension pneumothorax (cont’d) • S&S • Severe pain during breathing • Hypoxia • Cyanosis • Signs of shock • Hemothorax – coughing up frothy blood may also be seen

  45. Internal Complications (cont’d) • Pneumothorax, hemothorax, tension pneumothorax (cont’d) • Management: • Activate emergency plan, including summoning EMS • Assess vitals and treat as necessary

  46. Internal Complications (cont’d) • Heart injuries • Blunt cardiac injury • Leads to localized damage and necrosis of heart tissue • Concern: decreased cardiac output secondary to arrhythmias

  47. Internal Complications (cont’d) • Heart injuries (cont’d) • Blunt cardiac injury (cont’d) • Cardiac tamponade • Ruptures myocardium or lacerates coronary artery; ↑ fluid in pericardium; compresses venous return to heart

  48. Internal Complications (cont’d) • Heart injuries (cont’d) • Blunt cardiac injury (cont’d) • S&S • Jugular venous distention • Collapse within seconds and respiratory arrest

  49. Internal Complications (cont’d) • Heart injuries (cont’d) • Blunt cardiac injury (cont’d) • Management • activate emergency plan, including summoning EMS • Initiate breathing and chest compressions

  50. Internal Complications (cont’d) • Sudden Death in Athletes • Sudden death – an event that is non-traumatic, unexpected, and occurs instantaneously or within minutes of an abrupt change in an individual’s previous clinical state • Causes: hypertrophic cardiomyopathy; abnormalities in the coronary arteries; aortic rupture associated with Marfan’s syndrome; and mitral valve prolapse

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