ࡱ> G <bjbjَ 8]888LLLL8 tL ('''  - ${ o` 8'"''' _U___'88 LL' __=: , 8  HUQ,LLC AH 323 Throat, Chest, & Abdominal Injuries Laboratories Primary Survey Airway Check & monitor Breathing Check & monitor. Be prepared to provide artificial ventilation. Circulation Check & monitor. Be prepared to provide cardiopulmonary resuscitation--CPR, if necessary. Call 911. If the patient is unstable, activate the emergency medical system. Once your primary survey is completed and you determine the patient's condition is not life-threatening, perform: Secondary Survey History Calm & reassure Mechanism of injury Onset of symptoms Location of injury Quantity and quality of pain Type & location of any abnormal sensations Progression of signs & symptoms Activities that make the symptoms better or worse Nausea Weakness Bleeding Dyspnea or (shortness of breath) Observation Patient's positions, movements & signs of guarding or apprehension Respiratory rate & rhythm for dyspnea (shortness of breath) Temperature Skin Moistness Color Level of consciousness Signs of trauma Hemoptysis (coughing up blood) Hematemesis (vomiting up blood) Ecchymosis Evidence of mass Evidence of penetrating trauma Evidence of shock pale skin cyanosis (pale or bluish skin color from poor oxygenation of the blood) lips fingertips fingernails Symmetry of chest appearance & chest movements Signs of respiratory distress such as cyanosis Vomiting Auscultation Assesses normal vs. abnormal chest sounds Assesses breathing equality Assesses depth of breaths Assesses the presence or absence of bowel sounds Assesses abnormal bowel sounds Assesses abnormal vascular noises Percussion Listen for normal/abnormal sounds such as tympany, dullness, or hyperresonance Palpation Pulse rate Skin Temperature General and specific areas of tenderness Location of deformities Location & extent of swelling Signs of acute abdomen Rebound tenderness Rigidity Guarding Air crepitus (produced by air caught in subcutaneous tissue) Bony crepitus (produced by the rough edges of fractured bones rubbing together) Asymmetry Muscle rigidity Special tests Evaluate active, resistive, & passive range of motion to elicit painful ranges, limitations & musculoskeletal weaknesses Sagittal plane range of motion test (standing, sitting, supine, sidelying) Transverse plane range of motion test (standing, sitting, sidelying) Frontal plane range of motion test (standing, sitting, sidelying) Evaluate pain and dysfunction associated with inspiration and expiration Inspiration & Expiration Tests Inability to fully inspire Pain during breathing Guarding or apprehension with respirations Apply passive stress on the rib cage and sternum to check for fractures/separations Anterior/Posterior Chest Compression Test (standing, sitting, supine, sidelying) Lateral Chest Compression Test (standing, sitting, supine, sidelying) Valsalva Maneuver - provoke pain increase or mass protrusion Peritoneal irritation tests Iliopsoas test Obturator test Heel Pound test Consideration of Specific Cardiac Medical Conditions Myocardial infarction (Signs & Symptoms) Persistent chest pain or pressure unrelieved by rest, position changes, or medication Breathing difficulty (noisier, shorter, faster than normal) Irregular pulse rate (faster or slower than normal) Cyanosis Moist face or profuse sweating Radiation of pain to the left side (neck, shoulder, arm) Levine's sign (clenched fist over the chest) Hypotension or shock Cardiac contusions (Signs & Symptoms) Persistent chest pain or pressure unrelieved by rest, position changes, or medication Breathing difficulty (noisier, shorter, faster than normal) Irregular pulse rate (faster or slower than normal) Cyanosis Moist face or profuse sweating Radiation of pain to the left side (neck, shoulder, arm) Hypotension or shock Pericardial Tamponade (Signs & Symptoms) Tachycardia Shock Hypotension Distended neck veins Decreased heart sounds Cyanosis Consideration of Specific Lung Medical Conditions Pneumothorax Spontaneous Pneumothorax (Signs & Symptoms) No history of trauma preceding the event Dyspnea (shortness of breath) Chest pain usually localized to the involved side of the thorax Diminished breath sounds to auscultation Hyperresonance to percussion Traumatic pneumothorax (Signs & Symptoms) Crepitus over fracture site Dyspnea Marked or severe chest pain usually localized to the involved side of the thorax Diminished breath sounds to auscultation Hyperresonance to percussion Subcutaneous emphysema (air trapped under skin) Tension pneumothorax (Signs & Symptoms) A history of trauma preceding the event Tracheal deviation Tachycardia Distended neck veins Cyanosis Hyperresonance to percussion on involved side Dyspnea Chest pain usually localized to the thorax involved side Diminished breath sounds to auscultation Subcutaneous emphysema Hemothorax (Signs & Symptoms) A history of trauma preceding the event Shock Chest pain usually localized to the involved thorax side Dyspnea Diminished breath sounds to auscultation Dullness to percussion Pulmonary contusion (Signs & Symptoms) Shortness of breath Rapid respiration Increase or decrease in pulse rate Pain Hemoptysis (coughing up of blood) Tenderness over the site of trauma Fractures Rib Fractures Considerations Non-displaced fractures are the most common Displaced rib fractures may result in laceration of the lung or an associated intercostal vessel Injuries usually involve 5th to 9th ribs Tremendous forces are necessary to fracture 1st and 2nd rib Fracture of 7th through 12th ribs may be associated with liver, spleen, or kidney injuries Signs & Symptoms Pain at fracture site aggravated by coughing, breathing, movement, and compression tests Dyspnea Localized tenderness Bony or air crepitation Contusion Ecchymosis Sternal Fractures (Signs & Symptoms) Pain directly over sternum Pain aggravated by deep inspiration Possible associated myocardial contusion Costochondral sprains and separations (Signs & Symptoms) Tenderness over costochondral junction Deformity due to displacement Pain with inspiration, expiration or compression test Sternoclavicular dislocations (Signs & Symptoms) Pain Swelling Tenderness Displacement of sternoclavicular joint anteriorly, superiorly, or posteriorly Flail chest (Signs & Symptoms) Dyspnea Asymmetry of chest wall during movement (paradoxical movement) Pain with breathing Signs and symptoms of hemothorax or pneumothorax Musculoskeletal Rib contusions (Signs & Symptoms) Point tenderness Possible ecchymosis Pain with excessive movement Pain with deep inspiration/expiration Lack of crepitus Negative compression test Muscular strains (Signs & Symptoms) Point tenderness to direct palpation Pain with contractile movements of involved muscle Pain with passive stretching of involved muscle Weakness in movements controlled by involved muscle Deformity of muscle on the chest Ecchymosis Negative compression test Pectoralis Major Rupture (Signs & Symptoms) Sudden, sharp pain in upper arm or chest Ecchymosis Weakened adduction, flexion, internal rotation Deformity of muscle on the chest Muscular defect may be evident in axillary fold Respiratory Conditions Asthma--May be exercise induced. Bronchitis--Inflammation of the bronchial tubes. Bronchitis is usually characterized by a productive cough. Hyperventilation-- Symptoms include dyspnea and numbness and tingling in the hands, fingers, and around the mouth. Influenza--Characterized as an acute onset of fatigue, muscle ache, headache and fever which usually lasts one to two weeks. Pleuritic chest wall pain--Inflammation of the serous membrane lining between the lung & chest wall, causing pain with inspiration & expiration or cough. Pneumonia--Inflammation of the lungs caused primarily by bacteria, viruses, chemical irritants, vegetable dusts and allergy. Usual symptoms are fever, cough, and chest pain. Circulatory Conditions Tachycardia--Abnormal speed of heart action and is usually defined in adults as a heart rate over 100 beats per minute. Bradycardia--Abnormal slowness of heart action and is usually defined in adults as a heart rate under 60 beats per minute. Arrhythmia--Abnormal heart rhythm characterized by skipping of beat or an irregular pulse. Hollow Organ Injury (Signs & Symptoms) Decreased bowel sounds Signs of acute abdomen Rebound tenderness Rigidity Guarding Distended abdomen Signs and symptoms of shock--such as hypotension and tachycardia Spleen Injury (Signs & Symptoms) Signs of acute abdomen Rebound tenderness Rigidity Guarding Abdominal pain in left upper quadrant Left shoulder or neck pain (Kehr's Sign) Shock Possible rib fracture Liver Injury(Signs & Symptoms) Signs of acute abdominal pain Rebound tenderness Rigidity Guarding Abdominal pain in right upper quadrant Right shoulder or neck pain Possible right, lower rib fracture Kidney Injury (Signs & Symptoms) Hematuria Bloody discharge or inability to void Flank pain Positive Grey-Turner sign-Ecchymosis in flank No acute abdominal signs Possible bony crepitus due to rib fracture Abdominal muscle strains and contusions (Signs & Symptoms) Superficial, but not deep tenderness to palpation Point tenderness to direct palpation Pain with contractile movements of involved muscle Pain with passive stretching of involved muscle Weakness in movements controlled by involved muscle Deformity of muscle Ecchymosis Positive bowel sounds No distention No signs and symptoms of shock No signs of acute abdomen Abdominal Muscle Hematoma (Signs & Symptoms) Muscle guarding and tenderness Palpable mass in abdominal wall Point tenderness to direct palpation Pain with contractile movements of involved muscle Pain with passive stretching of involved muscle Weakness in movements controlled by involved muscle No signs of acute abdomen Non-traumatic abdominal injuries/conditions Appendicitis--Inflammation of the appendix, characterized by high fever, abdominal pain often localized in the right lower quadrant, nausea, vomiting, and anorexia. May be signs of acute abdomen. Dysmenorrhea--Pain associated with menstruation. Ectopic pregnancy--Implantation of a fertilized ovum outside of the uterine cavity. May be signs of acute abdomen if it ruptures. Gastroenteritis--Inflammation of the stomach and intestinal tract which is characterized by one or more of the following symptoms: nausea, vomiting, diarrhea. Usually due to viral infection, but can be bacterially induced. Hernia--Protrusion of abdominal viscera through a portion of the abdominal wall. Indigestion (heartburn)--Incomplete or imperfect digestion, usually accompanied by one or more of the following symptoms: pain, nausea, vomiting. Stitch in the side (sideache)--Sharp pain in the side usually associated with strenuous physical activity. May be caused by muscle spasm and/or trapped gas. Immediate Referral with the following signs and symptoms Difficulty in breathing Shortness of breath--inability to catch breath Severe pain increasing in chest Vomiting or coughing up blood Diminished chest movement on the affected side Shifting or moving of trachea with each breath Suspected rib fracture or costochondral separation Signs of shock Severe abdominal pain Signs of acute abdomen Rebound tenderness Rigidity Guarding Blood in the urine or stool Prolonged discomfort, sensation of weakness, or pulling in groin Superficial protrusion or palpable mass Increasing nausea Presence of fever Presence of radiating or referred pain Doubt regarding the nature and severity of the chest injury Throat, Chest, & Abdominal Injuries  Primary Survey _____ Airway _________________________________________________________________________ _____ Breathing _______________________________________________________________________ _____ Circulation______________________________________________________________________ Secondary Survey _____ History _________________________________________________________________________ _____ Mechanism of injury ____________________________________________________________ _____ Location of injury ______________________________________________________________ _____ Pain _________________________________________________________________________ _____ Sensations ____________________________________________________________________ _____ Progression of signs & symptoms __________________________________________________ _____ Observation _____________________________________________________________________ _____ Position & movements __________________________________________________________ _____ Respiratory rate & rhythm _______________________________________________________ _____ Symmetry ____________________________________________________________________ _____ Signs of trauma ________________________________________________________________ _____ Palpation _______________________________________________________________________ _____ Tenderness ___________________________________________________________________ _____ Deformities ___________________________________________________________________ _____ Swelling _____________________________________________________________________ _____ Crepitation ___________________________________________________________________ _____ Symmetry ____________________________________________________________________ _____ Muscle rigidity ________________________________________________________________ _____ Rebound tenderness ____________________________________________________________ _____ Stress __________________________________________________________________________ _____ Active range of motion __________________________________________________________ _____ Pain ______________________________________________________________________ _____ Range of motion _____________________________________________________________ _____ Iliopsoas test _______________________________________________________________ _____ Valsalva maneuver ___________________________________________________________ _____ Resistive movements ____________________________________________________________ _____ Sit-up _____________________________________________________________________ _____ Passive stress on rib cage ________________________________________________________ _____ Lateral compression __________________________________________________________ _____ Anterior/posterior compression _________________________________________________ _____ Heel pound test _____________________________________________________________ _____ Functional activities ____________________________________________________________ PAGE 5 PAGE 6  8b000<<<<<<<<<<<<<<<<< jU0JmH0J j0JU jUmH589HO_iab#7T & F  & F & F & F$89HO_iab#7T ¼xof]TK            F   f                         &                 Z(9Xjt 7 @ M w  & F & F & F & F & F Z(9Xjt 7 Ļ~wng^ULC      3                v                 =   T        i   u        7 @ M w  * y  ( 1 : w ¹~ule\SJA      ? 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