Thoracic Injuries New

Thoracic Injuries
Dr. syed basit ali shah

Thoracic Injuries
• Thoracic injuries are uncommon
• rigid ribs cage;
• It requires high energy and velocities;
• Protective padding by the athletes
 however if happen proper assessment is imperative to identify early sign
and symptoms of thoracic injuries;
Assessment
• A systematic approach must be followed to ensure that nothing is overlooked.
• First, observe the athlete’s general appearance while determining his or her
level of consciousness and evaluating the ABCs (airway, breathing, circulation).
• Take immediate action to correct any life threatening condition as it is found.
• Thorough, efficient and focused assessment on mechanism of injury;
• Asking the athlete the proper questions may be valuable in rapidly identifying the
injury.
• More chronic onset is more threatening, especially if the mechanism of injury is
unknown.
• General observation of the athlete should continue while obtaining the history
• Dyspnea may not be present in all cases of respiratory injury, but it is
present in most cases;
• Any athlete with difficulty breathing and who is unable to speak in full
sentences needs emergent referral to a hospital.
• The mental status of the athlete is also important to determine because
alterations in mental status are the first signs of hypoxia
1- Inspection
• In evaluating the quality of respirations be alert for the following:

• Nasal flaring,
• tracheal tugging
• Both indicate difficulty in breathing;
• Also observe cyanosis which is the indication of late sign of hypoxia;
• Vital signs are measured, including blood pressure, pulse oximetry, pulse rate and
quality, skin color and temperature, and quality and frequency of respirations;
Tracheal Tugging
2- Auscultation
Adventitious lungs sound
3- Palpation
• Palpate the chest by gently placing hands on the rib cage and feel for the
rise and fall during breathing;
• It should be equal in motion, rate, and rhythm.;
• Palpate the bony structures, looking for deformity of the ribs, unstable
segments, and congruency of the sternoclavicular and costosternal joints;
• Also, the presence of swelling, crepitus, or crackling of subcutaneous
emphysema (air under the skin) should be noted.
• The presence of subcutaneous emphysema is indicative of air escaping from
the respiratory system and is a serious sign.
• Pain elicited by compressing the thorax front to back or inward from the
sides indicates the possibility of a fracture to the ribs.
4- Percussion
• Evaluate either the sound is normal, hyperresonant or dull;

• These sounds indicates the density of underlying tissue;
• If the result is a resonant sound equal bilaterally, then it should be
considered normal.
• A hyperresonant or echoing response is indicative of excessive air
accumulating in the thorax as would be present in the case of a
pneumothorax;
• Dull sound is the indication of hemothorax or pleural effusion;
• Alignment of the trachea in the midline of the throat should also be
observed;
• Intercostal or suprasternal retraction or distention of the jugular veins,
indicative of a tension pneumothorax.
• In the case of an open wound it is important to determine if air movement in
and out of the wound is present.
• This would be indicative of an open pneumothorax and should be addressed
immediately.
Management
• When caring for an athlete with a potentially significant injury to the thorax
all treatment should be focused on maintaining adequate oxygenation for
the athlete;
• High-flow
• Supplemental oxygen should be administered to any athlete complaining of
difficulty breathing no matter what the underlying pathology.
• A common misconception is that people with chronic obstructive
pulmonary disease (COPD) will stop breathing if given high-flow oxygen
• Serious injuries to the thorax are life threatening, early recognition,
constant evaluation, and administration of oxygen is the part of athletic
trainer/ PT jobs.
• Prehospital treatment by paramedics may include intravenous
administration of fluid for shock and endotracheal intubation for severe
respiratory distress.
Ribs fracture
• The mechanism of injury for rib fractures in athletics is primarily either direct or indirect
force;
• Example of indirect force is an athlete may suffer an anterior rib fracture as a result of a
blow to the back;
• Fractures of ribs 10 through 12 may injure abdominal organs such as the liver or spleen,
whereas upper rib fractures may injure the lungs.
• Rib fractures present with localized pain that increases on compression of the rib cage.
• Crepitus at the fracture site may also be felt with deep inspiration. Respiratory effort is
limited because of pain, which typically prevents the athlete from being able to take a full
breath
• Although painful, a single rib fracture with no internal injury does not constitute an
emergency and can be treated with rest, ice, and medication for pain. X-rays are required
for a definitive diagnosis.
Pneumothorax: Simple, Tension, Open
• A Simple pneumothorax is defined as air between the parietal and visceral

pleurae..
• Air entry into the pleural space causes the lung to collapse as a result of the
pressure imbalance that develop;
• A simple pneumothorax may be spontaneous or result from trauma.
• A spontaneous pneumothorax may be seen in young, tall, thin males.
• The athlete will present with a sudden onset of a sharp chest pain and
difficulty breathing after exercising, strenuous coughing, or even air travel.
Treatment
• Treatment of a simple pneumothorax is based on the severity of the
symptoms. If marked respiratory distress is noted and tachycardia or
hypotension is present, then rapid chest decompression may be required.
• Placement of a chest tube at the hospital is the definitive treatment for any
pneumothorax greater than 15% of normal lung volume, associated rib
fracture, or significant dyspnea.
• For a stable athlete without breathing difficulty and whose vital signs are
within normal limits, transportation to a medical facility in a position of
comfort with continual monitoring is acceptable.
Tension pneumothorax
• A pneumothorax that expands to the point where it compresses on the
aorta, heart, and superior and inferior vena cava is called a tension
pneumothorax and is a life-threatening injury ;
• Because of a buildup of pressure, the mediastinum and trachea are pushed
away from the affected side.
• Compression of the superior vena cava results in jugular vein distension,
whereas compression of the aorta and heart decreases cardiac output and
results in both a drop in blood pressure and an altered mental status
Open Pneumothorax
• An opening in the chest wall that allows air to enter the pleural space is an
open pneumothorax (Fig. 11-11).
• The severity of this condition is dependent on the size of the opening in the
chest wall and the causative agent such as a bullet, knife, or javelin.
• If the wound is the result of an assault, athletic trainers must first ensure
their own safety by determining the location of the assailant and calling for
police and EMS before treating the injured.
Hemothorax
• Blood entering the pleural cavity results in a hemothorax, and the
mechanism is the same as a pneumothorax .
• As more blood is accumulated, there is less room for the lung and eventually
the lung is unable to function. If the lungs become compromised, the
athlete will develop dyspnea and chest pain and the jugular veins will
become distended.
• Symptoms of a hemothorax are the same as for a pneumothorax except
percussion will produce a dull hyporesonant sound.
Treatment
• Effective treatment of a hemothorax includes oxygen supplementation and

respiratory support.
• Intravenous fluid resuscitation is undertaken with great care because an
overload of fluid may result in significant pulmonary edema and difficulty in
ventilation during the hospital course of treatment.
• Adequate oxygenation and ventilation will most likely require endotracheal
intubation and positive pressure ventilation.
• Rapid transport to a trauma center is essential

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Thoracic Injuries

Dr. syed basit ali shah

• In evaluating the quality of respirations be alert for the following:

• Evaluate either the sound is normal, hyperresonant or dull;

• A Simple pneumothorax is defined as air between the parietal and visceral

• Effective treatment of a hemothorax includes oxygen supplementation and

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