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Thorax and Abdomen

12. Thorax and Abdomen. On-Field Assessment: Primary Survey. Observe surroundings and athlete. Establish consciousness. Check airway, breathing, and circulation. Assess vitals early (pulse, respirations, blood pressure). On-Field Assessment: Secondary Survey. History—note symptoms:.

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Thorax and Abdomen

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  1. 12 Thorax and Abdomen

  2. On-Field Assessment: Primary Survey Observe surroundings and athlete. Establish consciousness. Check airway, breathing, and circulation. Assess vitals early (pulse, respirations, blood pressure).

  3. On-Field Assessment: Secondary Survey History—note symptoms: Nausea Chest or abdominal pain Difficulty breathing Pain increase on inspiration Observation—note overall response: Pain Respiratory or cardiac distress Shock

  4. On-Field Assessment: Secondary Survey Palpate to assess potential structures involved: Chest wall (tenderness, deformity, swelling, asymmetry) Bony and soft tissue landmarks Abdomen (distension, guarding, rebound tenderness) Pulse

  5. Cardinal Signs of Internal Injury Decreased blood pressure Rapid and weak pulse Wet, white, and weak appearance Rapid and shallow respirations

  6. Sideline and Off-Field Assessment: History Chief complaint Mechanism of injury Onset, duration, and change in symptoms Pain profile Presence and location of referred pain (continued)

  7. Sideline and Off-Field Assessment: History Nausea, vomiting, difficulty breathing Presence of hematuria General health and previous injury history

  8. Sideline and Off-Field Assessment: Observation Response, position and posture Skin coloration and moisture Thorax (breathing pattern, signs of cardiac distress) Abdomen (rigidity, guarding, distension) (continued)

  9. Sideline and Off-Field Assessment: Observation Genitalia (swelling or abnormal appearance) Hematuria and hemoptysis Swelling, discoloration, lacerations, deformity, asymmetry Vital signs

  10. Sideline and Off-Field Assessment: Palpation Pulse Chest (tenderness, deformity, crepitus, asymmetry) Bony landmarks Soft tissue (continued)

  11. Sideline and Off-Field Assessment: Palpation Abdomen Muscle guarding Ridigity and distension Rebound tenderness Deep organ palpation (liver, spleen, kidney) Testicles (swelling, tenderness, masses, abnormalities)

  12. Abdominal quadrants anterior view posterior view

  13. Liver palpation

  14. Spleen palpation

  15. Anatomical position of the kidneys

  16. Kidney palpation

  17. Abdominal Sideline and Off-Field Assessment: Special Tests Anterior-posterior rib compression Lateral rib compression Auscultation (heart, lungs, bowel)

  18. Anterior-posterior rib compression

  19. Lateral rib compression

  20. Auscultation

  21. Sideline and Off-Field Assessment: ROM and Strength Range of motion Active for trunk, scapular, and shoulder motions Bilateral comparisons Strength Same motions as for ROM Note weaknesses and bilateral differences

  22. Sideline and Off-Field Assessment: Neurological Tests Neurological assessment is primarily sensory. Thoracic dermatomes Visceral pain referral patterns

  23. Functional Assessment Cardiorespiratory (aerobic exercise) Musculoskeletal (active sport-related movements) Reassess signs and symptoms during and after each functional activity.

  24. Follow-Up Assessment Signs and symptoms may not be present until hours or days postinjury. Ongoing follow-up care is important along with frequent evaluation and instruction.

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