Chapter 9: The Thorax and Abdomen

EDUCATIONAL OBJECTIVES

The learner should, at the completion of the chapter, be able to perform the following:

EVALUATION OF THORAX AND ABDOMEN

Thoracic and abdominal injuries are less common than extremity injuries. However, these injuries can be life threatening. In order to provide appropriate care, these injuries demand immediate evaluation and subsequent activation of the emergency medical system (EMS).

This chapter outlines general evaluation procedures used to assess thoracic and abdomen injuries. A slight deviation from the H.O.P.S. injury evaluation format is presented in this chapter. Specifically, the evaluation of thorax and abdomen must follow this precise assessment process: primary and secondary survey. Anatomical components of the thorax and abdomen, their function, specific conditions involving them, and the signs and symptoms usually revealed through evaluation are also presented. Common principles are shared and tests are demonstrated that can aid you, as an examiner, to better assess both acute trauma and non-traumatic conditions.

When thoracic injury is suspected, begin your evaluation with the primary survey. The primary survey assesses:

To conduct the primary survey, first survey the scene for indications of injury and approach your athlete in a calm and reassuring manner. In a conscious athlete, this enhances relaxation and maintenance of the respiratory and circulatory systems. With the primary survey, be prepared to clear and maintain the airway free of potential obstructions such as blood, vomitus, and foreign matter. Assist the patient in finding the most comfortable position for breathing. If necessary, be prepared to provide artificial ventilation or cardiopulmonary resuscitation (CPR) and to activate the emergency medical system.

Once your primary survey is completed and you determine the athlete's condition is non life-threatening, perform a secondary survey. The SECONDARY SURVEY consists of two elements.

The History is that part of the evaluation in which the examiner questions the athlete to determine: The Physical Examination is your next step. Remember, physical examination findings may vary tremendously from athlete to athlete, yet still be within a normal range. Factors such as physical activity and exercise may account for this variance. Some signs and symptoms that may vary are: respiratory rate; moistness, color and temperature of skin; pulse rate. Essential to the physical examination is the evaluation of these VITAL SIGNS: abnormal nerve response, blood pressure, movement, pulse, respiration, skin color, state of consciousness, and temperature.

Following determination of the vital signs, the Physical Examination then progresses to:

Inspection
Auscultation (listening for sounds)
Percussion (tapping)
Palpation and Special Tests During the Inspection stage of your physical examination, observe the following: Next, Auscultation is the process of listening for sounds produced in the thoracic and abdominal cavities. A stethoscope is usually used and auscultation is normally conducted by medical professionals with extensive training and experience in this complex skill. The specific techniques of auscultation are beyond the scope of this text. Auscultation determines: After completing auscultation, trained medical professionals usually perform percussion. Percussion involves tapping on various parts of the body and noting the sound produced. Percussion assists in determining the presence or absence of certain conditions. For percussion to yield informative results, extensive training and practice are required. Primarily, during percussion, medical professionals listen for normal/abnormal sounds such as tympany, dullness, or hyperresonance.

The performance of Palpation and Special Tests assists the health care professional in determining which specific anatomical structures have been injured and what appropriate medical treatment is needed. Palpation determines: general and specific areas of tenderness; location of deformities; location and extent of swelling; air crepitus (produced by air caught in subcutaneous tissue); bony crepitus (produced by the rough edges of fractured bones rubbing together); asymmetry; muscle rigidity; and abdominal rebound tenderness. Special tests aid in: evaluating active range of motion; resistance to movement in the different planes to elicit painful ranges and musculoskeletal weaknesses; evaluation of pain and dysfunction associated with inspiration and expiration; and passive stress on bony structures to assess possible fractures/separations. This area of the body is innervated by a number of different nerves. The sensory distribution of a nerve root is called a dermatome, which produces feeling in a certain anatomical area. The motor distribution of a group of muscles innervated by a single nerve root is called a mytome and it produces movement in anatomical structures.

The abdominal cavity is divided into these four quadrants: Right Upper Quadrant, Left Upper Quadrant, Right Lower Quadrant, and Left Lower Quadrant. When examining the abdomen, each quadrant should be auscultated, percussed, and palpated.

One of the most important functions of palpation is to determine signs and symptoms of an acute abdomen. These symptoms may be present due to the leakage of blood, puss, or bowel contents into the abdominal cavity causing peritoneal irritation.

Signs of an acute abdomen

Rebound Tenderness
Rigidity
Guarding
Rebound tenderness is identified by the examiner pressing deeply into the abdominal cavity and then quickly releasing, allowing the abdominal wall to rebound back to its original position. If this procedure is painful, peritoneal irritation may be present. Rigidity of the abdominal wall muscles occurs when peritoneal irritation causes reflex spasm of the abdominal muscles, producing a board-like hardness, thus preventing the examiner from performing deep palpation. Guarding occurs when the patient voluntarily tries to prevent the examiner from palpating the abdomen.

The Valsalva Maneuver is used to provoke an increase in pain or mass protrusion if significant intra-abdominal trauma has occurred.To perform the Valsalva Maneuver, have the athlete take a deep breath, hold their breath, and strain as if having a bowel movement. Any worsening of pain or mass protrusion through the abdominal wall is considered a positive test.

When evaluating Range of Motion, your assessment is divided into active, passive, and resistive motions and may be approached from the three anatomical planes of motion:

Visually note any apprehension, limited range, and painful arcs within each plane. While observing the range of motion, ask the athlete to state and describe the locations and qualities of any abnormal or painful sensations elicited by movement.

The Sagittal Plane motion assesses range of motion limitations and associated findings in the sagittal plane. To evaluate, the athlete stands and slowly flexes the trunk to the point where the hands touch the toes or the floor. Ask the athlete to slowly return from full trunk flexion to trunk extension.

The Frontal Plane motion assesses range of motion limitations and associated findings in the frontal plane. To evaluate, the athlete should stand, and than slowly, laterally flex the trunk to the right as far as possible. Then the athlete laterally flexes the trunk through the neutral standing position to the far left.

The Transverse Plane motion assesses range of motion limitations and associated findings in the transverse plane. To evaluate, the athlete stands and slowly rotates the trunk to the right as far as possible. This position is held and then slowly rotated to the extreme left.

The Inspiration and Expiration Tests assess inspiratory and expiratory function and elicit signs and symptoms of thoracic injury. Evaluate Inspiration and Expiration by having the athlete breathe in as much air as possible and hold for a few seconds. Then, ask the athlete to breathe out slowly and fully in an attempt to expire all air from the lungs. Instruct the athlete to hold the maximally expired position for a few seconds. During these breathing activities, observe any patient apprehension or limitations in the inspiratory movement as well as any display of associated pain. Question the patient regarding location and nature of any symptoms elicited by these procedures. Some specific signs or symptoms are:

Next, in assessing thoracic injuries, fractures and separations may occur in the bones and costal cartilages of the rib cage. If there is a complete separation or fracture, crepitus, grating, and popping sensations may be present with active and passive chest movements. In some cases passive stress may be applied to the rib cage to elicit and further appreciate these signs and symptoms. Again, use caution when examining the thorax as other associated internal injuries may exist. The two tests that should be performed to determine if rib cage and sternum fractures or separations exist are the Anterior/Posterior Chest Compression Test and Lateral Chest Compression Test.

These chest compression tests can help distinguish between muscle contusions/strains and loss of bony stability and integrity. The chest compression testing may be accomplished in the standing or sitting position. However, if the athlete is having complications, the supine and sidelying position may allow for better patient comfort and relaxation.

Anterior/Posterior Chest Compression Test assesses lateral rib cage bony integrity. To perform the anterior/posterior compression test, instruct the athlete to either sit or stand. You should place the palmar surface of one hand anteriorly on the chest wall at the level of the affected area. Place your other hand at the corresponding level posteriorly. Compress the rib cage by pushing your hands toward each other. This inward pressure anteriorly and posteriorly will cause the rib cage to bow outward laterally which will elicit pain and bony crepitis if the injury to the lateral rib cage is a fracture. However, if the injury is a contusion or muscle spasm, no pain or crepitis will be elicited.

The Lateral Chest Compression Test assesses anterior or posterior rib cage bony integrity. To perform the lateral compression test, instruct the patient to either sit or stand. Then, as the examiner, place the palmar surface of your hands laterally on the athlete's chest wall sides at the affected area level. Compress the rib cage by pushing your hands toward each other. This inward pressure from both sides will cause the rib cage to bow outward anteriorly and posteriorly. This inward pressure laterally will cause the rib cage to bow outward which will elicit pain and bony crepitis if the injury to the anterior/posterior lateral rib cage is a fracture. However, if the injury is a contusion or muscle spasm, no pain or crepitis will be elicited.

THORAX AND ABDOMEN ANATOMY

Bones

  1. Sternum
  2. Ribs (12)
  3. Thorax Vertebrae (12)
  4. Lumbar Vertebrae (5)
  5. Sacral Vertebrae (5)
  6. Coccyx Vertebrae (4 fused)
Muscles and Functions
  1. Pectoralis Major: pulls rib cage up; adducts arms; rotates arms medially; prime mover for arm flexion.
  2. Pectoralis Minor: draws scapula forward and downward; draws rib cage superiorly.
  3. Latissimus Dorsi: extends upper arm; adducts upper arm posteriorly
  4. External Intercostals: lifts the rib cage.
  5. Rectus Abdominis: flexes and rotates lumbar region.
  6. Internal Obliques: aids rectus abdominis; aids the back muscles in trunk rotation and lateral flexion.
  7. External Obliques: aids rectus abdominis; aids the back muscles in trunk rotation and lateral flexion.
  8. Transverse abdominis: compresses abdominal contents.
Anatomical Planes

Sagittal Plane: bisecting body into right and left halves

Transverse Plane: bisecting body into upper and lower halves

Frontal Plane: bisecting the body into front and back halves

Internal Organs

Thorax

Heart

Lungs

 Abdomen Right Upper (superior) Quadrant: liver and adrenal gland, gallbladder, pylorus of the stomach, head of pancreas, portion of colon, and small intestine. The right kidney is located posteriorly.

Left Upper (superior) Quadrant: stomach, spleen and adrenal gland, portion of the pancreas, portion of the colon, and small intestine. The left kidney is located posteriorly.

Right Lower (inferior) Quadrant: appendix, portion of the small and large intestines, portion of the colon, and structures of the urinary and reproductive systems.

Left Lower (inferior) Quadrant: portion of the small and large intestine, portion of the colon, and structures of the urinary and reproductive system

 Hollow Organs Stomach

Gall bladder

Urinary bladder

Intestines

Vessels

 Solid Organs Spleen

Liver

Kidneys

Abdominal Muscles
 
 

Dermatomes

 C4 - Upper chest across the clavicle

C5 - The skin and the lateral aspect of the arm over the insertion of the deltoid muscle.

C6 - The biceps muscle lateral to the base of the thumb.

C7 - The triceps muscle with distribution to the second and third fingers.

C8 - Intrinsic muscle with distribution to the fourth and fifth fingers.

T2 - Across upper chest above the nipples.

T3 - Across upper chest above the nipples.

T4 - At the nipples.

T5 - Across the abdomen.

T6 - Across the abdomen.

T7 - Across the sternal notch.

T8 - Across the abdomen, supplies motor function for abdominal muscle contraction.

T9 - Across the abdomen; supplies motor function for abdominal muscle contraction.

T10 - Umbilicus.

T11 - Below Umbilicus.

T12 - Just below groin.

Myotomes

C4 - Shoulder Shrugs

C5 - Abduction Test of the Arms

C6 - Wrist Extension

C7 - Triceps (Extension)

C8 - Finger Flexion

T1 - Finger Abduction

T2 - T 10: Thorax/Abdominal Muscle Contractions

L1 - Hip Extension and Adduction

L2 - Hip Flexion

L3 - Knee Extension

L4 - Dorsiflexion of ankle

L5 - Toe extension

S1 - Plantar flexion of ankle or Hamstring Curl, foot eversion, hip extension

S2 - Dorsiflexion of foot

When testing, resistive technique should be used to determine strength of myotome.

ASSESSMENT TESTS

All injured anatomical structures should be properly evaluated. The purpose of a thorough evaluation is to enable the allied health professional to properly assess the severity of the injury and to make recommendations regarding medical treatment and possible return to participation. Listed below is a review of evaluation techniques utilized by physician and certified athletic trainer.

Tests for Bony Integrity

Palpation: physical inspection
Compression: inward force applied to thorax and ribs through inspiration and manual pressure.
Distraction: outward force applied to thorax and ribs through expiration.

Compression Tests: Thorax/Ribs

Anterior/Posterior and Lateral: compression force applied to thorax and ribs through manual pressure.

Compression Tests: Pelvis

Anterior/Posterior and Medial/Lateral: compression force applied to pelvis through manual pressure.

Breathing

Inspiration: action of taking a breath (inhaling)
Expiration: action of releasing a breath (exhaling)

Range of Motion: Torso

Flexion: moving the torso forward in the sagittal plane, the athlete stands and slowly flexes the trunk to the point where the hands touch the toes or the floor.
Extension: moving the torso backward in the sagittal plane, the athlete stands and slowly flexes the trunk to the point where the hands touch the toes or the floor. Lateral Flexion: moving the torso laterally in the frontal plane, the athlete should stand and slowly, laterally flex the trunk to the right as far as possible. Then, the athlete laterally flexes the trunk through the neutral standing position to the far left.
Rotation: rotating the torso in the transverse plane, the athlete stands and slowly rotates the trunk to the right as far as possible, then slowly rotates to the extreme left.

Signs of Acute Abdomen

Rebound Tenderness: pain in the abdomen upon the release of pressure from the abdomen.
Rigidity: upon palpation, abdomen is rigid or hard and not fully palpable.
Guarding: patient contracts muscles while palpating so that the palpation does not hurt.

Tests to Detect Possible Peritoneal Irritation (intra-abdominal pressure)

Iliopsoas Test: moving leg into hip flexion, which causes abdomen pain.
Obturator Test: with hip and knee in 90 degree flexion, internal and external rotation of hip will cause abdomen pain.
Heel Pound Test: with hip and knee in full extension, tap heel to increase pain in abdomen
Valsalva Maneuver: athlete take a deep breath, hold their breath, and strain as if having a bowel movement.

IMMEDIATE REFERRAL IS NECESSARY IF THE FOLLOWING SIGNS AND SYMPTOMS ARE PRESENT IN A THORACIC AND/OR ABDOMINAL ASSESSMENT.

COMMON INJURIES: THORAX

Acute traumatic injuries occurring to the thorax may involve the heart, lungs, and rib cage. Remember, evaluation of such injuries require current First Aid and C.P.R. certification. As an allied health professional, it is essential that you are trained in current basic life support techniques.

The Heart is located in the center of the thoracic cavity and positioned slightly to the left. The heart pumps oxygenated blood from the heart to the body and de-oxygenated blood from itself to the lungs. One of the more common conditions involving the heart is a myocardial infarction, commonly referred to as a heart attack. Myocardial Infarctionis ischemia (decrease in oxygenated blood flow) to cardiac tissue which may result in a disturbance of normal heart function characterized by arrhythmia.

Signs and Symptoms of Myocardial Infarction:

As an allied health professional you should be aware of other conditions involving the heart including cardiac contusions and pericardial tamponade (compression of the heart). These conditions occur quite rarely but the results can be catastrophic, particularly if they are not immediately recognized and appropriately managed. Cardiac contusions result from a direct blow to the anterior chest wall in the heart region. Blunt trauma to the anterior chest wall may cause pericardial tamponade. With pericardial tamponade, bleeding accumulates inside the pericardial sac and will gradually increase, causing external pressure on the heart, thereby preventing proper contraction.

The Lungs, located in the thoracic cavity and protected by the rib cage, are formed by a network of branching tubes and air sacs. This network provides respiration whereby the blood from the body is re-oxygenated. A Pneumothorax occurs either spontaneously or traumatically from blunt or sharp trauma to the chest wall. Pneumothorax is characterized by air accumulation in the pleural space. The air escapes from the lung upon each inspiration, collects in the pleural space and eventually results in lung collapse. Spontaneous, traumatic, and tension pneumothorax signs and symptoms should be explored with your patient. Another serious lung condition, Hemothorax, results when blood accumulates in the pleural space.

Thoracic related bony and joint injuries can occur to the rib cage structure. The Rib Cage outlines the thoracic borders and provides protection to the heart, lungs, great vessels (aorta and vena cava), liver, and spleen. Its ability to expand and relax is essential in assisting the lungs' respiratory function. Other than contusions and strains, rib fractures are the most common injuries seen in the thoracic area. Nondisplaced fractures are usually benign; however, displaced fractures may result in lacerations to the lung and associated intercostal vessels. You should remember the following about rib fractures:

non-displaced are the most common; displaced rib fractures may result in laceration of the lung or an associated intercostal vessel; injuries usually involve the 5th to 9th ribs; tremendous forces are necessary to fracture the 1st and 2nd ribs; and fracture of the 7th through 12th ribs may be associated with liver, spleen, or kidney injuries.

The signs and symptoms of rib fractures are:

There are other conditions related to the thoracic cavity, which, as a health professional, you should be aware of and learn more about. Respiratory conditions related to the thoracic cavity are common. Following are some conditions and brief definitions. Asthma: an inflammatory respiratory condition characterized by bronchospasm (wheezing) and shortness of breath (dyspnea). Asthma may be exercise induced.

Bronchitis: inflammation of the bronchial tubes. Bronchitis is usually characterized by a progressive cough.

Hemoptysis: expectoration of blood arising from the lungs (patient's coughing up blood or blood-stained sputum).

Hyperventilation: increase in respiratory rate usually associated with anxiety which causes a change in the acid-base balance of the blood. Symptoms include dyspnea and numbness and tingling in the hands, fingers, and around the mouth.

Influenza: a viral illness characterized as an acute onset of fatigue, muscle ache, headache, and fever; usually lasts one to two weeks.

Pleuritic chest wall pain: inflammation of the serous membrane lining, which lies between the lung and chest wall, causing pain with inspiration and 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.

 COMMON INJURIES: ABDOMEN

The abdominal cavity is divided into these four quadrants: Right Upper Quadrant, Left Upper Quadrant, Right Lower Quadrant, and Left Lower Quadrant. When examining the abdomen, each quadrant should be auscultated, percussed, and palpated. One of the most important functions of palpation is to determine signs and symptoms of an acute abdomen which are rebound tenderness, rigidity, and guarding. Additionally, a positive valsalva manuever could indicate significant intra-abdominal trauma has occurred.

The Spleen is the body's largest lymphatic organ and is located in the left upper quadrant, directly below the diaphragm and behind the 9th, 10th, and 11th ribs. It serves as a reservoir of red blood cells and regulates the number of red blood cells in circulation. The spleen also destroys old or defective red blood cells and produces white blood cells. Signs and symptoms of spleen injury are:

The Liver is located in the right upper quadrant with a small porton found in the left upper quadrant. It is a solid organ with a variety of functions including manufacturing of plasma proteins, manufacturing and storage of blood cells, removal of old or defective red blood cells, breakdown of toxic substance, glucose and fat metabolism, mineral and vitamin storage, and bile production. Signs and symptoms of acute liver injury are: The Kidneys are paired solid, bean-shaped organs located in both the right and left upper quadrants near the spine. The kidneys function to help control blood volume. They also remove waste from the blood in the form of urine. Signs and symptoms of kidney injury are: Although all abdominal injuries can be life-threatening, some are classified as non-traumatic. Non-traumatic injuries/conditions of the abdomen include:

Appendicitis--Inflammation of the appendix. Generally affects the young and is more common in males. Appendicitis is characterized by high fever, signs of acute abdominal pain often localized in the right lower quadrant, nausea, vomiting, and anorexia.

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, usually caused by muscle spasm and/or trapped gas.

REHABILITATION

Before sending an athlete back to competition, the following rehabilitation guidelines must be met:

The sports medicine team should design the athletes comprehensive rehabilitation program. A list of suggested rehabilitation exercises are outlined.
 
 

Range Of Motion Exercises Torso

Flexion
Extension
Lateral Flexion
Rotation

Anatomical Plane Movement

Sagittal
Frontal
Transverse

Thorax and Abdomen Exercises

Abdominal Crunches
Abdominal Lift
Abdominal Sit-up/Curl-ups
Arm Extension
Arm Flexion
Bench Press
Incline Press
Pelvic Tilts
Prone Extension
Prone Push-up

Included in any rehabilitation protocol are the following:

PREVENTIVE/SUPPORTIVE TECHNIQUES

Whether to apply adhesive and/or elastic bandages to an uninjured anatomical structure is a decision the certified athletic trainer will have to make. All injured joints should be supported initially. Here is an outline of taping and wrapping techniques:

Wrapping Techniques for Support

Hip Flexor
Hip Adductor
Glenohumeral

Taping Techniques for the Hip

Hip Pointer

Taping Techniques for the Thorax and Low Back

Rib
Low Back

Taping Techniques for the Shoulder

Acromioclavicular Joint
Glenohumeral Joint

PROTECTIVE DEVICES

The use of protective devices is beneficial, if they are properly selected, used in the appropriate setting, correctly fitted, properly applied, and used within the rules and guidelines of the specific sport. Consultation with a equipment specialist and certified athletic trainer is highly encouraged. Listed below are various protective devices that are commercially available to use as an adjunct or replacement to a taping or wrapping procedures.

MUSCULOSKELETAL CONDITIONS/DISORDERS

Listed below are conditions/disorders that affect the thorax and abdomen. Using a medical dictionary, review and define these conditions/disorders.

Thorax

Abdomen
REFERENCES

American Red Cross (1996) Responding to Emergencies (2nd ed.). St. Louis: Mosby Lifeline.

Anderson M. and Hall S. (1995) Sports Injury Management Baltimore: Williams and Wilkins.

Booher, J. & Thibodeau, G. (1994). Athletic Injury Assessment. St. Louis: Times Mirror/Mosby College.

Daniels, Lucille and Worthingham, Catherine. Muscle Testing: Techniques of Manual Examination. Philadelphia: W.B. Saunders, 5th ed., 1986.

Donnelly, J. (1990) Living Anatomy Champaign, Human Kinetics

Gallaspy J. and May D. (1995) Signs and Symptoms of Athletic Injuries St. Louis: Mosby.

Hafen, B. (1994) First Aid for Health Emergencies. (4th ed.) St. Paul, MN: West Publishing.

Harrelson G. & Andrews J. (1993) Physical Rehabilitation of the Injured Athlete Philadeplhia: W.B. Saunders

Hoppenfield, S. (1976) Physical Examination of the Spine and Extremities New York: Appleton, Century, and Crofts.

Kissane, J. (1990) Anderson's Pathology (vol 1, 9th ed.) St. Louis: Mosby.

Mellion, M., Walsh, W. & Shelton, G. (1992) The Team Physician's Handbook. Philadelphia: Hanley & Belfus.

Mueller, F. and Ryan, A. (1991) Prevention of Athletic Injuries: The Role of the Sports Medicine Team. Philadelphia: F.A. Davis.

NATA Research Foundation (1997) Sudden Death in Athletes: The preparticipation physical examination and non-traumatic cardiovascular. Dallas: NATA Research
Foundation.

Norkin & White (1985) Measurement of Joint Motion: A Guide to Goniometry Philadelphia: F.A. Davis Co..

Parcel, G. (1990) Basic Emergency Care of the Sick and Injured. (4th ed.) St. Louis: Mosby.

Porth, C. (1994) Pathophysiology. Philadelphia: Lippincott.

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Williams, P. & Warwick, R. (1980) Gray's Anatomy (36th ed.) Philadelphia: W.B. Saunders.

Wright K. & Whitehill W. (1996) The Comprehensive Manual of Taping and Wrapping Techniques Gardner: Cramer Products

Wright, K, Harrelson, G. Fincher L & Floyd, R. (1996) Sports Medicine Evaluation Series: Thorax Dubuque: McGraw Hill.

Wright, K, Harrelson, G. Fincher L & Floyd, R. (1996) Sports Medicine Evaluation Series: Abdomen Dubuque: McGraw Hill.

Wright K. & Whitehill W. (1997) Sports Medicine Taping Series: Knee Dubuque, : McGraw Hill.

 
Chapter 9 - Review Questions
 Completion: 1. __________/__________ __________ test and __________ __________ test can differentiate between a contusion/muscle spasm injury and possible rib fracture.

2. Inflammation of the bronchial tubes and is usually characterized by a progressive cough is _____.

3. A myocardial infarction is commonly referred to as a ____________ ____________ .

4. A heart rate over 100 beats per minute in adults is commonly a disorder known as ___.

5. Traumatic injuries to the thorax may involve the ____________ , ____________ , and ____________ .

 Short Answer:

1. Define the two respiratory conditions found in many athletes.

2. Name the four quadrants of the abdominal cavity and a specific organ of concern in each.

3. List vital signs:

4. What are the three elements for auscultation assessment?

5. Name the signs of acute abdominal injury.

6. What is the primary survey for a thoracic injury?

7. What does the secondary survey consist of?

8. What are the signs and symptoms that are revealed in your abdominal assessment for immediate referral?

9. What are the signs and symptoms of myocardial infraction?

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