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Internal Injuries - ThoraxRib Contusion:Cause:__________________________________________________________________________Signs and SymptomsPainful breathing (particularly if muscles are involved)___________________________; pain with rib __________________________Management______________ and NSAID’s_______________________________________________Rib Fractures:Cause:______________________________________________________________________________Can be caused by violent coughing and sneezingA flail chest is one where 3+ consecutive ribs are fracturedSigns and Symptoms___________________ is critically important______________________________________________________________________________Management______________________________________________________________; braceCostochondral Separation:Cause:______________________________________________________________________________Signs and SymptomsLocalized pain in region of ____________________________________________________________________________________________________; difficulty with breathingPoint tenderness and possible deformityManagement_________________________________________________________________Healing may take ____________________________Sternum Fractures:Cause:_____________________________________________________________________________May also cause contusion to underlying cardiac muscleSigns and Symptoms___________________________________ over the _____________________Pain with ________________________________________________________________Signs of shock, or ______________________________ may indicate more severe injuriesManagement_____________________________________________________________________________Muscle Injuries:Cause:_____________________________________________________________________________Occur most often from ____________________ or sudden ______________________________Signs and SymptomsPain occurs on active motions; pain with inspiration and expiration, coughing, sneezing and laughingManagement______________________________________________________________________________After hemorrhaging is controlled, immobilize the injury to make the patient comfortableBreast Injury:Cause:______________________________________________ (particularly in large breasted women)Stretching of ___________________________________Runner’s and cyclist’s nippleManagementFemales should wear well-designed bra that has minimum elasticity and allows for little movementSpecial plastic cup-type brassieres may be required in sports with high levels of physical contactUse of an adhesive bandage can be used to prevent runner’s nippleWearing a windbreaker can prevent cyclist nippleLung Injuries:Cause:_____________________________ - _____________________ becomes filled with ______, negatively pressurizing the cavity, causing a _________________________________Will produce _____________________________________________________________________________________________________________________ on one side fills with _______________________________, compressing the _____________________________May cause shortness of breath, chest pain, absence of breath sounds, cyanosis, distention of neck veins, deviated trachea_____________________________________________________________________ causes tearing or puncturing of the lungs or pleural tissuePainful breathing, dyspnea, coughing up frothy blood and signs of shock______________________________________Result of a ____________________________________________________Causes ____________________________________________Signs include purple discoloration of the trunk and head, conjunctivas of the eyeCondition requires immediate mouth to mouth resuscitationManagementEach of these conditions are medical emergencies and require immediate attention________________________________________________________Hyperventilation:Cause:Rapid rate of ventilation due to __________________________________________________________________________________________________________________________________Signs and SymptomsPatient has difficulty getting air in and seems to struggle with breathingPanic state with _____________________________________________Management___________________________________________________________Slow respiration rate and alter respiration techniques___________________________________________________________Normal respiration should return within 1-2 minutes, initial cause must be determinedSudden Cardiac Syndrome in Athletes:Cause:____________________________- thickening of cardiac muscle w/ no increase in chamber sizeAnomalous origin of coronary arteries__________________- abnormality in connective tissue results in weakening of aorta and cardiac vesselsSeries of additional cardiac causes___________________________________________________________________Right ventricular dysplasia; cardiac conduction abnormalities; aortic stenosisWolf-Parkinson-White syndrome____________________________________________________________________________________________________________________________________________________________Signs and Symptoms______________________________________________________________________________May exhibit chest pain, heart palpitations, syncope, nausea, profuse sweating, shortness of breath, malaise and/or feverManagement/PreventionCounseling and screening are critical in early identification and prevention of sudden deathScreening questions should address the following__________________________________________________________________________________________________________________________________________________________________________________________________Thickening of heart or history of Marfan’s syndromeCardiac screening - electrocardiograms and echocardiogramsHeart Murmur:Cause:_____________________________________________________________________________________________________________ = no organic heart dysfunctionForceful blood flow (high cardiac output) through healthy valves___________________________________ = blood flow through damaged valve________________________ – can lead to infective endocarditis or aortic regurgitation_______________________________ – narrowing due to scarring from infections (rheumatic fever); if untreated could result in heart failure_________________________ – scarring and thickening of aortic valve due to arthrosclerosis; tends not to be dangerousSigns and Symptoms____________________________________________ (clicking, whooshing, swishing)Abnormal murmurs could result in symptoms of other heart problemsManagement_______________________________________________________Mitral valve prolapse and innocent murmurs don’t require additional managementOthers will require medication to reduce chance of infection, prevent clots, control irregular beats, control heart beat/fluttering, relax dilated vessels______________________________________________________________________Athletic Heart Syndrome:Cause:Structural and functional heart changes due to greater than one hour on most daysResults in increased left ventricle mass, diastolic capacity dimension, wall thickness_________________________________ = low resting heart rate & longer diastolic filling timeSystolic and diastolic function remain normalSigns and Symptoms______________________________________________________________May exhibit bradycardia, systolic murmur, extra heart sounds with ECG abnormalities being commonManagementIf serious cardiac conditions are ruled out – no treatment necessaryCommotio Cordis:Cause:__________________________________________________________________________Unfortunate timing relative to re-polarization phase of cardiac cycle________________________________________________________________________Signs and Symptoms__________________________________________________________________Management____________________________________________________________________Early defibrillation with ________________ and resuscitation is _________________Heart Contusion:Cause:___________________________________________________________________________Most severe consequence would involve an ___________________________________Signs and Symptoms_______________________________________________Heart may exhibit arrhythmias causing a _____________ in cardiac output, followed by _____________ if medical attention is not administeredManagement____________________________________________________________________Prepare to administer __________________ and treat for _______________________Internal Injuries – AbdomenKidney Contusion:Cause:Result of an ____________________________Susceptible to injury due to normal distention of bloodSigns and SymptomsMay display signs of shock, nausea, vomiting, rigidity of back muscles and hematuria (blood in urine)_____________________ (costovertebral angle posteriorly radiating forward around the trunk)Management____________________________________________________________________________Surgery required if hemorrhage fails to stop____________________________________________________________________________Monitor status of urine (hematuria) - refer if necessary_______________ hospitalization and observation with a gradual increase in fluid intake _______________ of rest and close surveillance following initial return to activity is necessaryKidney Stones:Cause:Unknown causeMay be small (grain of sand), large (marble-size), smooth, or jaggedMay remain in kidney causing blockage and pressure in renal systemIf breaks free and travels through urinary tract it is very painfulSigns and Symptoms____________________________________________________________________________ _______________________________________________________________________________________________________________________________________Cool, clammy, pale and sweaty skinBurning with frequent urination (possible blood in urineManagement__________________________________________________________________________________________________In 80-85% of cases smaller stones move through ureter and drops into bladder, coming out in urine____________________________________________________________________________Contusions of the Ureter, Bladder, & Urethra:Cause:______________________ to the lower abdomen may avulse ureter or contuse/rupture bladder______________ is often associated with contusion of bladder during running (runner’s bladder)Injury to the urethra (more common in males) may produce severe perineal pain and swellingSigns and SymptomsPain, discomfort of lower abdominal region, abdominal rigidity, nausea, vomiting, shock, bleeding from the urethra, increased quantity of bloody urine, _______________________________________________________________________________________________________ to low back and trunk as well as upper thigh region anteriorly and suprapubically Prevention____________________________________________________________________________________________________________________________________________________________________________________________________________________________________Cysts & Urinary Tract Infections:Cause:Inflammation of the bladder associated with a urinary tract infection (bacteria-related)Occurs due to incorrectly wiping following bowel movement, rough sexual intercourse or activities that push bacteria into bladderOccurs most often in sexually active females ages 20-50; rarely occurs in men with normal urinary tractsSigns & Symptoms____________________________________________________________________________Burning sensation with urination; passing small amounts of urine, blood in urine, passing cloudy or strong smelling urine____________________________________________________________________________Management__________________________________________Symptoms usually subside within a few days____________________________________________________________________________________________ due to potential infection fighting propertiesPracticing sanitary bowel and bladder habitsWashing genitals before intercourse and emptying bladder afterImmediately removing contraceptive diaphragms after intercourseUrethritus:Cause:Inflammation of the urethra caused by gonorrhea, chlamydia, herpes virus, or bacterial infection_____________________________________________________________________________Signs & Symptoms_____________________________________________________________________________Itching, tenderness or swelling in penis; pain with intercourse; ulcers on genitals; blood in urine or semenIf it spreads to other organs there may be back or abdominal pain, fever, nausea or swollen jointsManagement_____________________________________________________________________________Internal Injuries – Digestive SystemGastrointestinal Bleeding:Cause:Distance running, _______________________, ________________________, ingestion of aspirin or NSAID’s, __________________, bowel irritation, _________________Signs and symptoms____________________________________________Abdominal pain, watery stool (w/pus) dehydration, intermittent fever (if colitis is involved)Management__________________________________________________________Liver Contusion:Cause:__________________________________________________________________________________________________________________________________Signs and SymptomsHemorrhaging and shock may present__________________________________________________________________Presents with referred pain in right scapula, shoulder and sub-sternal area and occasionally in left anterior side of chestManagement___________________________________________________________________________Appendicitis:Cause:____________________________________________________________________________________________________________________________________________________________Early stages it presents as a gastric complaint, that gradually develops from red swollen vessel to a gangrenous structure that can rupture into bowels causing peritonitisSigns and Symptoms_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ManagementSurgical intervention is often necessary (particularly if it is resulting in an obstructed bowel = life threatening)Internal Injuries – Lymphatic Organs & Abdominal WallInjury of the Spleen:Cause:____________________________________________________________________________Signs and SymptomsIndications of a ruptured spleen involve history of a direct blow, signs of shock, abdominal rigidity, nausea, vomiting________________________ManagementConservative treatment involves 1 wk of hospitalization and a gradual return to activitySurgery will result in three months of recovery while removal of spleen will result in a 6 month removal from activityAbdominal Muscle Strain:Cause:______________________________________________________________________________Signs and Symptoms____________________________________________________________________________________________________________________________________________________________ManagementIce and compression with conservative treatment____________________________________________________________________Contusions of Abdominal Wall:Cause:______________________________________________________________________________Extent of injury depends on whether force is blunt or penetratingSigns and SymptomsMay cause a hematoma to develop under fascia of surrounding muscle tissue_____________________________________________________________________________Management_____________________________________________________________________________Be sure to check for signs of internal injuriesHernia:Cause:____________________________________________________________________________________________________________________________________________________________Complications and strangulated herniasSigns and SymptomsAcquired hernia occur when natural weakness is further aggravated by a direct blow or strainHistory of direct blow to groin area, pain and prolonged discomfort, superficial protrusion with pain increasing with coughing & reported pulling sensation in groin areaManagement____________________________________________________________________Blow to Solar Plexus:Cause:___________________________________________________________________________Signs and Symptoms___________________________________________________________________________Generally transitoryManagementMust help athlete overcome apprehensionUse short inspirations and long expirations____________________________________________________________________________Athletic trainer should question possibility of internal injury ................
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