Dr. Martin's notes

Tuesday April 4, 2017

The Thoracic Cavity

The thorax is that portion of the body commonly known as the chest, which lies between the base of the neck and the diaphragm. It is contained within the thoracic vertebrae and the twelve pairs of ribs that give it its shape. Its main function is to protect the vital respiratory and circulatory organs and to assist the lungs in inspiration and expiration during the breathing process.

The questions asked to determine a history in the case of thoradc and abdominal injuries are somewhat different than those questions pertinent to musculoskeletal injuries of the extremities. The primary mechanism of injury should be determined first.
• What happened to cause this injury?
• Was there direct contact or a direct blow?
• What position were you in?
• What type of pain is there (sharp, dull, localized, etc.)?
• Was there immediate or gradual pain?
• Do you feel any pain other than in the area where the injury occurred?
• Have you had any difficulty breathing?
• Are certain positions more comfortable than others?
• Do you feel faint, lightheaded, or nauseous?
• Do you feel any pain in your chest?
• Did you hear or feel a pop or crack in your chest?
• Have you had any muscle spasms?
• Have you noticed any blood in your urine?
• Is there any difficulty or pain in urinating?
• Was the bladder full or empty?
• How long has it been since you have eaten?
If the athlete is observed immediately following injury, check for normal breathing and respiratory patterns.
• Most important, is the athlete breathing at all?
• Is the athlete having difficulty breathing deeply, or is the athlete struggling to catch the breath?
• Does breathing cause pain?
• Is the athlete holding the chest wall?
• Is there symmetry in movement of the chest during breathing?
• If the wind was knocked out, did normal breathing return rapidly or was there prolonged difficulty? This difficulty may indicate a more severe injury.
• What is the body position of the athlete?
• Is there protrusion or swelling of any portion of the abdomen? This may indicate internal bleeding.
• Does the thorax appear to be symmetrical? Rib fractures can cause one side to appear different.
• Are the abdominal muscles tight and guarding?
• Is the athlete holding or splinting a specific part of the abdomen?