ch 23 - Throat, thorax, and visceral conditions
causes of uric acid stones
diet high in meat and chemotherapy
pulsus paradoxus
drop in blood pressure >10 mmHg with inspiration
microalbuminuria
early sign of renal disease involving the presence of albumin in the urine in amounts greater than expected but too low to be detected by dipstick testing
three components of the sternum
manubrium, body, and xiphoid process
costochondral sprain
- separation of cartilage at attachment to rib/sternum caused by collision forces or twisting of the thorax
side stitches
- sharp pain/spasm in lower chest wall during exertion - can be caused by trapped gases, localized hypoxia, liver congestion, and poor conditioning - tx: regulate breathing, lean away from affected side, and stretch the arm of the affected side
indirect hernias
- weakness in the peritoneum around the deep inguinal ring allows the abdominal viscera to protrude through the ring into the inguinal canal and occasionally extend into the scrotum - large indirect hernias may reduce spontaneously because they cannot extend easily into the inguinal canal
tension pneumothorax
-air accumulates in pleural space during inspiration and cannot escape on exhalation; expansion compresses heart and lung - chest pain, tracheal deviation, respiratory distress, distention of neck veins, hypotension, circulatory compromise - activate EMS
abdominal red flags
- abdominal pain - nausea - thirst - localized tenderness and rigidity - cramps or muscle guarding - rebound pain -referred pain - shallow breathing; rapid, weak pulse; decreased BP - coughing up blood
pneumothorax
- air trapped in pleural space causing lung to collapse - can result from traumatic or spontaneous episodes - symptoms include: shortness of breath, chest pain, deviation of trachea, confusion, fatigue, referred pain, and altered chest sounds - activate EMS and keep patient calm
causes for false-positives when testing urine
- alkaline urine - dipstick immersed too long - highly concentrated urine - gross hematuria - presence of penicillin/other medicines - presence of pus, semen, or vaginal secretions
non-traumatic renal hematuria
- also called athletic pseudoneohritis - decreased renal blood flow leading to ischemia
rib fractures
- can be stress fractures or compression fractures - usually caused by indirect forces - listen for abnormal/absent breathing sounds
pulmonary contusions
- caused by non-penetrating chest trauma (body slam on ground) - blood and protein leak into alveoli and interstitial spaces leading to pulmonary collapse - mild cases can heal 2-10 days - severe cases require hospitalization and ventilator
blunt scrotal trauma
- damage to testes - causes nausea and pain - immediate internal hemorrhage, effusion, and muscle spasm, can lead to contusion, hematoma, torsion, dislocation, or rupture
traumatic asphyxia
- direct, massive trauma to thorax - bluish ting on neck/facial regions, subconjunctival hemorrhage, loss of vision - activate EMS
gynecomastia
- excessive development of mammary glands - causes nipple soreness/tenderness but can resolve spontaneously 6-12 months - associated with steroid use - may indicate pathology of testes, pituitary glands, or adrenal glands
blunt cardiac injury
- heart is compressed between sternum and spine - damages heart tissue - disrupts circulation - beck triad, pulsus paradoxus, collapse - activate EMS
hemothorax
- loss of blood into pleural cavity - tearing of lung tissue (fracture of rib) - severe pain, difficulty breathing, cyanosis, coughing blood, shock - treat for shock and activate EMS
cardiac tamponade
- massive blunt trauma ruptures myocardium or lacerates coronary artery - shock and death can rapidly evolve
contusions/fractures to the trachea, larynx, and hyoid bone
- occur during hyperextension of the neck - can be fatal in rare instances - delayed onset of issues/symptoms is a major concern - keep patient calm, maintain open airway, focus on breathing rate - symptoms include hoarseness, dyspnea, difficulty swallowing, and coughing
trauma to the abdomen
- potential for internal hemorrhage - activate EMS, treat for shock, manage vitals
femoral hernias
-allow the abdominal viscera to protrude through the femoral ring into the femoral canal, compressing the lymph vessels, connective tissue, and the femoral artery and vein - presents as a mass inferolateral to the pubic tubercle and medial to the femoral artery and vein
laryngospasm
adductor muscles of the vocal cords pull together in a shutter-like fashion, and the upper surface of the vocal cords closes over the top, causing complete obstruction
heart murmur
an abnormal sound from the heart produced by defects in the chambers or valves
what do deep, quick breaths indicate?
asthma or pulmonary obstruction
bacteriuria
bacteria in the urine
hematuria
blood in the urine, could be caused by direct kidney injury, bladder contusion, UTI, medication, infection, sickle cell disease, or other preexisting pathologies
Four types of kidney stones
calcium stones, uric acid stones, struvite stones, cystine stones
breast contusions
can produce fat necrosis or hematoma formation, treat with standard acute care
causes of struvite stones
chronic UTIs
nipple irritation
friction causes abrasions or blisters
causes of cystine stones
hereditary disorder that causes kidneys to excrete excessive amounts of amino acids
indications of gastroenteritis
hyperperistalsis (rushing sounds), cramps, and diarrhea
beck triad
hypotension, distended neck veins, distant heart sounds
cystitis
inflammation of hte bladder
urethritis
inflammation of the urethra
what does pink/bloody sputum indicate?
internal bleeding
causes of calcium stones
large amounts of vitamin D, thyroid hormones, overactive parathyroid glands, some kidney conditions
what is the Adam's apple?
larynx
What is auscultation?
listening through a stethoscope
acquired hernias
occur after birth and may be aggravated by a direct blow, strain, or abnormal intra-abdominal pressure
McBurney point
one-third the distance between the ASIS and the umbilicus
what do noisy, raspy breaths indicate?
partial airway obstruction
Kehr sign
persistent dull pain in the upper left quadrant, left lower chest, and left shoulder
cyclist's nipples
perspiration+ wind chill= pain; prevent with wind proof jacket
congenital hernias
present at birth and may be related to family history
direct hernias
result from a weakness in an area of fascia bounded by the rectus abdominis muscle, the inguinal ligament, and the epigastric vessels
what is hypoperistalsis and why is it serious
silent abdomen, may indicate serious underlying problems like obstructions or hemorhages
why is chest protection especially important for adolescents?
their rib cage is less rigid, a direct impact from a baseball could cause death
pleura
thin, double-layered membrane that lines the thoracic cavity
what is purpose of the epiglottis?
to close the trachea when swallowing to prevent choking or anything to enter the airway
why is the left lung smaller than the right?
to make room for the heart
what is dysesthesia
unpleasant abnormal sensation