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