OK, I want to thank AOSSM, of course, ACSM, for allowing me to be here today. This is going to be the Cliff Notes version, of course, of chest and abdominal injury in sport, not to be all-encompassing. All right, so objectives today, we're going to identify some of the common injuries with blunt force trauma, and then identify some of the common signs and symptoms. You will see this. Please recognize it. Thankfully, while being rare, that it's devastating, it makes national news when it does. I don't have any financial disclosures. All right, we'll take a look at some of the epidemiology. There was a good study done a few years ago where a group looked across three national surveillance systems amongst high school and collegiate athletes over a 10-year period and found 174 internal organ injuries. So again, uncommon, but they do happen, nine of them being catastrophic in this particular study. Catastrophic meaning some sort of significant disability associated with it, and unfortunately, four deaths. Those four deaths being liver, spleen, blunt force chest trauma. The vast majority of these tend to occur in males and male contact sports. That's why we cover Friday night lights, right? Football, lacrosse, ice hockey, that's where you tend to see these the most. All right, so we'll go through a quick clinical scenario. We fast forward a few months here in the mid-Atlantic. Starts to get cool September, October or so. Friday night, you're covering that rivalry game, hard hitting. This is a scary scenario for me. I feel like when I see this, it happens a little bit in slow motion. That high school wide receiver goes up for a wobbly bubble screen pass, arms extended out, everything exposed in the front. That cornerback comes up and just pops them head first, pops them right in the chest. What do we do? Well, in my experience with high school athletes, it takes a minute or two to just feel out whether they're sort of doing OK or not or having them even respond to you. They're teenagers, so you say, how are you doing? You may get a grumble at most. And it might just be the wind knocked out of them or it might be something more serious. But you get them to the sideline and you start down this pathway, the mnemonic of CAB. So circulation, airway, and breathing. The problem with internal organ injuries for a lot of these are going to be hypovolemic shock, blood loss, internal bleeding. Let's take a look at their circulatory status. Are they perfusing? Heart rate, blood pressure, take their pulse, the 80-70-60 rule. So if they have a radial pulse, they probably have a systolic over 80-millimeter mercury. Is their airway repeating? And then look at their breathing. After you calm them down for a minute or two and sort of notice that they're in mini-shock almost of what happened to that hard hit, take their chest protectors off. Take a look at the breathing. Do you see any paradoxical movements? So as they breathe in, the chest cavity should expand, not go inward. Take a listen to them. Do they have breath sounds equal on all sides? And then feel. Of course, you're going to feel for crepitus and deformities of rib cartilage or rib fracture injuries. But of course, there's things that lie underneath that can be the problem. When it comes to thoracic injuries, of course, there's a whole list of light threatening and things that are more urgent or subacute. We're not going to cover all of them, of course, but really go over some of the top few. So I'll review pneumothorax, hemothorax, and flail chest, commotion of cortis. We already had a talk about sudden cardiac deaths. You all are very knowledgeable, of course, about sternocavicular dislocations. Cardiac tamponade being very rare in the sports world. Aortic injury, unfortunately, being usually fatal at the time. So unfortunately, not a whole lot you can do about that. All right, pneumothorax. You'll see these. Long enough, you've covered enough sideline events. Post-traumatic, sometimes spontaneous. The athlete will have chest pain, neck pain, back pain. Shortness of breath, just feel discomfort, of course, just around their chest. This is where you look, listen, and feel at their lungs. Do they have decreased breath sounds on one side or not? Most of these, thankfully, end up being stable. But of course, they become unstable, you're dealing with a tension pneumo. That air pocket within the pleural cavity expands to the point that on the bottom x-ray shoves all the organs off to the other side. You see a deviated trachea, distended neck veins. If they're that unstable, you think about needle decompressions. You've got to get them to the hospital fast if you don't have any sort of tools on the sidelines, which, of course, most of us don't. Thankfully, again, many of them being stable, you observe them with some serial chest x-rays. They're OK. The quirk about this thing is if you're covering your national high school team or your collegiate team and you're at an away game, they cannot fly for at least two or three weeks. Why? Well, if they have an acute north thorax, they have air in that pleural space. You take them up in a plane, up in elevation, the relative air pressure drops. The air inside the pleural cavity expands. Flying is already terrible enough. How about flying with a pneumo that expands? And now you have some real problems at 30,000 feet. Hemothorax is going to be similar as the pneumo. Problem is these things can bleed and bleed a lot. That's where we go back to circulation, airway breathing. Monitor for hypovolemic shock. They can acquire a huge amount of blood loss very quickly. If you recognize anything like this, it's immediate hospital transport and supportive measures. Flail chest tends to be pretty rare in sports. But when you do see it, you'll see multiple rib fractures at two different sites on the same rib of at least three straight ribs. So you have this area that's really not attached to anything. And this is where you'll see the paradoxical motion in their breathing. So as they inspire real big, that particular area will collapse in. Yeah, they're going to have tender ribs. Yeah, they'll have painful breathing. Most of them just pain control and let the rib fractures heal. But of course, what you want to watch out is a pneumo or hemothorax where they can potentially get into more trouble. All right, let's go back to our case scenario. Instead of getting popped in the chest, he gets popped in the abdomen. Collapses down like a sack of potatoes, get him to the sideline. This is the area where it can become occasionally hairy. Acute life-threatening injuries, hepatic splenic renal injuries. You'll see muscular contusions. Of course, the wind knocked out of them, diaphragmatic spasms, rectus sheath hematoma. But the left side, of course, is what keeps us up at night. Hepatic injuries, one of the two most injured organs along with the spleen. It's covered by the lower ribs, which are false ribs. So those ribs are a little more mobile, a little more flexible. You crack a rib or you get hit hard enough in that area, you get a direct blow, hepatic or splenic injury. Typically, they'll be doubled over. Significant abdominal pain, sometimes nausea, vomiting. Internal bleeding, that's what we worry about these guys. If severe, they can have significant hemodynamic compromise, and we run into trouble. Thankfully, the vast majority of these end up being non-operative. I don't really care to go over these grades to know that the vast majority are non-op, and we can simply observe. So if they're stable, we can get a CAT scan, abdomen, pelvis, and IV contrast. If they're unstable, we got to move a lot faster. If they're stable, which the vast majority are, we observe them for a few days, follow some serial hemoglobins and vitals, make sure they're not dropping and losing blood, and then return to play is quite variable depending on the severity of injury. Splenic injury, basically the same as hepatic, just the other side. They can have referred pain to the left shoulder that doubled over appearance, nausea, vomiting. If severe again, internal bleeding is the problem. This is where we lose our kids. If they're unstable, they get a splenectomy. They're back to play in a few months. Problem is, sometimes you can have delayed presentation. Splenic capsule can contain a huge amount of blood. Whenever you have someone, an athlete on the sideline, get really rocked in the abdominal area, I really encourage you to stay by their side. You got to watch them because things can go down very quickly. The reports that we have of kids losing their life, essentially, is they're OK, they seem all right, and then they collapse. We got to get them to definitive care quickly. Renal injury, thankfully not as serious most of the time. Usually a direct blow to that flank area. Of course, they'll flank pain, but they're also complaining about gross hematuria. Get a CT, abdomen, pelvis, with IV contrast. Rarely do they get into hemodynamic compromise issues. So you can observe them. Most of them are minor. They'll be peeing blood for a little bit. And then once they're healed up, then we get them back to play. This is a quirky one that you might run into once in a while, thankfully not life-threatening. Direct trauma right to the abdomen area, ruptures one of the epigastric veins or arteries, leading to a small hematoma within the rectus sheath. It'll look like this tender mass or nodule over the area. It may even look like a hernia. But if you do a CAT scan, or if you have someone who's really adept at musculoskeletal ultrasound, you can see that it's just a localized area of hematoma within the rectus sheath. Thankfully, vast majority of them are non-surgical. Rest them, ice them up, and then they're good to go. So in conclusion, liver, spleen, kidney, lung injury is going to be the most common. But again, I really encourage you to stay by their side. Things can go downhill quickly. You've got to watch these guys. Have a very low threshold for getting them off to hospital transport and definitive care. Yes, while the vast majority are going to be treated conservatively and just observation with serial scans and serial hemoglobin and hematocrits, you just never know when that one person is going to turn into national news. So be by their side, low threshold for hospital transport, and get them out. Thank you.

chest injuries

abdominal injuries

blunt force trauma

sports injuries

internal organ injuries