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Key Terms



Flail segment




Nasal flaring

Needle thoracentesis


Pulmonary embolism


Subcutaneous emphysema

Tracheal tugging



The star center from your basketball team reports to the athletic training room after practice. He describes a sudden onset of sharp chest pain just after the conditioning portion of practice. He is short of breath and says he feels like he can’t take a deep breath. He states that he felt fine during practice and hasn’t had any other problems. As you are questioning him he appears to become more anxious and uncomfortable. As you continue your evaluation you note that he has a pulse rate of 110 beats per minute, his blood pressure is 128/82, and his respirations are 24 per minute and shallow. You have difficulty hearing breath sounds on his left side, but sounds seem normal on the right side.


The vital organs of the thoracic cavity—the heart, lungs, and major vessels—are well protected by the rib cage (Fig. 11-1). It takes high energy and velocity forces to cause injury to these structures. In the athletic setting it is uncommon for those energies to be experienced because protective padding is worn and because humans are not typically able to generate such forces. Still, it is not impossible for athletes to suffer significant thoracic injury. Early suspicion and detection of symptoms are paramount to the survival of an individual with injuries to the contents of the thoracic cavity.

Figure 11-1.

Vital organs are protected by the rib cage.


Assessment of an athlete with suspected thoracic trauma must be thorough, efficient, and focused on the mechanism of injury. A systematic approach to evaluating the athlete will ensure that nothing is overlooked. First, observe the athlete’s general appearance while determining his or her level of consciousness and evaluating the ABCs (airway, breathing, circulation). Take immediate action to correct any life-threatening condition as it is found.

Much can be learned from taking a thorough history. Although dyspnea may not be present in all cases of respiratory injury, it is present in most cases. Asking the athlete the proper questions may be valuable in rapidly identifying the injury. The rapid onset of symptoms versus a more chronic onset is more ominous, especially if the mechanism of injury is unknown. General observation of the athlete should continue while obtaining the history. Noting the athlete’s demeanor, level of anxiety, and ability to speak in full sentences will provide valuable information regarding the severity ...

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