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Now, let’s quickly recap the anatomy and physiology of the diaphragm, which is a dome-shaped sheet of skeletal muscle that divides the thoracic cavity from the abdominal cavity. It curves superiorly into right and left domes, or hemidiaphragms, with the liver lying just beneath the right dome. It has a mobile, central portion known as the central tendon and a peripheral muscular portion that is fixed to the bones, cartilages, and ligaments of the thoracic cage.
Now, the diaphragm is the chief muscle for inspiration; meaning that when it contracts, it helps us breathe in. During contraction, the central portion of the diaphragm depresses, increasing the volume of the thoracic cavity, which, in turn, increases the volume in the lungs. This makes the intrapulmonary pressure fall below the atmospheric pressure, creating a partial vacuum that allows fresh air to be sucked in! The diaphragm also helps with circulation. During contraction, the increased intra-abdominal pressure and decreased intrathoracic pressure help with the venous return of blood towards the heart through the inferior vena cava.
Less commonly, diaphragm rupture can be caused by blunt abdominal trauma, such as a motor vehicle crash, which causes a sudden increase in intra-abdominal pressure, causing the diaphragm to rupture. This rupture is far more common on the left hemidiaphragm compared to the right hemidiaphragm, which is protected by the liver.
Rupture of the diaphragm is a condition in which the diaphragm, a sheet of muscle that separates the chest and abdominal cavities, tears or breaks. It is usually caused by penetrating trauma or blunt abdominal trauma, and risk factors include sustaining injuries such as gunshot wounds, stab wounds, falls, and being involved in a motor vehicle crash.
A ruptured diaphragm can cause serious medical complications and even death if it is not treated quickly. People with a ruptured diaphragm can present with shortness of breath, cough, chest pain, and respiratory distress, which presents as short, shallow, and rapid breathing, as well as decreased SpO2, but these manifestations may be masked by other injuries the client sustained.
Diagnosis is made based on history, physical exam, and imaging findings on chest X-ray as well as other imaging methods such as ultrasound or chest CT. Treatment depends on the severity, with small tears only requiring monitoring and large tears requiring surgical repair and chest tubes post-operatively. Management of care focuses on maintaining adequate oxygenation and ventilation.
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