Rib fracture: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Thoracic trauma DDX}} | {{Thoracic trauma DDX}} | ||
==Management== | |||
*Dilaudid PCA upon decision to admit<ref>Dept of Surg Edu at Orlando Regional Medical Center. Multi-modality pain control for rib fractures. Surgical Critical Care. 11/30/2010. http://www.surgicalcriticalcare.net/Guidelines/rib%20fracture%202010.pdf</ref> | |||
*Incentive spirometry | |||
*EzPAP® positive airway pressure system | |||
*Early NSAIDs for multiple rib fractures to reduce pna | |||
**Ibuprofen 800 mg IV q6hrs | |||
**OR ketorolac 15-30 mg IV q6 hrs<ref>Yang Y et al. Use of ketorolac is associated with decreased pneumonia following rib fractures. Am J Surg. 2014 Apr;207(4):566-72. doi: 10.1016/j.amjsurg.2013.05.011. Epub 2013 Oct 7.</ref> | |||
**Limit IV NSAIDs to maximum of 5 days | |||
*Transition to PO narcotics and NSAIDs whenever possible | |||
*Consider addition of: | |||
**Continuous epidural bupivacaine infusion if failure of PCA/NSAIDs | |||
**Diazepam 10 mg IV/PO q4-6 hrs if respiratory rate adequate | |||
=Disposition= | =Disposition= | ||
Revision as of 22:14, 28 September 2015
Background
- Diagnostic goal: detect commonly associated conditions: hemopneumothorax, pulmonary contusion, intra-abdominal injury, major vascular injury
- Pediatrics: <2 years old with >2 rib fractures = 50% mortality
- Ribs more flexible in children, so fractures require extreme force
- Elderly: double the mortality of younger patients
Diagnosis
- Chest x-ray
- 1st & 2nd rib fractures associated with severe chest trauma and underlying injury
- 9th, 10th, 11th rib fractures associated with intra-abdominal injury
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Management
- Dilaudid PCA upon decision to admit[1]
- Incentive spirometry
- EzPAP® positive airway pressure system
- Early NSAIDs for multiple rib fractures to reduce pna
- Ibuprofen 800 mg IV q6hrs
- OR ketorolac 15-30 mg IV q6 hrs[2]
- Limit IV NSAIDs to maximum of 5 days
- Transition to PO narcotics and NSAIDs whenever possible
- Consider addition of:
- Continuous epidural bupivacaine infusion if failure of PCA/NSAIDs
- Diazepam 10 mg IV/PO q4-6 hrs if respiratory rate adequate
Disposition
- Strongly consider admission for more than one rib fracture in elderly patient or patient with preexisting pulmonary disease
- Difficult for these patients to cough / clear secretions
- If discharged:
- Teach how to splint and cough
- Be liberal with pain medicine
- Encourage incentive spirometer or tell to blow up balloons
- Discourage rib belts or straps
See Also
Source
- Tintinanlli
- ↑ Dept of Surg Edu at Orlando Regional Medical Center. Multi-modality pain control for rib fractures. Surgical Critical Care. 11/30/2010. http://www.surgicalcriticalcare.net/Guidelines/rib%20fracture%202010.pdf
- ↑ Yang Y et al. Use of ketorolac is associated with decreased pneumonia following rib fractures. Am J Surg. 2014 Apr;207(4):566-72. doi: 10.1016/j.amjsurg.2013.05.011. Epub 2013 Oct 7.