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Emergency Department Management of Rib Fractures (Trauma CME)
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Publication Date: November 2021 (Volume 23, Number 11)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 11/01/2024.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional approval.

Author

Patrick Maher, MD, MS
Assistant Professor, Emergency Medicine and Critical Care, Icahn School of Medicine at Mount Sinai, New York, NY

Peer Reviewers

Whitney Bryant, MD, MPH, MEd
Associate Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
Drew Clare, MD
Assistant Professor, Department of Emergency Medicine, University of Florida College of Medicine–Jacksonville, Jacksonville, FL

Abstract

Rib fractures resulting from blunt thoracic trauma are often associated with life-threatening complications of injury to cardiorespiratory systems. Given the risk for morbidity and mortality, the emergency clinician must be swift and thorough in diagnosing and managing these injuries. Society guidelines have been published to assist in determining best-practice approaches to pain control, imaging, and treatment. This issue reviews the recent studies and evidence for multimodal pain control, decision tools for diagnostic imaging, ventilatory support, and operative fixation. Scoring systems to determine disposition of patients are evaluated, with particular attention given to the special risks to the elderly patient.

Case Presentations

CASE 1
A 70-year-old man who fell down some stairs presents to the ED with severe chest pain…
  • As you start your shift, your first patient is a 70-year-old man who fell while walking down a flight of stairs. He is complaining of severe pain around his right chest that is worse when breathing.
  • The patient denies use of any blood thinners, recent illnesses, or pain or tenderness in any other location.
  • Chest radiograph reveals simple rib fractures of ribs 4, 5, and 6, with no associated pneumothorax.
  • The patient asks what can be done for his pain, and whether he is safe to go home…
CASE 2
A 21-year-old woman on her college crew team says she is experiencing pain in her upper chest when rowing…
  • She says that her right upper chest has begun to hurt while rowing, and she is no longer able to participate in practice due to the pain.
  • Imaging demonstrates a stress fracture at the site of the pain around her second rib, with no other injuries.
  • She asks you how she should treat the injury, and whether she will be able to return to compete in the race next week…
CASE 3
EMS brings in a 45-year-old man who was in a motor vehicle crash, intubated, in respiratory distress…
  • EMS reports that the patient was previously healthy, but they intubated him in the field after he demonstrated worsening signs of respiratory distress.
  • Your complete trauma evaluation reveals a right-sided pneumothorax with flail chest.
  • While speaking with the admitting intensive care unit team, you consider what kinds of treatment this patient might require for his injury…

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