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.
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Following are the most informative references cited in this paper, as determined by the authors.
1. * Kasotakis G, Hasenboehler EA, Streib EW, et al. Operative fixation of rib fractures after blunt trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2017;82(3):618-626. (Meta-analysis; 22 studies, 986 patients) DOI: 10.1097/TA.0000000000001350
7. * Henry TS, Donnelly EF, Boiselle PM, et al. ACR Appropriateness Criteria(®) Rib Fractures. J Am Coll Radiol. 2019;16(5s):S227-s234. (Guidelines) DOI: 10.1016/j.jacr.2019.02.019
18. * Brasel KJ, Moore EE, Albrecht RA, et al. Western Trauma Association Critical Decisions in Trauma: management of rib fractures. J Trauma Acute Care Surg. 2017;82(1):200-203. (Practice guideline) DOI: 10.1097/TA.0000000000001301
20. * Witt CE, Bulger EM. Comprehensive approach to the management of the patient with multiple rib fractures: a review and introduction of a bundled rib fracture management protocol. Trauma Surg Acute Care Open. 2017;2(1):e000064. (Review) DOI: 10.1136/tsaco-2016-000064
21. * Galvagno SM Jr, Smith CE, Varon AJ, et al. Pain management for blunt thoracic trauma: a joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016;81(5):936-951. (Practice guideline) DOI: 10.1097/TA.0000000000001209
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Keywords: trauma, rib, fracture, cardiorespiratory, flail chest, pneumothorax, hemothorax, aorta, opioid, ketamine, gabapentin, regional anesthesia, binder, kinesiotaping, spirometer, NIPPV, HFNC, high-flow nasal cannula, fixation, Battle score
Dr. Ashoo is a practicing emergency physician, board-certified in emergency medicine and clinical informatics. Join him as he takes you through the November 2021 issue of Emergency Medicine Practice: Emergency Department Management of Rib Fractures (Trauma CME)
Patrick Maher, MD, MS
Whitney Bryant, MD, MPH, MEd; Drew Clare, MD
November 1, 2021
November 30, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits
Date of Original Release: November 1, 2021. Date of most recent review: October 10, 2021. Termination date: November 1, 2024.
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Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits.
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