Rib Fracture

HISTORY:

‍RightLeft chest wall injury sustained ‍ ‍days ago

Event: ‍ ‍falldirect blow

Severity: ‍mildmoderatesevere, ‍012345678910 / 10

Type: ‍sharpstabbing

Pattern: ‍constantintermittent

Worsening factors: ‍nonemovementdeep breathing

‍shortness of breath

‍pleuritic chest pain

‍cough, ‍non-productiveproductive

‍sputum, ‍clearcolored

‍bruising

‍swelling

‍crepitus

‍limited range of motion

Treatments tried: ‍none, ‍effectiveineffective



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Chest: ‍tenderness on ‍rightleft ‍

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Skin: ‍no rash



ASSESSMENT:

‍Rib fracture ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Chest X-ray

- Rib X-ray

- CT scan of the chest

- Activity as tolerated

- ‍Acetaminophen

- ‍NSAIDs

- ‍Opioids

- Respiratory exercises four times daily

- Follow-up in ‍ ‍daysweeks with repeat X-ray

- Return if pain worsens or if new symptoms develop such as difficulty breathing or coughing up blood

- Go to ER if severe chest pain, difficulty breathing, or fever occurs