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Rib Fracture
HISTORY:
Right
Left
chest wall injury sustained
days
ago
Event:
fall
direct blow
Severity:
mild
moderate
severe
,
0
1
2
3
4
5
6
7
8
9
10
/ 10
Type:
sharp
stabbing
Pattern:
constant
intermittent
Worsening factors:
none
movement
deep breathing
shortness of breath
pleuritic chest pain
cough
sputum
bruising
swelling
crepitus
limited range of motion
Treatments tried:
none
,
effective
ineffective
Other elements:
previous rib fractures
osteoporosis
chronic obstructive pulmonary disease
corticosteroids
anticoagulants
EXAM:
General appearance:
well-appearing
Vital signs:
normal
,
BP
,
HR
,
RR
,
SpO2
%
,
Temp
°
Neck:
normal
Heart:
RRR
,
normal S1 and S2
Lungs:
clear
,
retractions
Chest:
tenderness
on
right
left
,
bruising
swelling
wound
Abdomen:
soft
,
non-tender
,
non-distended
,
Extremities:
edema
,
warm
,
cap refill
< 3 sec
> 3 sec
,
pulses
normal
,
ASSESSMENT:
Rib fracture
likely
suspected
possible
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
days
weeks
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