Rib Fracture

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍rightleft chest pain following an injury ‍ ‍days ago

Mechanism of injury: ‍ ‍falldirect blow

Rated at ‍012345678910 / 10 ‍

Described as ‍sharpstabbing

Pattern ‍persistentintermittent

Worsening factors: ‍nonemovementdeep breathing

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍shortness of breath

‍pleuritic chest pain

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍bruising

‍swelling

‍crepitus

‍limited range of motion



Contributing factors:

no history of: ‍previous rib fractures, ‍osteoporosis, ‍chronic obstructive pulmonary disease

no use of: ‍corticosteroids, ‍anticoagulants





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Chest: ‍tenderness on ‍rightleft ‍

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Rib fracture ‍likelysuspectedpossible

DDx: rib fracture, chest wall contusion, muscle strain, costochondral separation, sternal fracture, thoracic spine fracture, pneumothorax, hemothorax, pulmonary contusion, myocardial contusion, traumatic aortic disruption, esophageal injury, diaphragmatic injury, anxiety/panic disorder related to trauma





PLAN:

Investigations:

- Chest X-ray

- Rib X-ray

- CT scan of the chest

Treatments:

- Activity as tolerated

- ‍Acetaminophen

- ‍NSAIDs

- ‍Opioids

- Respiratory exercises four times daily

Further care:

- 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

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