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Jan 18, 2005Comments: 0 · Posts: 1857 · Topics: 45
Not looking for sympathy from anyone - just any tips/advice from anyone out there who's ever had cracked ribs before??? Not too much info. to be foun
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Jan 18, 2005Comments: 0 · Posts: 13612 · Topics: 756
What to do:
Examine the patient for possible associated injuries; e.g., do an abdominal exam to look for any signs of a splenic or hepatic injury. If there was a significan mechanism of injury, the patietn may require a comprenhensive evaluation to rule out life and limb threatening injuries.
When there is a history of minor trauma, check for pain with indirect stress on the suspected fracture site. Compress the rib medially if a posterior or anterior fracture is suspected. Compress the rib anteriorly/posteriorly if a fracture is suspected at a lateral location. When pain occurs at the suspected fracture site with indirect stress, this is clinical evidence of a fracture or separation and should be so documented on the chart.
Obtain any history of chronic pulmonary problems or heavy smoking.
Unless the patient is elderly or has pulmonary disease, have him try out a rib belt during his wait for x rays.
Send the patient for a PA & lateral chest x ray to rule out a pneumothorax, hemothorax, evidence of pulmonary contusion, etc. Additional oblique rib films for radiological documentation of a fracture are optional and often unproductive, but these films are indicated when there is a suspicion of multiple rib fractures, especially in the elderly.
If there is no suspicion of underlying injury and when there is clinical or radiologic evidence of a rib fracture or chondral separation:
Provide a potent oral analgesic (Motrin, Aleve, Tylenol with codeine, Lorcet, Percocet).
Instruct the patient on the intermittent use of an elastic and velcro rib belt if it reduces pain. Place the top of the belt at the inferior tip of the xyphoid process, tightening it around the chest enough to obtain maximum pain relief. the fib belt may be left on almost continuously for the first one to four days but it should be removed as comfort allows thereafter.
Instruct the patient on the importance of deep breathing and coughing (without the rib belt but using a pillow splint) to help prevent pneumonia. Tell him to take enough pain medicine to allow coughing and deep breathing.
Provide the patient with an appropriate work excuse and refer him for followup care in 48 hours. Tell him to expect gradually decreasing discomfort for about two weeks, and forbid strenuous activity for approximately eight weeks.
Severe worsening of chest pain, shortness of breath, fever or purulent sputum may signal pulmonary complications and should prompt a return visit. A greater incidence of complications can be expected in patients with displaced rib fractures.
When patients are elderly or have pulmonary or cardiac compromise, or multiple fractures or other injuries which might compromise respiratory dynamics, consider hospitalization for observation, pain control and pulmonary toilet. Blood gases and pulmonary function tests can aid in evaluation of breathing.
When there is no clinical or radiologic evidence of a fracture, treat the pain as you would any other contusion, using an appropriate analgesic.
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Jan 18, 2005Comments: 0 · Posts: 13612 · Topics: 756
What not to do:
Do not confuse simple rib fractures with massive blunt trauma to the chest. The evaluation and management is quite different.
Do not tape ribs or use continuous strapping. This will lead to an atelectatic lung prone to pneumonia.
Do not assume there is no fracture just because the x rays are negative. Rib fractures are often not apparent on x ray, especially when they occur in the cartilagenous portion of the rib. The patient deserves the disability period and analgesics commensurate with the real injury
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Jan 18, 2005Comments: 0 · Posts: 1857 · Topics: 45
Hey Q - so thank you for all that info. Your the best doc around:-) Just a slip on the stairs when my son left his metal-dectector oh them.....I shud smack his bottom hard:-)!!!
A x
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Jan 18, 2005Comments: 0 · Posts: 13612 · Topics: 756
i'll be damn... wish you best my lady..
god bedring (as we in Norway says)..
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Jan 18, 2005Comments: 0 · Posts: 13612 · Topics: 756
whish you better days my lady..
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Jan 18, 2005Comments: 0 · Posts: 13612 · Topics: 756
Hope everything is ok with you..
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Jan 18, 2005Comments: 0 · Posts: 3881 · Topics: 128
Alana!!! O dear...sorry to hear that. Does it still hurt badly? You porre thing. You've had your share of falls recently.I don't know much about how you shoudl treat it but I'd imagine you should take it very easy and don't over exert yourself with lifting things.
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Jan 18, 2005Comments: 0 · Posts: 1857 · Topics: 45
Thanks again Free..Q, Mellowdee and SB for info. - thankfully today there's more ease around the ribcage:-)!!! - starting to appreicate the gift of health and just normal breathing big time:-) - hope your better Missmorals after yourde-ribbery episode!!:-) And next time, yeah, I'll take the elevator!!! - just got to go out now and get one installed in the gaff!!:-)
A x
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Jan 18, 2005Comments: 3 · Posts: 15387 · Topics: 830
Christine
what is with this? Fell down the stair I do that but I drink a bit. I use a big ass ace bandage and wrap it tight hurts like hell but you can move about and keeps things from getting worse. hang in there sweetness and XXXXXXXXXXXXOOOOOOOOOOOOOOOO on any sore spot you have
Tate
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Jan 18, 2005Comments: 0 · Posts: 1857 · Topics: 45
Thank you so much Jamesy:-) - your kiss has just hit the sore spot - oops and others spots besides!!!! You're too hot to handle JT!!
A x
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Jan 18, 2005Comments: 0 · Posts: 1362 · Topics: 217
Alana Dear
So sorry to hear about your broken ribs. But glad to see that you manage to be in such high spirits and continue to light up this board.