How to diagnose “fracture rib” ?
Clinically
Physical examination findings in fracture ribs (3 points)
- local tenderness
- crepitus over site of fracture
- bruises
Indications for endotracheal intubation (3 points)
- respiratory rate > 30/ min
- PaO2< 60
- PaCO2 > 45
Indications of thoracotomy (3 points)
- initial chest tube output > 1500cc
- hourly output > 200 cc/hour for 2-4 hours
- progressive opacification of CXR (every 6 hours)
What we look for in patient with rib fracture ?
- number of ribs
- age
- underlying pulmonary status
Complications of “tracheobronchial trauma” (5 points)
- empyema
- clotted haemothorax
- bronchopleural fistula
- bronchial stenosis
- chylothorax
What’s the gold standard fo “diaphragmatic injury” diagnosis
Direct visualization
Tension pneumothorax symptoms (5 points)
- severe respiratory distress
- distended nick veins
- deviated trachea
- absent breathing sounds
- deviated apex pulse
What we do if “rib fracture case” was positive clinically and negative x-ray
Treat as fracture
Most common ribs to get fracture ?
4-10 ribs
Primary treatment for “clavicular fracture”
Immobilization
Figure of eight bandage / clavicle strap 3-4 weeks
Most common associated injuries with “sternum fracture” (3 points)
- rib fracture
- long bone fracture
- closed head injury
Why we use x-ray in rib fracture patient ?
- confirm the diagnosis
- detects associated conditions
(Pneomothorax , hemothorax)
Indications for admission for “rib fracture”
- unable to cough and clear secretions
- COPD
- age >65
- associations
- first and second rib fracture
Sources of bleeding in “heamothorax” (5points)
- intercostal vessels
- internal mammary artery
- injury to the heart or great vessels
- pulmonary parenchymal injuries
- major pulmonary vessels
Most common site for clavicular fracture
Middle third 80%
Where the sternal fracture located ?
Transverse
In the upper and middle portions of the body of sternum
Symptoms of rib fracture (2 points)
- inspiratory chest pain
- discomfort over the fractured rib
