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Rib Fracture Management Algorithm for the Traumatically Injured, Non-intubated Patient

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Abstract

The goal of this algorithm is to recognize patients who are high risk for respiratory compromise and guide analgesia, pulmonary support, and clinical monitoring. Implementation of a structured rib fracture management algorithm has been shown to decrease ICU and hospital lengths of stay, pneumonia, and mortality.

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References

  1. Todd SR, McNally MM, Holcomb JB, Kozar RA, Kao LS, Gonzalez EA, Cocanour CS, Vercruysse GA, Lygas MH, Brasseaux BK, et al. A multidisciplinary clinical pathway decreases rib fracture-associated infectious morbidity and mortality in high-risk trauma patients. Am J Surg. 2006;192:806–11.

    Article  PubMed  Google Scholar 

  2. Holcomb JB, Moore FA, et al. Morbidity from Rib Fractures Increases After Age 45. JACS. 2003 Oct;196(4):549–55.

    Google Scholar 

  3. Dehghan N, de Mestral C, McKee MD, Schemitsch EH, Nathens A. Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank. J Trauma Acute Care Surg. 2014;76:462–8.

    Article  PubMed  Google Scholar 

  4. Hamrick MC, Duhn RD, Ochsner MG. Critical evaluation of pulmonary contusion in the early post-traumatic period: risk of assisted ventilation. Am Surg. 2009;75:1054–8.

    PubMed  Google Scholar 

  5. Witt C, Bulger E. Comprehensive approach to the management of the patient with multiple rib fractures: A review and introduction of a bundled rib fracture management protocol. Trauma Surgery Acute Care Open. 2017;2:e00064.

    Article  Google Scholar 

  6. Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. 2000;48:1040–6. discussion 1046–7

    Article  CAS  PubMed  Google Scholar 

  7. Stawicki SP, Grossman MD, Hoey BA, Miller DL, Reed JF III. Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc. 2004;52:805–8.

    Article  PubMed  Google Scholar 

  8. Rockwood K, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005 Aug 30;173(5):489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Brasel K, Moore E, Biffl W, et al. Western Trauma Association Critical Decisions in Trauma: Management of Rib Fractures. J Trauma Acute Care Surgery. 2016;82(1):200.

    Article  Google Scholar 

  10. Battle CE, Hutchings H, Evans PA. Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury. 2012;43:8–17.

    Article  PubMed  Google Scholar 

  11. Galvagno SM Jr, Smith CE, Varon AJ, Hasenboehler EA, Sultan S, Shaefer G, To KB, Fox A, Alley DE, Ditillo M, et al. Pain management for blunt thoracic trauma: a joint practice management guideline from the Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society. J Trauma Acute Care Surg. 2016;81:936–51.

    Article  PubMed  Google Scholar 

  12. Rafiq S, Steinbruchel DA, Wanscher MJ, Andersen LW, Navne A, Lilleoer NB, Olsen PS. Multimodal analgesia versus traditional opiate based analgesia after cardiac surgery, a randomized controlled trial. J Cardiothorac Surg. 2014;9:52.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bayouth L, Safcsak K, Cheatham ML, Smith CP, Birrer KL, Promes JT. Early intravenous ibuprofen decreases narcotic requirement and length of stay after traumatic rib fracture. Am Surg. 2013;79:1207–12.

    PubMed  Google Scholar 

  14. Yang Y, Young JB, Schermer CR, Utter GH. Use of ketorolac is associated with decreased pneumonia following rib fractures. Am J Surg. 2014;207:566–72.

    Article  PubMed  Google Scholar 

  15. Bulger EM, Edwards T, Klotz P, Jurkovich GJ. Epidural analgesia improves outcome after multiple rib fractures. Surgery. 2004;136:426–30.

    Article  PubMed  Google Scholar 

  16. Mohta M, Verma P, Saxena AK, Sethi AK, Tyagi A, Girotra G. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs—a pilot study. J Trauma. 2009;66:1096–101.

    Article  PubMed  Google Scholar 

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Correspondence to Walter Biffl .

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Biffl, W., Zhao, F. (2018). Rib Fracture Management Algorithm for the Traumatically Injured, Non-intubated Patient. In: de Moya, M., Mayberry, J. (eds) Rib Fracture Management . Springer, Cham. https://doi.org/10.1007/978-3-319-91644-6_10

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  • DOI: https://doi.org/10.1007/978-3-319-91644-6_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-91643-9

  • Online ISBN: 978-3-319-91644-6

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