Cardiovascular cases
Lt Col Edward Sellon, David C Howlett, Nick Taylor in Radiology for Medical Finals, 2017
Sudden onset shortness of breath with a background of malignancy suggests:Pulmonary embolus.Myocardial infarction with acute heart failure.Malignant pleural effusion.Pneumonia secondary to chemotherapy (immunosuppression).Pneumothorax.Rib fracture.Metastases (lung or bone).
Cancer pain syndromes
Nigel Sykes, Michael I Bennett, Chun-Su Yuan in Clinical Pain Management, 2008
Pathological fractures of the ribs are relatively common in cancers of the breast and prostate, and in multiple myeloma. A rib fracture may well be painless at rest, particularly if a patient is already taking analgesics. The rectus abdominis muscles, however, are attached to the inner aspect of the lower ribs. Thus, when the body is moved from a sitting to a lying position, or vice versa, these muscles tug on a fractured bone and cause transient severe pain. Deep breaths, coughing, laughing, and twisting the trunk also cause severe pain. However, the diagnosis may not be made because the patient simply complains of new severe chest pain. A clinician who is alert to the possibility of rib metastases will ask the appropriate questions and elicit the classical features of the syndrome.
Injuries in Children
Ian Greaves, Keith Porter, Jeff Garner in Trauma Care Manual, 2021
Rib fractures are rare in the children, and their presence will be associated with severe underlying chest injury. If they occur in children under 12 months of age, the possibility of NAI needs to be considered as well as osteogenesis imperfecta or rickets. A first rib or posterior rib fracture is highly suspicious of child abuse. If a rib fracture is detected, the emergency physician should be alerted to the possibility of associated injuries such as pneumothorax, haemothorax or major vascular injury. Multiple rib fractures are a marker of severe injury and are associated with high mortality rates. The management of rib fractures is supportive. The goal is to provide oxygenation and pain relief in order to prevent atelectasis and secondary pneumonia.
Development and implementation of a time- and computationally-efficient methodology for reconstructing real-world crashes using finite element modeling to improve crash injury research investigations
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Casey Costa, James P. Gaewsky, Joel D. Stitzel, F. Scott Gayzik, Fang-Chi Hsu, R. Shayn Martin, Anna N. Miller, Ashley A. Weaver
Injury timing accuracy is critical for CIREN case reconstructions. All reconstructions displayed sharp and significant elevations in chest compression during belt loading, followed by sustained or increased chest compression during airbag and steering assembly loading, indicating that the belt was the primary component causing chest deflection. This is expected because shoulder belts are designed to absorb the majority of the occupant energy in a frontal crash and airbags are intentionally designed to absorb the remaining energy surplus (Petitjean et al. 2003). Though the shoulder belt appears to be the primary component causing chest compression, this is not always true for rib fracture. In cases 19 M-RSL, 56 F-R, and 61 F-RSH, rib plastic strain did not develop until the M50-OS model loaded the steering wheel airbag and assembly, indicating that these components may have played a crucial role in generating fracture. The Case 56 F-R BioTab aligns with this finding, but the 19 M-RSL and 61 F-RSH BioTabs, which attribute the shoulder belt as the primary causative component of injury, do not. Therefore, this indicates that it may have been more appropriate to assign equal confidence (and therefore equal contribution) to both the shoulder belt and the airbag for these cases.
Challenges experienced during rehabilitation after traumatic multiple rib fractures: a qualitative study
Published in Disability and Rehabilitation, 2018
Jacqueline Claydon, Gregory Maniatopoulos, Lisa Robinson, Paul Fearon
Traumatic multiple rib fractures are a sub-set of the major trauma population, with nearly 90% experiencing additional simultaneous injuries [1]. The more serious rib injuries are often associated with concomitant fractures of the chest wall, including scapulae, clavicle, and sternum and can cause complications for respiration [2]. Approximately 59% of patients will require mechanical ventilation for a mean of 12.1 days [3] and up to 33% do not survive the trauma [4] highlighting the potentially critical nature of these injuries. Those that survive rib trauma are recognized to experience pain and long-term morbidity [3]. The nature of rib fracture injury can affect lung function in addition to bony and soft tissue injuries and therefore poses a unique clinical presentation compared with orthopedic and brain major trauma. The impact of injury and implications for rehabilitation warrant special consideration. A greater insight into the entire recovery journey from the patients’ perspective can inform the development of education and rehabilitation interventions that address the unique clinical presentation of traumatic rib fractures and focus on the issues that matter most to patients.
Ultrasound -guided erector spinae plane block (ESPB) versus intravenous opioids based analgesia in patients with rib fractures
Published in Egyptian Journal of Anaesthesia, 2023
Soha Elmansy, Mohammed Abdelkhalek, Sherif Farouk, Randa Shoukry, Ahmed Khames
Our study focused on patients who had at least three rib fractures, as these injuries have higher mortality rates and require prolonged hospital and ICU stays. Multiple rib fracture pain can result in muscle spasms and voluntary splinting that result in atelectasis, hypoventilation, pneumonia, and respiratory failure. Effective analgesia that is started as soon as possible reduces hypoventilation, allowing appropriate coughing and cooperation with chest physical therapy, which lessens subsequent pulmonary complications.
Related Knowledge Centers
- Flail Chest
- Metastasis
- Pneumonia
- Pulmonary Contusion
- Bruise
- Bone Fracture
- Pneumothorax
- Rib
- Traffic Collision
- Crush Injury