What's Your Diagnosis? Emergency Department Management of Rib Fractures

Welcome to this month’s What’s Your Diagnosis Challenge!

But before we begin, check to see if you got last month’s case on Emergency Department Management of Cervical Spine Injuries right.

Case Presentation: Emergency Department Management of Rib Fractures

As you start your shift, your first patient is a 70-year-old man who fell while walking down a flight of stairs. He is complaining of severe pain around his right chest that is worse when breathing. The patient denies use of any blood thinners, recent illnesses, or pain or tenderness in any other location. Chest radiograph reveals simple rib fractures of ribs 4, 5, and 6, with no associated pneumothorax. The patient asks what can be done for his pain, and whether he is safe to go home…

Case Conclusion

Because this elderly gentleman had 3 rib fractures, you admitted him to the inpatient service for observation. Although he initially asked whether it might be possible for him to return home, he agreed to stay after you engaged him in shared decision-making and informed him of the risks of rib fractures for his age group, which included a risk of mortality of nearly 20%, based on registry data. He received adequate analgesia, which included a prescription for acetaminophen 650 mg to take by mouth every 6 hours for moderate pain, 3 days of oxycodone 5 mg tablets to take by mouth every 6 hours as needed for severe pain, and incentive spirometry training.