December 2005, Volume 35 Number 12 , p 17 - 17
D'ARCY, YVONNE CRNP, CNS, MS
QUESTION: My 66-year-old patient fractured four right-side ribs in a fall. She has constant, severe pain at the injury site and can't effectively cough or deep-breathe. How can I best manage her pain?
ANSWER: Guidelines for treating blunt thoracic trauma (such as rib fractures and flail chest) recommend epidural analgesia as the preferred technique for maximum pain relief. Before we discuss this and other treatment options, let's quickly review blunt thoracic trauma.
Always suspect blunt-force trauma when a patient has been thrown against a solid surface at high velocity. Common causes of blunt force trauma include being thrown or falling against a car steering wheel, being ejected from a vehicle into a tree, being struck by a motor vehicle, and physical assault.
Assessing and treating pain in these circumstances can be challenging; the patient may not be able to report pain or may underestimate the significance of what she perceives to be ...