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Results for “RIB FRACTURES”

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At least 163 records · Page 9Linked to original sources
PubMed1982

Epidural analgesia or mechanical ventilation for multiple Rib fractures?

A protocol for treating thoracic trauma is proposed. Severe pulmonary lesion with increased venous admixture (e.g. contusio, atelectasis, aspiration) is treated by mechanical ventilation. Rib fractures with minor pulmonary lesion and therefore with only moderately abnormal gas exchange but with remarkably reduced vital capacity (even with flail chest) are controlled by thoracic epidural analgesia following vital capacity, tidal volume and respiratory rate. If both a severe pulmonary lesion and serial rib fractures are present, the patient is ventilated for 2-3 days and then extubated to breath spontaneously with epidural analgesia. The indication for a mechanical ventilation or for spontaneous breathing with thoracic epidural analgesia is therefore deducted more from functional variables than from morphological facts. The course of a consecutive series of 283 patients is presented. 155 patients were treated with primary ventilation and 112 patients with primary epidural analgesia, while 16 patients could be managed with general analgesia. The duration of treatment morbidity and mortality show this protocol to be very useful.

Adult↗
PubMed1984

[On-demand analgesia with tramadol in bilateral multiple rib fractures].

A 41-year-old woman sustained bilaterally multiple rib fractures in a severe car accident. She developed severe pain-related dyspnoea. On-demand analgesia with tramadol (by pressing a button the patient could self-administer single doses of 20 mg) rapidly decreased the pain and respiration became almost normal. Daily doses of about 400 mg were sufficient. The ability to self-administer the analgesic clearly was an important psychological factor in the good response to the usually relatively weakly effective opioid.

Adult↗
PubMed1993

Fractured rib with penetrating cardiopulmonary injury.

Described is an unusual injury, arising from a motorized vehicle accident, in which a detached fractured rib from a flail chest caused lung perforation and hemopericardium. The full diagnosis was only appreciated on computed tomography. Therefore, thoracotomy averted potential disaster.

Adult↗
PubMed1980

Epidural morphine. A method of management of multiple fractured ribs.

Epidural injection of morphine 2 mg in 10 ml was used as a method of analgesia in treatment of fractured ribs in six patients. This method was effective and appears to have advantages over the use of bupivacaine, both in terms of duration of action and lack of side effects such as hypotension.

Adult↗
PubMed2006

Acupuncture for central pain affecting the ribcage following traumatic brain injury and rib fractures--a case report.

This case report describes the use of acupuncture in the management of chronic central pain in a 51 year old man following severe traumatic brain injury and multiple injuries including rib fractures. The patient reported rapid and significant improvements in pain and mood during a course of acupuncture treatment. Chronic pain following traumatic brain injury is a significant problem. Chronic pain after rib fractures is also commonly reported. Acupuncture is widely used in the management of pain but its use has been reported rarely in the traumatic brain injury literature. This case report suggests that acupuncture may be a useful option to consider in these patients. Outcome was assessed formally using a 0-10 verbal numerical rating scale for pain, and the Hospital Anxiety and Depression Scale (HADS) for psychological status before and after the course of treatment. These scales are widely used in clinical practice as well as in research involving patients with traumatic brain injury, although they have not been validated in this population. The changes in this patient's outcome scores were not consistent with the benefits he reported. Treatment of this patient highlighted the difficulties of using standardised self rating scales for patients with cognitive impairment. The report also discusses the effects of acupuncture on this patient's mood.

Acupuncture Therapy↗
PubMed2005

Biomechanically based criteria for rib fractures induced by high-speed impact.

Biomechanically based correlations for rib fractures induced by high-speed impact were developed from animal studies, finite-element simulations, and statistical analysis. Using subject-specific finite-element models of swine thorax developed from medical images and customized for each animal subject, simulations were conducted for animal tests. The peak motions, internal forces, stresses, and strains were calculated for individual ribs. Statistical analysis then was used to determine represented variables that were statistically significant and that better fit the test data. The findings showed that the main loading modes during impacts are local bending and shearing. Stress-based variables fit the injury data very well. Strains also were relevant, but did not correlate with the data as well as stresses. The results also indicate that motion responses, such as displacement and velocity, and internal forces are not good correlates in high-speed impacts. The regression risk curves were developed using the stresses as correlates, and the threshold values are given consistent with bone strength data.

Acceleration↗
PubMed1995

Prediction of rib fracture injury outcome by an artificial neural network.

Outcome-based therapy is becoming the standard for assessing patient care efficacy. This study examines the ability of an artificial neural network to predict rib fracture injury outcome based on 20 intake variables determined within 1 hour of admission. The data base contained 580 patient records with four outcome variables: Length of hospital stay (LOS), ICU days, Lived, and Died. A 522-patient training set and a 58-patient test set were randomly selected. Nine networks were set up in a feed-forward, back-propagating design with each trained under different initial conditions. These networks predicted the test set outcome variables with an accuracy as high as 98% at the 80% testing level. Internal weight matrix examination indicated that age, ventilatory support, and high trauma scores were strongly associated with both ICU days and mortality. Being female, injury severity, and injury type were associated with increased LOS. Smoking and rib fracture number were low-level predictors of the four outcome variables.

Adolescent↗
PubMedDate not supplied

[The determination of the type of external exposure by rib fractures].

The paper deals with differential diagnosis of an external exposure (blow, compression) from rib fractures in chest trauma. New informative parameters of bone microdestruction in fracture zones which may serve as expert criteria for conditions of their formation are proposed. Registration of microfissures in thickness of rib compact plates and spongy substance on both sides of the basic fracture, their character, direction and original mosaic makes it possible to determine the type of an external exposure blow, compression) with high accuracy.

Adult↗
PubMed2004

Isolated first rib fracture in athletes.

Isolated fractures of the first rib are uncommon. They are caused by major blunt trauma, a violent muscular pull, or fatigue. Diagnosis is usually made by chest radiography and computed tomography. Angiography is justified when certain criteria are met. Treatment is rest and mild analgesia. Early and late complications have been reported and are treated accordingly. The purpose of this article is to report a case of first rib stress fracture in a kick boxer and review the pertinent literature.

Adult↗
PubMed1983

Rebound rib: stress-induced first rib fracture.

Reported are two cases of stress-induced fracture of the first rib in young, healthy basketball players. Presumably the fractures resulted from violent contraction of the scalene musculature. This is the usual method of production of stress-induced first rib fracture, but basketball-related cases have not been reported previously. This entity probably is underdiagnosed, and is amenable to conservative outpatient management in most cases.

Adolescent↗
PubMed2003

Continuous thoracic paravertebral infusion of bupivacaine for pain management in patients with multiple fractured ribs.

STUDY OBJECTIVE: To evaluate the efficacy of a continuous thoracic paravertebral infusion of bupivacaine for pain management in patients with unilateral multiple fractured ribs (MFR). DESIGN: Prospective nonrandomized case series. SETTING: Multidisciplinary tertiary hospital. PATIENTS: Fifteen patients with unilateral MFR. INTERVENTIONS: Insertion of a catheter into the thoracic paravertebral space. We administered an initial injection of 0.3 mL/kg (1.5 mg/kg) bupivacaine 0.5% with 1:200,000 epinephrine followed 30 min later by an infusion of bupivacaine 0.25% at 0.1 to 0.2 mL/kg/h for 4 days. MEASUREMENTS AND RESULTS: The following parameters were measured during the initial assessment before thoracic paravertebral block (TPVB), 30 min after the initial injection, and during follow-up on day 1 and day 4 after commencing the infusion of bupivacaine: visual analog pain score at rest and during coughing; respiratory rate; arterial oxygen saturation (SaO(2)); bedside spirometry (ie, FVC, FEV(1), FEV(1)/FVC ratio, and peak expiratory flow rate [PEFR]); arterial blood gas measurements; and O(2) index (ie, PaO(2)/fraction of inspired oxygen ratio). There were significant improvements in pain scores (at rest, p = 0.002; during coughing, p = 0.001), respiratory rate (p < 0.0001), FVC (p = 0.007), PEFR (p = 0.01), SaO(2) (p = 0.04), and O(2) index (p = 0.01) 30 min after the initial injection, which were sustained for the 4 days that the thoracic paravertebral infusion was in use (p < 0.05). PaCO(2) did not change significantly after the initial injection, but on day 4 it was significantly lower than the post-TPVB value (p = 0.04). One patient had an inadvertent epidural injection, and another developed transient ipsilateral Horner syndrome with sensory changes in the arm. No patient exhibited clinical signs of inadvertent intravascular injection or local anesthetic toxicity. CONCLUSION: Our results confirmed that continuous thoracic paravertebral infusion of bupivacaine is a simple and effective method of providing continuous pain relief in patients with unilateral MFR. It also produced a sustained improvement in respiratory parameters and oxygenation.

Adult↗