Trauma nursing 2: management of patients with rib fractures

Lucena-Amaro, Susana
Zolfaghari, Parjam

Susana Lucena-Amaro is matron, adult critical care unit, Royal London Hospital, Barts Health NHS Trust, and honorary lecturer in major trauma, City, University of London; Parjam Zolfaghari is consultant in intensive care medicine and anaesthesia, Royal London Hospital, Barts Health NHS Trust, and honorary senior lecturer, Queen Mary University of London.

Nursing Times 118(12):p 28-32, December 2022.

Abstract

Rib fractures are common after blunt trauma to the chest, accounting for 10% of hospital trauma admissions. Complications can be life threatening and can result from the initial impact, as well as from persistent acute pain impairing the ability to breathe effectively. Medical management remains largely conservative, and good outcomes rely on expert nursing care in a multidisciplinary team. Nursing care should focus on effective pain control to improve lung mechanics, prevent atelectasis and aid secretion clearance. Evidence shows that nursing interventions, patient monitoring and collaborative care are best delivered using standardised care processes with clear escalation pathways.

This article has been double-blind peer reviewed

In this article…

The injury characteristics of rib fractures and associated complications
Why and how to carry out respiratory assessment in this group of patients
The importance of proactive multimodal pain management

Key points

Rib fractures are common and can be life threatening if they are not treated

Each additional rib fracture increases the risk of death by 20%, especially in older people

Rib fractures are very painful, limiting the ability to breathe normally and cough

A proactive approach to pain management with multimodal analgesia is key

Protocolised care with early escalation in the case of respiratory distress and/or uncontrolled pain is important