![]() ![]() Significant and uncontrolled pain contributes to splinting, guarding, low tidal volumes, decreased mobility, insufficient ability to cough and clear secretions, and inability to participate in chest physiotherapy. Chest wall pain resulting from multiple rib fractures can exacerbate pulmonary complications associated with blunt thoracic injury. As a result, rib fractures are associated with significant pain. The chest wall is highly innervated by pairs of intercostal nerves traveling along the inferior border of each rib. In this review, we will provide an overview of the evidence and current recommendations for the management of these types of chest trauma, with a particular emphasis on pain management for rib fractures, and changes to the recommended management of tension pneumothorax. Other common examples of chest injury encountered in anesthetic practice include pneumothorax, for which there have been some recent important changes to the recommended management, hemothorax, and injury to the heart and great vessels. The mainstay of this management includes pulmonary hygiene, early mobility, and, importantly, excellent analgesia, which anesthesiologists can directly influence. Optimal management of rib fractures can prevent complications and reduce associated mortality. With the significant amount of force required to break ribs and the associated energy transfer, damage to underlying tissues occurs resulting in injuries such as pulmonary contusions. ![]() This most commonly occurs at the posterior aspect of the rib, the weakest point. The most common presentation of blunt chest trauma is rib fractures. This can be due to the injury itself or because of the development of secondary complications, such as respiratory failure and pneumonia. ![]() Patients suffering from chest trauma are at high risk of developing significant morbidity and mortality. Chest trauma resulting from blunt or penetrating mechanisms is common, occurring in approximately 10% of patients admitted to hospital following injury. ![]()
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December 2022
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