Managing Pain in Elderly Rib Fracture Patients (>65 years) - #9Take Quiz
Review an algorithm for pain management of rib fractures.
Hospitalized elderly patients with rib fractures.
Implement an effective pain management protocol for elderly patients hospitalized with rib fractures.
Rib fractures are a common injury for patients presenting to emergency departments with blunt thoracic trauma, with approximately 10% of these patients requiring admission to a trauma center. The Medicare Short-term Stay Survey from 2007 identified nearly 353,000 patients admitted with a rib fracture diagnosis code, with the true incidence of rib fractures likely higher as bony fractures within the thorax are often under-detected using traditional radiography (Simon et. al., 2005). Rib fractures are most often sustained during falls, traffic-related events involving motor vehicles and pedestrians, or crush events involving high energy loads. When rib fractures result from major trauma or high energy loads, concurrent injuries to the heart, lungs, liver and spleen are not uncommon. Mortality rates may range from 3-13% (Carrier et al., 2009), and as high as 18% in patients 65 years and older (Winters, 2009). Age and the number of rib fractures are the strongest predictors of mortality.
- Explain the underlying etiology of acute rib fracture pain in elderly patients.
- List pulmonary complications which may result from poor pain management.
- Apply the “Pain Plan” for elderly rib fracture patients correctly in patient care.
Review of Systems (ROS)
- Bulger EM, Arneson MA, Mock CN, Jurkovich GJ. Rib fractures in the elderly. J Trauma. Jun 2000; 48(6):1040-6. http://www.ncbi.nlm.nih.gov/pubmed/10866248
- Carrier FM, Turgeon AF, Nicole PC, Trepanier CA, Fergusson DA, Thauvette D, Lessard MR. Effect of epidural analgesia in patients with traumatic rib fractures: a systematic review and meta-analysis of randomized controlled trials. Canadian Journal of Anesthesiology 2009; 56(3):230-42. http://www.ncbi.nlm.nih.gov/pubmed/19247744
- Simon BJ, Chu Q, Emhoff TA, Fiallo VM, Lee KF. Delayed hemothorax after blunt thoracic trauma: An uncommon entity with significant morbidity. J Trauma 1998; 45:673-6. http://www.ncbi.nlm.nih.gov/pubmed/9783603
- Winters BA. Older adults with traumatic rib fractures: an evidence-based approach to their care. J Trauma Nurs. Apr 2009; 16(2):93-7. http://www.ncbi.nlm.nih.gov/pubmed/?term=older+adults+with+traumatic+rib+tractures+an+evidence+based+approach
- Lanza FL, Chan FK, Quigley EM. Guidelines for prevention of NSAID-Related ulcer complications. Am J gastroenterology 2009; 104(3):728-38. http://www.ncbi.nlm.nih.gov/pubmed/19240698
Users are free to download and distribute Geriatric Fast Facts for informational, educational, and research purposes only. Citation: Jeremy Juern MD, John Petronovich, Travis Webb, MD, Kathryn Denson MD, Bambi Wessel - Fast Fact #9: Managing Pain in Elderly Rib Fracture Patients (>65 years) , February 2012.
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