Year: 2024
Type: article
Study design: Case Report
Abstract: An adult patient presented after a high-speed motor vehicle collision with left 7–10 rib fractures and left hemopneumothorax. At the transfer facility, they required chest tube placement and intubation due to hypoxia. The patient was admitted to our intensive care unit (ICU) and was successfully extubated on hospital day 1. Of note, the patient had a history of pelvic radiation, and their home chronic pain regimen included the following: 80 mg oxycodone extended release and hydrocodone taken as needed 10–325 up to 8 pills per day. The pain service was consulted on hospital day 1, and despite an erector spinae plane block and epidural analgesia catheter placement, the patient experienced two uncontrolled pain crises overnight. The trauma service requested a new CT chest with 3D reconstruction on hospital day 3, which revealed multiple oblique fractures with displacement of ribs 7–10 ( figure 1). Worsening atelectasis further underscored the need for intervention. Per the Chest Wall Injury Society Guideline, the patient did not meet the traditional criteria for rib plating at admission or with the new CT chest.1 The patient had >3 ipsilateral acute rib fractures within ribs 3–10 with >pulmonary physiologic derangements (pain score >5/10 and poor cough) despite locoregional anesthesia and multimodal pain therapy; however, the ribs were not severely displaced (≥50% of the rib width on axial CT). The patient’s acute pain crisis has now prompted a re-evaluation of their management strategy.
Source: Trauma Surgery & Acute Care Open
Institutions: Rocky Vista University, University of Colorado Anschutz
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,100
OpenAlex ID: W4401454645