Episode 36 - Rib and Sternal Fractures

Point-of-care ultrasound serves as an effective bedside tool for diagnosing rib and sternal fractures by identifying cortical disruptions, though clinicians must avoid misinterpreting the sternomanubrial joint as a fracture. Beyond diagnosis, managing rib fractures requires aggressive analgesia and pulmonary hygiene to prevent "pulmonary embarrassment"—complications like pneumonia or respiratory failure. Risk stratification is critical; patients with three or more rib fractures, advanced age, or underlying lung disease face higher morbidity and may require transfer to level one trauma centers. Blunt cardiac injury, while rare, warrants evaluation with an EKG and potentially troponin levels in symptomatic patients. Finally, pulmonary contusions showing opacification on CT within twelve hours of blunt trauma indicate a higher risk for acute lung injury, necessitating careful monitoring and positioning to optimize respiratory function.