The Ottawa Hospital Pathway For Early Intervention In Rib Fracture Patient with rib fracture(s) HIGH RISK PATIENTS are patients with any one of the following characteristics: > 4 rib fractures 65 years old or greater History of: Coronary Artery Disease Congestive Heart Failure Pulmonary Disease Obesity BMI > 40 Diabetes Patient intolerant of opioids Assess pain and oxygenation every 2 hours Ensure multimodal analgesia and bowel regimen prescribed for all patients High Risk? Or Severe Pain? Does the patient require > 4 L/min O2 to maintain SpO2 > 96% START HERE NO YES NO Refer for Anesthesia / RT assessment (possible BiPAP/CPAP). Ensure NPO >6 hrs YES Refer to APS (consideration for epidural / paravertebral). Hold anti-thrombotic / anti-platelet agents