1. 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