Critical Care Scenarios Episode 50: Rib fractures and surgical plating with Ron Barbosa
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Aug 14, 2022 Join trauma surgeon Ron Barbosa, director of the trauma ICU in Portland, as he dives into the complexities of rib fractures. He discusses the nuances of ICU admissions versus ward placements, highlighting the limitations of traditional rules. Ron shares insights on multimodal pain control strategies and the importance of monitoring gradual respiratory deterioration. Delve into surgical rib fixation's indications and technique, alongside the importance of patient selection and outcomes. This conversation unveils critical insights for managing rib fracture cases.
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Coordinate Anticoagulation With Epidural Timing
- If planning epidural, adjust VTE prophylaxis timing: prefer once-daily dosing before placement and hold anticoagulation if placement imminent.
- Start chemoprophylaxis promptly unless epidural placement is clearly imminent.
Deterioration Can Be Delayed And Subtle
- Respiratory deterioration after rib fracture can be gradual and delayed up to a week or more.
- Barbosa notes monitoring trajectory matters more than a fixed inpatient-day threshold for ICU stay.
Assess Anatomy Early With 3D CT For Plating
- Evaluate surgical fixation (SSRF/rib plating) by both clinical need and anatomic accessibility; obtain 3D CT reconstructions for planning.
- Limit candidate ribs to roughly ribs 3–10 and avoid routine fixation of ribs 1–2 and 11–12.