Genesys Regional Medical Center
Trauma and Emergency Services
Pain Management Guidelines in Blunt Thoracic Trauma
Definition: Blunt thoracic trauma is defined in these guidelines as soft tissue trauma and
injuries to the bony thorax such as rib fractures and flail chest.
Preferred interventions: Pain control, chest physiotherapy, incentive spirometry and early
mobilization are the preferred interventions for blunt thoracic trauma.
Epidural analgesia is the optimal modality of pain relief for blunt chest wall injury and is the
preferred technique after severe blunt thoracic trauma
Indications:
1.
2.
Patients with 4 or more rib fractures, who are > 65 years of age should
receive epidural anesthesia
Younger patients with 4 or more rib fractures or patients aged > 65 with
lesser injuries should be considered for epidural anesthesia.
Method:
1.
2.
3.
4.
5.
6.
7.
Do not start Lovenox on patients with rib fractures.
Lovenox may not be given for 24 hours before or after insertion of an epidural
catheter.
May use Heparin 5000 units subcutaneously q 8 hours
Call Anesthesia main pager at 972 0227
Anesthesia will assess patient, obtain informed consent, choose appropriate
medication and perform procedure.
For break through pain
a. call trauma surgery to assess reason for increasing pain
b. call anesthesia to assess and treat.
Anesthesia will round on patient daily.
Adjuncts to pain control:
1.
All patients with rib fractures not on the ventilator should perform Incentive
spirometry every hour while awake.
2.
Unless contraindicated by hemodynamic status, orthopedic or spinal column
or cord injuries, all patients should be up in chair and preferably ambulated at
least 3 times in 24 hours.
3.
Oxygen protocol
Monitoring:
1.
Continuous pulse oximetry
2.
Breath Sounds every 4 hours
3.
Temperature every 4 hours
2005
Revised June 2007