Rib Fractures

Rib fractures are painful skeletal injuries, but their immediate clinical significance is respiratory. Pain with every inspiration encourages splinting: tidal volumes fall, the cough becomes ineffective, secretions accumulate, and atelectasis can develop. The original force may also have injured the lung or pleura, and pulmonary contusion can become more apparent over the next 48–72 hours. A patient who initially has a normal oxygen saturation may therefore deteriorate later. At the bedside, pair the pain assessment with a breathing assessment. Ask whether the patient can take a deep breath and cough, then examine respiratory rate, work of breathing, chest-wall symmetry, breath sounds, and room-air SpO₂ when safe. Focal tenderness supports the diagnosis but does not exclude pneumothorax, hemothorax, pulmonary contusion, or abdominal injury from lower-rib trauma. Treatment has two simultaneous aims: restore effective ventilation without excessive sedation, and detect associated injury or delayed respiratory decline. Regional blocks and surgical stabilization require an appropriately credentialed anesthesia or trauma team and must follow local Canadian policy and privileging.