What are the discharge instructions for a patient with a rib fracture?

Discharge Instructions for Rib Fractures

Patients with rib fractures should receive comprehensive discharge instructions focusing on pain management, respiratory care, activity guidelines, and warning signs to monitor, as these interventions reduce complications and improve outcomes.

Pain Management

• Oral acetaminophen should be administered regularly every 6 hours as first-line treatment for rib fracture pain 1
• NSAIDs can be used as second-line treatment for patients with severe pain, considering potential adverse events and drug interactions 1
• Ketorolac may be considered for additional pain control in moderate rib fracture pain without high-risk factors 2
• Low-dose ketamine (0.3 mg/kg over 15 minutes) can be used as an alternative to opioids for severe pain 1
• Avoid ketorolac in patients with aspirin/NSAID-induced asthma, pregnancy, or cerebrovascular hemorrhage 2

Respiratory Care

• Instruct patients to perform deep breathing exercises every 1-2 hours while awake to prevent atelectasis 3
• Use of incentive spirometry should be encouraged, aiming for >50% of predicted volume 1
• Monitor for respiratory rate >20 breaths per minute, which may indicate respiratory compromise 4
• Teach effective coughing techniques to clear secretions while supporting the injured area 1
• Splinting the chest with a pillow during coughing can help reduce pain 3

Activity Guidelines and Recovery Timeline

• Inform patients that rib fractures typically heal within 6-8 weeks, but complete recovery may take up to 2 years in some cases 1
• Gradual return to normal activities should be encouraged as pain allows 1
• Avoid strenuous activities and heavy lifting for at least 4-6 weeks 5
• Return to work may be possible within 8-12 weeks for simple fractures and up to 6 months for complex injuries 1
• Sleeping in a semi-upright position may help reduce pain 3

Warning Signs to Monitor

• Instruct patients to seek immediate medical attention for:
  • Worsening shortness of breath or difficulty breathing 1
  • Increasing chest pain not controlled by prescribed medications 1
  • Fever above 100.4°F (38°C), which may indicate pneumonia 3
  • Coughing up blood or yellow/green sputum 6
  • Dizziness, confusion, or extreme fatigue 1

Special Considerations for High-Risk Patients

• Patients over 60 years of age have increased risk of complications and should be monitored more closely 1
• Each rib fracture in elderly patients increases the risk of developing pneumonia by 27% and the risk of mortality by 19% 3
• Patients with multiple (≥3) rib fractures, flail chest, or pulmonary contusion are at higher risk for complications 1
• Patients with chronic respiratory disease, obesity, or on anticoagulation therapy require more vigilant monitoring 1
• Consider earlier follow-up appointments for high-risk patients 1

Follow-up Care

• Schedule follow-up appointment within 1-2 weeks of discharge 6
• Pain should show significant improvement by 4 weeks post-injury with appropriate management 1
• Consider imaging at follow-up visits to monitor healing in cases of severely displaced fractures 4
• Evaluate for chronic pain syndromes, which develop in up to 40% of patients 1
• Assess for non-union (failure to heal), which occurs in approximately 1-5% of cases and may require surgical intervention 1

Surgical Considerations

• Patients with flail chest (≥2 consecutive ribs each fractured in ≥2 places) may benefit from surgical fixation 4
• Surgical fixation should be considered for patients with severe refractory pain or chest wall deformity 1
• Multiple (≥3) ipsilateral severely displaced rib fractures may warrant surgical evaluation 4
• Surgical stabilization performed within 48-72 hours of injury can shorten recovery time in selected patients 1
• Inform patients that surgical fixation is associated with lower pain scores and faster return to work in appropriate candidates 7