Take a deeo breath and…

Sunday, August 19, 2007

Chest wall injuries can be tough stuff when it comes to pain and the basic function of breathing. If it weren’t for football players, that sales pitch at the bedside would be a lot harder. Most people can understand when a player goes down with a knee, ankle or shoulder injury, but sometimes can’t understand why rib contusions keep these armor plated athletes out for 4-6 weeks.

Rib injuries tend to be common in people when they fall, or bump up against things. When a patient shows up to their doctor’s office or to the ER, the question asked is: “Do I have a rib fracture.” The doctor, who seems not to listen says:” It doesn’t really matter. I’ll take an x-ray of your chest and make certain things are OK.” But the patient wants to know about the ribs. Shouldn’t the doc find out?

The rest of the story. We breathe like a bellows. Air is sucked into the lungs as the ribs swing out and the diaphragm pushes down. All works well until the ribs get hurt. Like any other injury site, the muscles around the area go into spasm for protection. This makes it hard for the bellows to work and for us to breathe.

The doc orders a chest x-ray to see if the lung underneath the injury site is damaged, either collapsed or bruised. If a rib fracture is seen, that’s a bonus, but there isn’t a need to order detailed rib films because it just doesn’t matter. Whether the ribs are broken or just bruised, the pain of injury breaks down the breathing mechanism.

Unlike injuries elsewhere, the treatment is different and demanding. I can give a patient a sling to rest an arm injury or put them on crutches for their ankle, but I can’t tell them to stop breathing. If the patient doesn’t take deep breaths, pneumonia can set in. It’s the major complication of chest wall and rib injury, because by not taking deep breaths, the lung can’t expand and clear its usual secretions. Dark, warm spaces that aren’t well ventilated are a set up for infection; think of your basement.

The treatment of rib injury is ice, ibuprofen and pain medication, so that the patient can take a deep breath and it’s going to hurt for a long time. Because you have to breathe 12-14 times a minute, the injured area moves that many times and never has a chance to fully heal. That’s why it takes 4-6 weeks for football players to come back from this injury, broken or bruised.

Recovery is also hampered because just moving will hurt. Getting out of bed requires the trunk muscles to twist, reaching up to get a glass from the cupboard will hurt, reaching down to tie shoes will hurt. Life in general will hurt, including and especially breathing. That’s why patients may also get an incentive spirometer to use. It’s a little plastic toy that is also used by people after surgery to give visual cues to take a deep breathe, because and not to belabor the point, it will hurt to breathe and in my experience, breathing is a good thing.

A little housekeeping. Pneumonia is an infection of the lung. It presents with shortness of breath, cough and fever.

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Take a deeo breath and…

Chest wall injuries can be tough stuff when it comes to pain and the basic function of breathing. If it weren’t for football players, that sales pitch at the bedside would be a lot harder. Most people can understand when a player goes down with a knee, ankle or shoulder injury, but sometimes can’t understand why rib contusions keep these armor plated athletes out for 4-6 weeks.

Rib injuries tend to be common in people when they fall, or bump up against things. When a patient shows up to their doctor’s office or to the ER, the question asked is: “Do I have a rib fracture.” The doctor, who seems not to listen says:” It doesn’t really matter. I’ll take an x-ray of your chest and make certain things are OK.” But the patient wants to know about the ribs. Shouldn’t the doc find out?

The rest of the story. We breathe like a bellows. Air is sucked into the lungs as the ribs swing out and the diaphragm pushes down. All works well until the ribs get hurt. Like any other injury site, the muscles around the area go into spasm for protection. This makes it hard for the bellows to work and for us to breathe.

The doc orders a chest x-ray to see if the lung underneath the injury site is damaged, either collapsed or bruised. If a rib fracture is seen, that’s a bonus, but there isn’t a need to order detailed rib films because it just doesn’t matter. Whether the ribs are broken or just bruised, the pain of injury breaks down the breathing mechanism.

Unlike injuries elsewhere, the treatment is different and demanding. I can give a patient a sling to rest an arm injury or put them on crutches for their ankle, but I can’t tell them to stop breathing. If the patient doesn’t take deep breaths, pneumonia can set in. It’s the major complication of chest wall and rib injury, because by not taking deep breaths, the lung can’t expand and clear its usual secretions. Dark, warm spaces that aren’t well ventilated are a set up for infection; think of your basement.

The treatment of rib injury is ice, ibuprofen and pain medication, so that the patient can take a deep breath and it’s going to hurt for a long time. Because you have to breathe 12-14 times a minute, the injured area moves that many times and never has a chance to fully heal. That’s why it takes 4-6 weeks for football players to come back from this injury, broken or bruised.

Recovery is also hampered because just moving will hurt. Getting out of bed requires the trunk muscles to twist, reaching up to get a glass from the cupboard will hurt, reaching down to tie shoes will hurt. Life in general will hurt, including and especially breathing. That’s why patients may also get an incentive spirometer to use. It’s a little plastic toy that is also used by people after surgery to give visual cues to take a deep breathe, because and not to belabor the point, it will hurt to breathe and in my experience, breathing is a good thing.

A little housekeeping. Pneumonia is an infection of the lung. It presents with shortness of breath, cough and fever.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.