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Management of the Trauma Patient’s Airway – Pearls and Pitfalls

Airway management is one of the most challenging and critical skills that the emergency medicine physician must master. This is particularly true in the setting of the trauma patient, where the ABCs of trauma evaluation begin with establishing the patency of the airway and ensuring adequate oxygenation and ventilation before moving through the remainder of the trauma algorithm. It is well known that delays in adequate airway management are one of the most common causes of preventable death in both the prehospital and emergency department setting.

intern report

Rib Fractures in the Elderly

Why is it important to aggressively and appropriately manage rib fractures in elderly trauma patients? Recently, an 82 year-old male suffered a fall from standing, striking his left posterior flank against a cinder block, sustaining fractures of the left 7th-11th ribs with displacement of the 8th-11th ribs, causing a moderate L hemopneumothorax. After placement of a chest tube, drainage of the hemothorax, and reinflation of the L lung, the patient was then transferred to our facility “for management of his rib fractures”. Given that this patient was going to be managed non-operatively, I found myself wondering why would this patient require transfer for such a seemingly common problem among trauma patients. Rib fractures are present in 10% of all traumas, and in 30% of chest trauma specifically. After assuming care of the patient, I quickly began to realize why this patient was given such a high level of attention. [...]