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Related Concept Videos

Flail Chest-II01:26

Flail Chest-II

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Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
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Flail Chest-I01:24

Flail Chest-I

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Overview of Flail Chest
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
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SBAR II: Application of SBAR01:14

SBAR II: Application of SBAR

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SBAR is an effective communication tool used by healthcare professionals to communicate patient information accurately. SBAR stands for Situation, Background, Assessment, and Recommendation. For a better understanding, an example is given below.
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
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Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care01:29

Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care

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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Standards of Care II01:19

Standards of Care II

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Nurses bear specific legal responsibilities under several federal statutes, including:
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Acute Respiratory Failure-II01:21

Acute Respiratory Failure-II

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Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
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Related Experiment Video

Updated: Apr 18, 2026

Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
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Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device

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Quantifying the Effect of the Rib Injury Guideline (RIG) Score Implementation at a Level I Trauma Center on Safety

Andrew Maneval1, Sophie Gonzalez1, Devon Callahan1

  • 1Division of Acute Care Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.

The American Surgeon
|April 16, 2026
PubMed
Summary

The Rib Injury Guideline (RIG) score reduced intensive care unit (ICU) admissions for elderly patients with rib fractures. This new guideline safely decreased ICU use without impacting patient outcomes or mortality.

Keywords:
Traumacritical caregeriatrics

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Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling
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Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
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Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling
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Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
06:57

Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome

Published on: September 13, 2020

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Area of Science:

  • Trauma Surgery
  • Geriatric Medicine
  • Critical Care Medicine

Background:

  • Rib fractures in elderly patients are associated with significant morbidity and mortality.
  • Previous guidelines recommended routine intensive care unit (ICU) admission for elderly patients with multiple rib fractures.
  • This practice led to potentially unnecessary ICU utilization.

Purpose of the Study:

  • To evaluate the impact of the novel Rib Injury Guideline (RIG) score on ICU admission rates for elderly trauma patients with rib fractures.
  • To assess the safety and efficacy of the RIG score in guiding patient disposition.
  • To determine if the RIG score could reduce ICU utilization without compromising patient outcomes.

Main Methods:

  • Retrospective review of trauma patients aged 65 years and older with at least one rib fracture admitted between January 1, 2020, and July 5, 2025.
  • Comparison of patient outcomes before (pre-RIG) and after (post-RIG) the implementation of the RIG score and its standardized smartphrase (SP).
  • Primary outcomes included ICU admission and unanticipated ICU upgrade; secondary outcomes included mortality and length of stay.

Main Results:

  • ICU utilization significantly decreased in the post-RIG cohort (37%) compared to the pre-RIG cohort (61%), particularly for patients with multiple rib fractures (38% vs. 67%).
  • There was no significant difference in unanticipated ICU upgrades between the two groups (1%).
  • Mortality, ICU length of stay, and hospital length of stay remained similar between the pre-RIG and post-RIG cohorts.

Conclusions:

  • Implementation of the RIG score, integrated with a standardized smartphrase, effectively reduced ICU admissions for elderly patients with rib fractures.
  • The RIG score demonstrated a favorable safety profile, with no increase in adverse events or compromise in patient outcomes.
  • The RIG score represents a valuable tool for optimizing resource allocation in geriatric trauma care for rib fractures.