Splinting

When a patient has multiple rib fractures, the dreaded complication is actually pneumonia. Rib fractures are surprisingly painful, so much so that patients splint when taking a deep breath or coughing. Splinting is the sudden arrest of a breath, often quite involuntary. Instead of taking slow, deep breaths, these patients take shallow rapid breaths. We often have to coach them to take fuller breaths with a device called an incentive spirometer.

The issue is that coughing is the body's natural way of getting secretions up from deep within the lungs. If a patient can't cough, they can't clear these secretions, and that provides a perfect medium for an infection. While rib fractures and lung contusions are rarely life threatening, a bad pneumonia in a patient who can't take deep breaths or cough is quite serious. This is such a problem that we often place epidural catheters in trauma patients with multiple rib fractures or lung surgery patients in order to help the patient breathe deeply and cough.

On a hike over the weekend, I slipped and fell on a log, and probably had some sort of rib contusion as a result. Compared to multiple rib fractures, this is really nothing, but for the first time, I experienced splinting. When I take deep breaths or try to cough, I can feel my muscles tense up, resisting me because my body knows its going to hurt. I was surprised how involuntary this felt. I takes so much willpower just to do the simplest motions. Now I know have a little more empathy for my patients who have much bigger injuries.

Image showing rib fractures shown under Creative Commons Attribution Share-Alike License, from Wikipedia.