Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Pain control in a patient with rib fractures and a spinal cord transsection

Ralph Gordon, MD
Physician
June 1, 2011
15 Shares
Share
Tweet
Share

When I was called to see the patient after a motorcycle accident I expected the worst. The patient sustained a thoracic spine injury with cord transsection at T5 level as well as significant chest wall injury on the right side.

Multiple ribs were broken; some with a significant displacement. Managing patients with a significant chest wall trauma could be a nightmare. Pain control is only one of the challenges.

Mechanics of the respiratory mechanism is impaired. Patients often are unable to take a deep breath and fully expand their lungs. Clearance of the secretions is a concern as well. Many patients with severe chest wall injury succumb to pneumonia and respiratory failure.

To facilitate pulmonary clearance, improve pain control and pulmonary mechanics chest wall stabilization has become a practical option. The technique of realigning and stabilizing ribs with metal plates is yet to be widely adopted. I have witnessed on multiple occasions that the patients with a stabilized chest do better and recover faster then the patients treated conservatively.

I was surprised to see that the patient was, actually, doing Ok from the respiratory standpoint. He was describing that he could feel his whole right side of the chest shifting when he was being moved. Besides that, pain was not a major issue and his respiratory status, otherwise, was stable.

The explanation for this surprising “wellness” was not in any way satisfying. He also sustained a severe spine injury with cord transsection at T5 level. His sensory level was just below his nipples. The patient simply could not feel the pain from the chest injury.

In no way I can call it even a mixed blessing. Most of us would likely take severe pain over being paralyzed.

It did make me think, nevertheless, about the importance of pain control in these trauma patients. Huge doses of narcotics are often unable to control the discomfort. Epidural analgesia is frequently employed to alleviate the pain. Some centers even utilize pain control techniques like intercostal blocks to achieve analgesia.

Ralph Gordon is a critical care physician who blogs at realICU.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

Practical advice for medical students starting clinical rotations

June 1, 2011 Kevin 3
…
Next

Work should be about optimizing your productivity and health

June 1, 2011 Kevin 1
…

Tagged as: Emergency Medicine, Patients, Specialist

Post navigation

< Previous Post
Practical advice for medical students starting clinical rotations
Next Post >
Work should be about optimizing your productivity and health

More by Ralph Gordon, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Navigating the path of contradictory medical opinions

    Ralph Gordon, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Do Not Resuscitate and the need for a central line

    Ralph Gordon, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Intubating the combative patient

    Ralph Gordon, MD

More in Physician

  • The power of business knowledge for medical professionals

    Curtis G. Graham, MD
  • Using the language of art to create work-life balance

    Sarah Samaan, MD
  • Lively communication in the service industry

    Deepak Gupta, MD
  • Reigniting after burnout: 3 physician stories

    Kim Downey, PT
  • Inside the grueling life of a surgery intern

    Randall S. Fong, MD
  • The shifting landscape of gastroenterology manpower and compensation

    Brian Hudes, MD
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Out-of-office infusions in oncology care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Balancing motherhood and medicine [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Misunderstandings about opioid use disorder

      Amy Baxter, MD | Conditions
  • Recent Posts

    • Out-of-office infusions in oncology care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The power of business knowledge for medical professionals

      Curtis G. Graham, MD | Physician
    • Using the language of art to create work-life balance

      Sarah Samaan, MD | Physician
    • Levamisole is good for your dog, but bad for your cocaine

      Robert Killeen, MD | Meds
    • Physician autonomy and patient interactions in corporate health care

      Michele Luckenbaugh | Conditions
    • PSA screening: What you need to know [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Vascular Conditions Offer No Clarity on Pollution-Dementia Link
  • FDA Staff Voice Serious Concerns About Investigational ALS Cell Therapy
  • Primary Prevention Benefits of Lowering LDL Also Apply to the Elderly
  • Doctors Should Stay Away From 'Grateful Patient' Fundraising
  • AI System Outperforms Standard Review of Imaging for Retinal Disease

Meeting Coverage

  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • ERS Roundup: Cell Transplant Boosts Lung Function in COPD Patients
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Out-of-office infusions in oncology care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Balancing motherhood and medicine [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Misunderstandings about opioid use disorder

      Amy Baxter, MD | Conditions
  • Recent Posts

    • Out-of-office infusions in oncology care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The power of business knowledge for medical professionals

      Curtis G. Graham, MD | Physician
    • Using the language of art to create work-life balance

      Sarah Samaan, MD | Physician
    • Levamisole is good for your dog, but bad for your cocaine

      Robert Killeen, MD | Meds
    • Physician autonomy and patient interactions in corporate health care

      Michele Luckenbaugh | Conditions
    • PSA screening: What you need to know [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...