Rib Plating and Thoracic Lab

Logistics and Sponsor: 

EPA Addressed: 

Supplies needed: 

Goals and Objectives

Goals:

Objectives:

Clinical Scenarios

Scenario #1:

A 45-year-old male was the unrestrained driver in a high-speed motor vehicle collision. EMS had to extricate the patient and the stearing wheel was bent. He presented with severe chest pain as his only complaint. He is protecting his airway. He has blunted breath sounds bilaterally, crepitus over the right chest with paradoxical motion of his right lateral chest and saturations at 90% despite 15L O2 on a non-rebreather mask. He has good distal pulses with a blood pressure of 145/90 and a heart rate of 110 bpm without ectopy. There are no other signs of trauma. Initial chest x-ray demonstrates multiple rib fractures bilaterally including left 4-7 non-displaced anterolateral rib fractures and right 3-9 displaced anterolateral rib fractures with 4-8 broken posteriorly with minimal displacement. He has a hemopneumothorax on the right and a pneumothorax on the left. 

Scenario #2:

A 32-year-old male is brought to the emergency department by ambulance after sustaining a gunshot wound to the left anterior chest during an altercation. On arrival, he is visibly pale and diaphoretic. His vital signs are: blood pressure is 85/55 mmHg, heart rate 135 beats per minute, and respiratory rate 28 breaths per minute. He is protecting his airway but has tracheal deviation to the right. On auscultation, breath sounds are diminished on the left side, and there is evidence of subcutaneous emphysema. Chest examination reveals a 2-cm gunshot wound just below the left nipple. 1 unit of whole blood increases the blood pressure to 95/60, but his heart rate stays at 135 bpm. eFAST demonstrates a left pneumothorax with a large associated pleural effusion, no pericardial effusion, and no intraabdominal fluid. 

Scenario #3:

A 28-year-old female presents to the emergency department following a stab wound to the precordial region sustained during an altercation at a local gas station. Upon arrival, she is confused and in significant distress. Her initial vital signs reveal a blood pressure of 80/50 mmHg, a heart rate of 130 beats per minute, and a respiratory rate of 26 breaths per minute. Physical examination shows a 1.5-cm stab wound located just inferior to the left nipple, with surrounding ecchymosis. Cardiac auscultation reveals distant heart sounds, and there is evidence of jugular venous distension. A focused assessment with sonography for trauma (FAST) reveals a pericardial effusion with signs of tamponade physiology. 

Instructional Resources

Primary resources:

Additional resources:

ribfix_advantage_surgical_tech.pdf
ribfix_titan_surgical_technique.pdf
sternalock_blu_surgical_techni.pdf

Mock Orals

Scenarios are made up, and any similarity to real cases is by coincidence only. 

Checklists