Resource

Under Review

Under Review

09/07/25

09 July 2025

Secondary survey - Chest including clavicles, ribs and sternum

NAIF Post Fall Medical Examination 05 Chest

i. History

  • Was there direct impact onto the chest wall? Is the patient experiencing pain, shortness of breath, hypoxia?

 

ii. Examination

Observe for:

  • increased work of breathing, expansion, asymmetrical or abnormal breathing
  • contusions and haematomas
  • distended neck veins (can be caused by tension pneumothorax or cardiac tamponade).

Feel for:

  • crepitus (indicates subcutaneous emphysema due to pneumothorax), expansion, chest wall tenderness, tracheal deviation.

Percuss: is there hyper- or reduced resonance?

Auscultate: symmetrical air entry throughout? Added sounds? Heart sounds? 

 

iii. Investigation

Consider a CT chest to diagnose rib fractures and lung contusions.

 

iv. Management

Rib fractures in the older patient should raise significant concern, as the incidence of pneumonia and mortality is significantly higher than in younger patients (17). Proactive pulmonary hygiene, e.g. chest physiotherapy within 24 hours (18), and analgesia are the mainstays of treatment to optimise ventilation and reduce complications. Access to regional or neuroaxial blocks is highly recommended, and therefore referral to pain/anaesthetic services to review the patient should be considered (19).

Use of risk scoring, such as the Battle score, can help identify those patients requiring a higher level of care and consideration of treatment escalation plan.

Follow local trauma network pathways for management of rib fractures to ensure access to appropriate specialist input.

Go back to main resource: Post-fall medical examination explanatory notes