A follow-up chest x-ray should be taken of patients with fractures of two or more ribs even if the first x-ray showed normal lungs. The strapping must not impede respiratory function. #Broken or fractured rib symptoms skin#
Skin friendly adhesive material can be used here.
In some cases, supporting the fracture area locally with strapping can relieve the pain. The patient should be advised to return to the emergency department immediately if they experience breathing difficulties again after discharge. The pain will continue for the next few weeks, subsiding gradually and controllable with analgesics. A rib fracture is often disturbingly painful at first. Injection of bupivacaine (3–5 ml under the lower costal margin video «Diagnosis of rib fracture and intercostal nerve block» 1) will give pain relief for several hours and can be repeated if necessary. There is no time to lose if the patient is tachycardic, breathing shallowly, anxious, has a greyish skin colour and is clearly in a bad state. If symmetrical breath sounds are heard from the lungs but the patient is cyanotic and in a poor condition, with bulging jugular veins, the patient may be suffering from cardiac tamponade. Introduce the cannula on the side with absent breath sounds. In an emergency situation the decision about thoracocentesis must be made based on auscultation findings if immediate imaging is not available. 
Acute tension pneumothorax should be released with the thickest venous cannula if no other equipment is at hand.
Pneumothorax «Pneumothorax» 1 and haemothorax should be treated with a chest tube placed by tunnelling. In patients with flail chest, respiratory support is needed (if conscious, using a CPAP mask if unconscious, by intubation and ventilation). If clinical examination reveals widespread tenderness around the injury site and the energy involved was significant, the patient should be referred for treatment at hospital even if no rib fractures have been confirmed. The risk of bleeding is increased as well. 
In fractures of two or more ribs, the energy involved in the injury will have been so high that pleural rupture and development of pneumothorax are possible.
In multiple rib fractures, follow-up observation and treatment require observation or hospitalization in the initial phase.The patient should not hesitate to contact the emergency department again if the symptoms get worse. A low-energy uncomplicated fracture of one rib can usually be treated at an outpatient clinic.
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