Chest Pain (cont.)
What is the diagnosis and treatment for causes of chest pain?
Treatment for chest pain depends upon the cause. Many times, situations
require the evaluation, diagnosis and treatment occur at the same time, but
when there is opportunity, the sequence of history, physical examination,
testing, diagnosis, and treatment should be followed. A synopsis of common chest
pain presentations and treatments follows.
The Chest Wall
Broken or bruised ribs
Bruised or broken ribs are common injuries. Symptoms of broken or bruised
ribs include:
- Tenderness over the site of injury
- A broken rib may be palpated (the healthcare provider can feel the rib
fracture move when pressed)
- The pain tends to be pleuritic (it hurts to take a deep breath and can
be associated with shortness of breath).
- Because the surrounding muscles go into spasm, there is pain with any
movement of the trunk.
The healthcare provider will want to listen to the chest to make certain
that there is no associated lung damage. A
chest x-ray may be done to look for a
pneumothorax (collapsed lung) or pulmonary contusion (a bruised lung). Special
x-rays looking for rib fracture are not needed since the presence or absence of
a fracture will not alter recuperation. Special attention will be
given to the upper abdomen since the ribs protect the spleen and liver, to make
certain there are no associated injuries.
The major complication of rib injuries is pneumonia. The lungs work like
bellows. Normally, when one takes a breath, the ribs swing out and the diaphragm
moves down, sucking air into the lungs. Because it hurts to take a deep breath,
this mechanism is altered, and the lung underlying the injury may not fully
expand. The result is a potential breeding ground for a lung infection
(pneumonia).
Rib injury treatment:
- Pain control with anti-inflammatory
medications like ibuprofen and narcotic pain medications.
- Apply ice to the affected area and periodically deep take breaths. An incentive
spirometer may be provided to help visualize the amount of breath to take.
- Ribs
are no longer wrapped or taped to help with comfort because of the risk of
pneumonia.
- Whether broken or bruised, rib injuries take 3-6 weeks to heal.
Next: Costochondritis »
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