Welcome to the Emergency Medicine Cases podcast. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.

EM cases is part of Shremi, the Schwartz-Riseman Emergency Medicine Institute. That's the nonprofit organization dedicated to improving EM care through high

quality research and education. The opinions expressed on this podcast are intended for general information and educational purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from a qualified practicing position. Unless stated otherwise, the opinions expressed by the hosts or guests are made in their individual capacity, not on behalf of the Institute nor Medicine cases. This is part two of our two-part series on geriatric trauma with Barbara Hoss,

Burke Tillman, and Camilla Wong. Institute nor medicine cases. This is part two of our two-part series on geriatric trauma with Barbara

Haas, Burke Tillman, and Camilla Wong.

In the last episode, we covered the CABCs, the under-triaging of older trauma

patients, some important physiologic and anatomic considerations, some injury patterns,

and some decision-making around head and C-spine injuries.

I'd like to now move down from the head and neck and talk about chest injuries in the older

trauma patient.

Now, in young people, an isolated rib fracture is generally not a serious injury, but in older people, a couple of rib fractures can

lead to death not so uncommonly. Dr. Wong, could you tell us more about why rib fractures are

so important to diagnose in older patients? Yeah, so we know that rib fractures in older adults are a strong predictor for mortality.

And even in those who don't die, many of them will go on to developing other complications

like pneumonia, respiratory failure resulting in, you know, the need for ventilation.

And so these are usually under-recognized, under-treated.

There's a lot of pain associated with the rib fractures.

And when the pain is suboptimally managed, this also leads to agitation and delirium.

And then obviously all the complications that are related to the management of agitation.

All right.

Now, does that apply to both a single rib fracture and multiple rib fractures?

I remember being taught that if it was multiple rib fractures, that's when you really need to worry

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