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First aid for rib impacts

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First aid for rib impacts

Old 09-10-15, 03:41 PM
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treesloth
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First aid for rib impacts

Starting off, please let me know if there's a proper specialized forum for this. I didn't see one.

I'm a ride leader for a high school mountain biking team. I've been surprised at how many rib impact incidents there have been. One kid actually managed to noticeably bend a pretty beefy handlebar with his ribs. So, I've realized I don't really know how to administer first aid for rib impact injuries. There's a lot of information out there for, "So, you have broken ribs! Here's what to do." and "So, you have bruised ribs..." and so on. But those assume that the diagnosis is already made. What they don't do is something like, "So, you've just taken a serious impact to the ribs. Here's what to do." I'm not sure how to tell if ribs are fractured, bruised, etc. Any suggestions on good places for information that let you assess, in the field, the type of injury and then administer first aid? I suppose the field treatments might be the same for either type of injury, but I'd rather not assume when there's the potential for something sharp and pokey getting driven into a lung. Thanks in advance.

Please note that I'm talking about first aid. I have found sites that say, for example to pull out your trusty X-ray and start snapping pictures. I often forget to put that in my backpack. ;-)

Last edited by treesloth; 09-10-15 at 03:45 PM.
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Old 09-10-15, 04:23 PM
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The only first aide I can think of is ice and rest.
Even when ribs are cracked they don't do anything but pain meds, and anti inflammatories.
The days of taping up sore or cracked ribs ended when the risk of pneumonia was realized and that trumped the rib injury.
Perhaps you should find a less technical trail.
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Old 09-10-15, 05:48 PM
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Originally Posted by treesloth View Post
I'm a ride leader for a high school mountain biking team. I've been surprised at how many rib impact incidents there have been. One kid actually managed to noticeably bend a pretty beefy handlebar with his ribs. So, I've realized I don't really know how to administer first aid for rib impact injuries. There's a lot of information out there for, "So, you have broken ribs! Here's what to do." and "So, you have bruised ribs..." and so on. But those assume that the diagnosis is already made. What they don't do is something like, "So, you've just taken a serious impact to the ribs. Here's what to do." I'm not sure how to tell if ribs are fractured, bruised, etc. Any suggestions on good places for information that let you assess, in the field, the type of injury and then administer first aid? I suppose the field treatments might be the same for either type of injury, but I'd rather not assume when there's the potential for something sharp and pokey getting driven into a lung. Thanks in advance.

Please note that I'm talking about first aid. I have found sites that say, for example to pull out your trusty X-ray and start snapping pictures. I often forget to put that in my backpack. ;-)
Take a first aid class!!!!!! Get certified!!!!!

If you are a ride leader for a high school mountain biking team, full first aid certification should be an absolute non-negotiable requirement.

Contact St Johns Ambulance or Red Cross right now ... before you lead another ride ... and get signed up for the top level certification.
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Old 09-10-15, 05:50 PM
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And + 1000 to what Machka said.

If it hurts like hell, first and foremost call 911. The golden hour is very important since you don't have the benefit of the X-ray machine. There is no first aid for something you can't see. https://en.wikipedia.org/wiki/Golden...%28medicine%29

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Old 09-10-15, 07:06 PM
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Originally Posted by FBOATSB View Post
And + 1000 to what Machka said.

If it hurts like hell, first and foremost call 911. The golden hour is very important since you don't have the benefit of the X-ray machine. There is no first aid for something you can't see. https://en.wikipedia.org/wiki/Golden...%28medicine%29
True.
Also, another reason to call 911 is difficulty with breathing.
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Old 09-10-15, 07:23 PM
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Originally Posted by JanMM View Post
True.
Also, another reason to call 911 is difficulty with breathing.
Yes, pneumothorax (aka "collapsed lung") is a known risk after rib injuries.

Don't ask how I know…
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Old 09-10-15, 07:32 PM
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Having broken ribs while riding I can state that it's extraordinarily difficult to diagnose severity of a rib injury without an x-ray. Even then, some minor fractures don't show up for a week or so after swelling has gone down. In my experiences, the difference between broken and bruised USUALLY is that a break still feels very painful after two weeks. That can be misleading though and I well recall getting a chest x-ray once with the doctor asking me when I broke a rib in the front. I recall well the fall, but never experienced the same level of pain that I've had with bruises. Such is rib injuries.

It's a complete crap shoot as to a diagnosis on scene. If the rider is obviously in severe pain and disabled, then a 911 call is obviously warranted. ***** is, for a young athlete who's never experienced this kind of injury, you just don't know how serious and have no choice but to assume the worst, lung puncture, etc.., thus need to stop the ride and either walk the injured out, or call for help, and that's a tough call on scene.

Certainly a first aid course is warranted, if only for legal reasons, as BTW.
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Old 09-10-15, 07:53 PM
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I'd go beyond first aid certification to suggest CPR plus EMT1 (Emergency Medical Technician) if you are responsible for high school kids in an off road riding situation.

In the meantime, get a kid with chest pain from ribs or any other cause to the ER as fast as possible. There are other complications that can occur besides a pneumo, such as flail chest, etc.
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Old 09-10-15, 09:39 PM
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One of the things you'll learn in the First Aid courses these days is that they have a fairly "hands off" approach. For most things, the advice is to ring your emergency number (000 here in Australia) and get an ambulance on the way.

But there are some practical tips you'll learn ... and as mentioned, it is a requirement to have that certification if you're going to work with kids.
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Old 09-10-15, 09:55 PM
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The pain alone can be serious... I had a wreck about a month ago. After ten days my road rash and bruises were healing up but my bruised ribs seemed to be getting worse. I took myself into urgent care for an x-ray, but they found nothing. It still hurts. It kept me off the bike for two weeks and off the mountain bike til now, though I'd go now if it weren't so hot.

I think it would be good for you to study up on the sort of trauma that often comes with bikes and mountain bikes, not just general first aid. Road rash, busted ribs, wrists, arms and elbows, collarbones, jaws, big lacerations, spine and head injuries should all be on the menu.
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Old 09-10-15, 10:16 PM
  #11  
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I suffered a pneumothorax from a bad fall during tennis match and another from a bike crash. It's easy to get something serious from impacts to the chest. Get training and have all the emergency numbers available.
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Old 09-11-15, 12:25 PM
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Originally Posted by Machka View Post
Take a first aid class!!!!!! Get certified!!!!!

If you are a ride leader for a high school mountain biking team, full first aid certification should be an absolute non-negotiable requirement.
Thanks for the reply. We are all first aid certified, I carry a FAK, and know how to use it. In fact, recerts are later this month. However, in the first aid course, there was less information on how to assess different types of rib injuries in the field than I would have liked; hence my question. As it happens, we have a coach that is an EMT (don't recall the level... whichever one is able to prescribe what he said was a "very limited" range of medications?). He was able to tell pretty quickly that was ok to move the rider I responded to, which was my (less confident) assessment as well. That was nice, and saved a 911 call. But, what I'm looking for now is for my own education. Again, thanks for the reply, and please don't worry that we have a bunch of unprepared ride leaders taking kids into the wilderness. There was a considerable set of certifications required before I ever took a ride.
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Old 09-11-15, 09:05 PM
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It's tricky even for the docs. The best thing they could tell from the X-Ray for me after my crash was at least one broken rib and at least one, maybe two cracked ribs. The first doctor thought she heard evidence of pneumothorax, the second doctor ruled it out.

It's hard to diagnose because the pain is actually not so bad at first. I even refused painkillers at the hospital...bah, I feel fine, I'll be back on the bike tomorrow. Well, let me tell you, the next day I could hardly move. Rib injuries must be the hardest type of injury to diagnose in the field.
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Old 09-12-15, 01:58 AM
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Originally Posted by treesloth View Post
Thanks for the reply. We are all first aid certified, I carry a FAK, and know how to use it. In fact, recerts are later this month. However, in the first aid course, there was less information on how to assess different types of rib injuries in the field than I would have liked; hence my question. As it happens, we have a coach that is an EMT (don't recall the level... whichever one is able to prescribe what he said was a "very limited" range of medications?). He was able to tell pretty quickly that was ok to move the rider I responded to, which was my (less confident) assessment as well. That was nice, and saved a 911 call. But, what I'm looking for now is for my own education. Again, thanks for the reply, and please don't worry that we have a bunch of unprepared ride leaders taking kids into the wilderness. There was a considerable set of certifications required before I ever took a ride.
Oh that's good. You had me worried there for a moment!

But yes, it can be difficult to diagnose in the field. Probably the best thing to do is to assume the worst.

When you take your re-certification, ask this exact question ... see if they can tell you anything.
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Old 09-14-15, 11:29 AM
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Originally Posted by treesloth View Post
Thanks for the reply. We are all first aid certified, I carry a FAK, and know how to use it. In fact, recerts are later this month. However, in the first aid course, there was less information on how to assess different types of rib injuries in the field than I would have liked; hence my question. As it happens, we have a coach that is an EMT (don't recall the level... whichever one is able to prescribe what he said was a "very limited" range of medications?). He was able to tell pretty quickly that was ok to move the rider I responded to, which was my (less confident) assessment as well. That was nice, and saved a 911 call. But, what I'm looking for now is for my own education. Again, thanks for the reply, and please don't worry that we have a bunch of unprepared ride leaders taking kids into the wilderness. There was a considerable set of certifications required before I ever took a ride.
Glad you're certified.

(Note: I'm not a doctor, and did not stay at a Holiday Inn Express. ) As far as rib injuries go, the ones that you would need to worry about immediate attention are the collapsed lung and the punctured lung from the ribs. Listen to their breathing. Try to keep them down of the ground for a few minutes to make sure they don't make matters worse. This is more to make sure that some of the kids don't try to tough out a bad injury and get on the bike. As others have said, if there's any doubt as to how bad the injury is, call 911 immediately.

When my wife was in a car accident, she had several broken and bruised ribs. Luckily, she did not have a collapsed or punctured lung. The treatment for her was rest, and a little physical therapy device where she had to blow a ping pong ball up a tube for several seconds at a time. This was too make sure that she was breathing deeply enough that she did not develop pneumonia (or at least this is what the people at the hospital told us it was for).

I had an accident on my bike about a month ago where I believe I bruised my ribs. I was going around a turn a little too quickly, and I hit a sewer/storm water grate, and down I went. I rode the handlebars down, so I hurt my ribs, exactly where my arm was on my side. It hurt the most the day after. I took a couple of days off from the bike, to let it heal some. To be honest, it often felt better just after a ride than many hours later. I can only attribute that to the endorphins, and the fact that I was breathing deeply on my ride, and my sedentary job would let the ribs/muscles settle in. And I'm just to the point where I don't have the occassional twinge in my side from the accident. I never did go to see a doctor, because I could breathe (even though it was painful) deeply. I'd advise you to call 911 for any thing as serious as what happened to me for one of your students, for liability reasons, if not to protect them from themselves.

Good Luck with your recertification, and it wouldn't hurt to take a couple of higher level first aid/EMT courses. Ask the school, they may have a program to reimburse you for the expenses, as it will reduce the school's liability to have a better trained (in first aid) coach.

GH
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