# Rib Compression - Special Test



## OnceAnEMT (Nov 12, 2014)

I'm curious, has anyone ever been taught this? It is apparently a "thing" in AT, and I'm not quite sure I am for it.

Procedure - With anterior-posterior placement of the palms at the level of the body of the sternum, push inwawrdly. Then, with both hands on either side of the patient just under the arm pit, squeeze medially. Just enough pressure to move the ribs.

Positive Test - Pain, crepitus

Implication - S/s replication upon anterior-posterior testing = lateral rib fracture, lateral testing = anterior or posterior rib fracture.

I know if this is "required", its at the bottom of my list, in hopes that I rule in or out a fracture before I have to potentially cause worthless pain. I feel palpating is much more appropriate.

Anyone ever heard of this? Thoughts?


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## DesertMedic66 (Nov 13, 2014)

Yeah. It's taught here as part of the BLS trauma/medical assessment.

It's frequently done on the rapid trauma assessment during the initial head to toe exam.


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## Fire51 (Nov 13, 2014)

When my grandpa fell, I did this and I could feel that one of his ribs were broken. It also helps to ask the person to take a deep breath in if they can while you feel. That was the only time I could tell he had a Brocken rib was when he breathed in.


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## MrJones (Nov 13, 2014)

Pretty much standard practice everywhere I've worked or trained.


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## gotbeerz001 (Nov 13, 2014)

Seems that the information that comes from such pain is hardly useless


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## Gurby (Nov 13, 2014)

gotshirtz001 said:


> Seems that the information that comes from such pain is hardly useless



Could you elaborate on how you plan to use this information and how it will change your treatment?


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## gotbeerz001 (Nov 13, 2014)

Gurby said:


> Could you elaborate on how you plan to use this information and how it will change your treatment?


Trauma w distracting injuries. 
I have had TC pts w a cut on their forehead so concerned w the little bit of blood that they didn't realize they had broken their ribs. 

As mentioned earlier, is a standard BLS practice. Hardly useless.


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## Gurby (Nov 13, 2014)

gotshirtz001 said:


> Trauma w distracting injuries.
> I have had TC pts w a cut on their forehead so concerned w the little bit of blood that they didn't realize they had broken their ribs.
> 
> As mentioned earlier, is a standard BLS practice. Hardly useless.



And once you learned that the pt had fractured a/their rib(s), how did that change your care of the patient?


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## gotbeerz001 (Nov 13, 2014)

It can help me decide to trauma activate my pt and also keep me from looking like an idiot who missed rib fx due to a piss-poor assessment. 

Also increased index of suspicion for possible pneumo development etc. 

Are you honestly asking these questions or just trying to be snarky...?


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## Gurby (Nov 13, 2014)

gotshirtz001 said:


> It can help me decide to trauma activate my pt and also keep me from looking like an idiot who missed rib fx due to a piss-poor assessment.
> 
> Also increased index of suspicion for possible pneumo development etc.
> 
> Are you honestly asking these questions or just trying to be snarky...?



Both 

I just think it's important to keep in mind why we do things.  If the information you gain could potentially influence your treatment of the patient in a meaningful way, then do what you need to do.  On the other hand, there are instances where it's not going to matter.

Telling the OP, "this is standard care and everyone does it" seems not that useful to me.  If he doesn't know WHY to do it and how he can use the information, then what's the point? 

I did a call during my EMT-B 3rd riding: we respond for the woman who fell.  Get on scene, ~80f pt says "I think I broke my hip" and has a lot of pain at that location.  We're 10 minutes away from a level 1 trauma center.  My FTO spent a whole bunch of time on scene trying to determine if it was actually broken or not.  In the end, we were going to treat it the same either way, transport to the same place either way, and this hospital doesn't want you to call ahead basically unless it's a CPR in progress.  If we had a more difficult transport decision, a more thorough assessment would probably have been indicated.  But in that specific situation, I think we should have just operated under the assumption that it was broken - the hospital is going to handle it the same way regardless of what we tell them.


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## OnceAnEMT (Nov 13, 2014)

I appreciate the replies. I understand the intent of the test, and surely it often works. But I see it as identifying a humeral fracture by stepping on it.

Then again, I squeeze limbs and pelvis during rapid trauma. Hows this different? My only real concern is by compressing you can cause that brokrn rib to tear the pleural lining. I feel that a solid observation and palpation would do the trick. 

By useless pain I meant unnecessary, just could not think of the word. Doesn't have to take pain to find something. Guess my rapid trauma needs to be more rapid. Can't ssy I've ever run a trauma alert unfortunately. Thats the only downside of working in a hospital. I use all of my EMT skills accept trauma assessment, and my practicing medical is cut off by a nurse wanting to do the triage. 

End soap box, been a long week.


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## gotbeerz001 (Nov 13, 2014)

Grimes said:


> I appreciate the replies. I understand the intent of the test, and surely it often works. But I see it as identifying a humeral fracture by stepping on it.
> 
> Then again, I squeeze limbs and pelvis during rapid trauma. Hows this different? My only real concern is by compressing you can cause that brokrn rib to tear the pleural lining. I feel that a solid observation and palpation would do the trick.
> 
> By useless pain I meant unnecessary, just could not think of the word. Doesn't have to take pain to find something.


1. Broken humerus usually presents with obvious swelling/deformity; ribs not so much. 
2. You are likely not gonna compress the ribs so far that you will create such damage; that would be unnecessary. Any damage would likely have happened during the incident. 
3. When there are multiple complaints, pain can often the most reliable tool to assess for injury. Once found, I try not to reoffend.


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## Akulahawk (Nov 13, 2014)

Checking ribs like that is a good thing for both EMT (on up) and in AT settings as part of a general trauma exam. If you determine that a rib fracture has occurred, there's something related you need to assess for... hemo or pneumothorax. AT courses teach you a LOT more physical assessment testing than you'll ever find in EMS courses. That testing can often be quite diagnostic.


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## OnceAnEMT (Nov 13, 2014)

Akulahawk said:


> AT courses teach you a LOT more physical assessment testing than you'll ever find in EMS courses. That testing can often be quite diagnostic.



I'm not denying this at all, I completely agree. But there is a difference between testing inferior GH instability and checking for fracture in the ribs, which surround everything you care about. The rib compression test is diagnostic, but it seems to also have a risk factor. The way we were being instructed was to apply pressure at the mentioned points so that you visualize the rib cage moving. But damn. That's some pressure. I feel that there are other ways to determine whether a rib fracture is present. But if there haven't been issues with the test, then I suppose my worry is misplaced.


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