Last Updated On: January 29, 2025
Table of Contents:
Do you know that 50% of patients who receive CPR suffer from rib fractures? With sudden cardiac arrests often happening in public places, bystanders with CPR experience become the first line of defense where immediate medical help isn’t readily available. Performing CPR (Cardiopulmonary Resuscitation) in episodes of severe cardiac arrest will multiply the survival odds for the victims. However, the biggest fear that deters bystanders from delivering CPR is the risk of doing more damage to the victim than good by breaking a rib. While ribs breaking during CPR is possible, they are rare and outweigh the potential to save a life.
So what do you do in such circumstances? Read on to learn how to act and proceed when ribs break during CPR and get the best possible outcome for the victim!
When you administer CPR, you need to use your entire upper body to do proper chest compressions, not push down simply just using your hands. It will take you prominent pressure to reach the heart, which is surrounded by ribcage. When the pressure exceeds what the ribs can withstand, especially in children and older adults with brittle bones, it will cause ribs to fracture.
Most trained bystanders and medical professionals are aware of the fractures. However, their immediate concerns are about restoring circulation and oxygen to the heart and brain. Here are some factors that contribute to rib injuries during CPR.
Elderly people are especially prone to ribs breaking during CPR. As people age, bone density decreases, and the bones become more brittle. The excess brittleness makes the ribs more likely to crack under the pressure of chest compressions. Increasing age also affects the cartilage and ligaments, which makes them less flexible and more susceptible to injury.
Women areAre more likely to suffer from rib fractures during CPR when compared to men. The difference is bone structure and density variations between genders. The bone structure of women is less dense than men, which makes them more vulnerable to injury due to the excess force of chest compressions.
Certain health conditions, like osteoporosis, further weaken bones and make them more fragile. In such events, performing CPR will induce additional risks to the victim’s health. As a result, individuals with such conditions require extra care during emergencies.
CPR usually involves chest compressions and artificial ventilation to ensure circulatory flow and oxygenation during cardiac arrest. The chest compressions are performed on the chest area to manually pump the heart so that the blood will continue to circulate across vital organs. However, the force required to achieve effective compression might lead to injuries, including fractures in the rib or sternum. Here’s a brief overview of the relationship between chest compressions and rib fractures:
Effective chest compressions demand significant force. To ensure proper blood circulation, you may need to perform around 2 to 2.5 inches of compression depth. This excess force will create adequate pressure to maintain blood flow. However, the force applied can also sometimes break the ribs and increase the risk of injury to the structures within the chest, particularly the sternum.
The anatomy of the rib cage contributes to the vulnerability of fractures during CPR. Your ribs and sternum act as the focal point for chest compressions, as it is located directly over the heart and major blood vessels. When you perform compressions over the ear, it will squeeze the heart, facilitating the blood flow. However, since the ribs have a rigid structure, they are prone to cracking or breaking under intense pressure. As a result, it will lead to fractured ribs and other severe bone injuries in cardiac arrest care.
For many lay responders, the idea of breaking victims’ ribs can be unsettling. However, you must keep in mind that the alternative can be far worse. Ribs breaking during CPR can heal, but the opportunity to save a life is fleeting. In the end, the collective goal should be to save as many lives as possible. Let us compare the diverse aspects of saving lives and bone injuries in cardiac arrest care:
The chest compressions in CPR will cause pain and discomfort in victims, especially if they are conscious or unconscious. However, your priority is to save their life, where the potential benefits outweigh the temporary pain.
The forceful nature of chest compressions can cause injury to internal organs. While this may be relatively rare, you need to be mindful of the possibility and provide chest compressions with adequate depth to reduce the risk of organ damage.
In certain cases, the force applied during chest compressions might lead to pneumothorax, which is known as a collapsed lung. Lung collapse results from the accumulation of air in the gap between the lung and chest wall. However, if you are properly trained, you can readily minimize the associated risks, which can be a potential complication.
Even though the above consequences are possible, the urgent demand for performing CPR will outweigh the dangers. With up-to-date knowledge and correct technique, you can administer CPR successfully and reduce the likelihood of complications.
Follow the established guidelines with proper training to minimize rib fractures during CPR. Here are some effective tips for sustaining organ function with CPR while reducing any possible injuries.
After the cardiac event, consider seeking feedback from medical professionals or qualified instructors on how the situation had to be handled. It will give you valuable insights for future emergencies. These sessions will allow you to practice on manikins and stay updated on the latest techniques. In addition, you can also take CPR recertification or refresher courses to improve your technique and convenience, thereby reducing the risk of bone-related injuries in cardiac arrest care.
While performing CPR, always aim to compress the center of the chest, pinpointed on the lower half of the sternum. This will distribute the force evenly, reducing the direct stress on the ribs. Moreover, avoid pressing down on the very top of the abdomen or the lower end of the sternum. Keep your elbows straight and use the weight of your upper body to administer compressions.
You should aim for the recommended depth of compressions within 2.2.4 inches for adults. The depth level is adequate to generate blood flow without causing excessive force. In addition, maintain an appropriate rate of 100-120 compressions per minute to balance the effectiveness and reduce the risk of injury.
If a fracture happens during CPR, ensure to commute with the compressions. Your priority should lie on maintaining blood flow and oxygen delivery, as saving life outweighs the concern for a broken bone. Once professional medical help arrives, they will assess and manage any injuries sustained during the resuscitation process.
The use of feedback devices will give you real-time information on compression depth and rate to achieve the correct technique. These devices will also give immediate guidance on performing the compressions within the recommended parameters.
If you happen to break the victim’s ribs while performing CPR, don’t panic. Handling broken ribs during CPR can be an unfortunate situation, but it’s recommended to continue performing CPR. A broken rib could be serious, but nothing when compared to a life-threatening situation of cardiac arrest. Your primary goal should be to maintain ideal blood flow to the brain and heart. However, learning to handle such situations with care and professionalism will reduce the discomfort of the victim, while you can stay focused and effective in your resuscitation efforts.
Here’s an expanded approach on how to respond if you encounter ribs breaking during CPR.
When performing CPR, you may find it challenging to notice if the victims’ ribs have been broken. However, if you know the signs, you can better manage the condition effectively. Here are some primary indicators:
Cracking or popping noises often occur when you apply excess pressure during chest compressions, which might fracture the ribs. Pay attention to any other unusual noises that might occur during the process.
If you notice the victim’s chest becoming unexpectedly unstable or loose, it indicates that the ribs have broken. Though the sensation could be a subtle sign, you have to be concentrated to be aware of any sudden changes in resistance when pressing down.
Swelling around the chest region indicates that internal inflammation or bleeding may have occurred at the injury. While it’s not possible to notice the swelling immediately, keep an eye on the victim’s chest for any visible changes.
Apart from these symptoms, you might also notice victims expressing pain (if conscious) or reduced effectiveness in your compression. Despite the signs, unless there is an immediate threat to the victim’s life other than cardiac arrest, continue to administer CPR without interruption.
Once you suspect CPR-related injuries, ensure to connect with the emergency services immediately. Inform them of the situation, including any other suspected injuries. Your information will prepare incoming professional medical help to handle potential complications and ensure the victim gets the appropriate care upon their arrival.
If you suspect a rib fracture while performing CPR, assess your hand position quickly and ensure it is in the proper position. Your hand should be positioned on the center of the victim’s chest, mainly on the lower half of the sternum. Do not randomly place your hand, as incorrect hand placement will increase the risk of fractures while decreasing the efficacy of the compressions.
This slight adjustment in your hand position during CPR will help distribute the pressure more evenly, although the primary focus should remain on ensuring proper compression depth and rate.
Rib fractures can happen during CPR, but they are a small price to pay when saving someone’s life. If CPR restores breathing and circulation, a rib fracture is a manageable outcome compared to the alternative. After such an event, it’s important to work closely with healthcare providers, follow their advice, and address any challenges during recovery. Let’s look at some common concerns about rib injuries that can occur during CPR.
Once emergency services arrive at the scene or the individual regains consciousness/ pulse/ normal breathing, document your actions and observations about any suspected fracture. This will help medical personnel provide subsequent care and verify your actions taken within the scope of emergency assistance for legal protection.
While fractured ribs could be a small price to pay for surviving, there are certain medical implications of the condition. After regaining consciousness, the victim will experience pain and discomfort in the rib cage, which will make it difficult to move, cough and breathe. In the long run, broken ribs might need consistent medical intervention to ensure proper healing, including follow-up visits and physical therapy.
Good samaritan laws facilitate the legal elements surrounding emergency medical intervention by bystanders in many states. These laws are built to encourage trained bystanders to assist in emergencies, assuring them with legal protection against liability as long as their actions are reasonable and delivered in good faith.
Performing CPR in an emergency will profoundly impact our physical and emotional well-being. As soon as possible, recognize and address this aftermath through counseling sessions. Alleviating such fears and concerns will empower you to become more capable first responders in your community.
Although there is a slight chance of ribs breaking during CPR, the priority of a first responder should be saving a life. Rib fractures, though concerning, are far less critical than ensuring the heart keeps beating, and blood continues to flow. Stopping CPR out of fear of breaking ribs can lead to far worse outcomes.
Broken ribs will eventually heal, and good Samaritan laws will protect you from any legal consequences. Nonetheless, with regular practice, you can still make an effort to avoid it from happening. The significance of CPR training cannot be overstated, and the potential of such injuries should not prevent you from learning and applying this life-saving technique in emergencies.
Read More:
