Thursday, May 9, 2013

Psychiatric Nurse Injuries; How to Survive a Broken Rib:

I read a study of Psychiatric Nurses yesterday regarding non-fatal injuries to mental health nurses. Turns out that within a Psychiatric Nurse's career, 64% of us will have injuries from patient assaults, at least, ten times. 95% of nurses reported at least one injury. And over the course of a year, 7% of Psychiatric Nurses will sustain an injury that involves missing work. Mostly Psychiatric Nurses accept the risks of our profession. We shrug it off and "handle it". I think we are a bit tolerant of the risks of our profession. This is an attitude that I wish would change. Only 5 percent of Psychiatric Nurses will go through their entire careers without having had an injury.

Over the last twenty years, I've been injured requiring missed work, five times. One time a patient tried to break my neck by yanking on my hair; once I ended up on the bottom of a "take down"pile where a 16 year old bit a chunk out of my arm; and  I've had three incidents of busted ribs.

This is my fourth rib injury. Three at work and one on my own time. I don't spend much time writing about my paid career because of the risks involved regarding confidentiality. If you don't write about your psychiatric career, you can't' violate confidentiality. I take as a role model, Noam Chomsky, who was a linguistics professor in his teaching work, but spends the majority of his intellectual time writing about culture and politics. Intellectuals should be able to handle more than one subject at once.

The last rib incident happened last Friday when a very large client hit my ribs as hard as he could with his elbow. The person next to me stated she could feel the percussion of the hit pass through my body into hers. It was a very hard blow. Twice. I don't know why they always go for my ribs. Bad luck.

At this point of my career, my ribs feel like Apollo Creed's during the last round of his fight with Rocky Balboa. I am bruised and battered.

Given this experience, I know how to treat damaged ribs. Doctors don't like this treatment protocol, but this is what works for me.

How to recover from damaged and broken ribs:

1. First off, you need a LazyBoy. Moving, coughing, lying down, bending over, laughing, tying your shoes, changing your clothes, dressing, reaching; all those activities are painful with a rib injury. The only position that doesn't cause pain is the LazyBoy Recumbent Position.  The head elevated position of a LazyBoy chair is the best position for recovering from a rib injury. The head elevated position doesn't put any undue strain on your diaphragm, allowing you to get some rest. And rest is what is needed.  You will live, at least, in the LazyBoy chair for two weeks.

2. Try not to move, except for a gentle daily walk, for two weeks. Spend the time in your LazyBoy watching TV, reading books, writing, talking on the phone. But do not do anything else. Rest.

3. Wear a Rib Belt. These are currently out of vogue due to the risk of pneumonia. But, believe me, the bigger risk is a re-injury to the rib. The ribs, upon any strain, tend to jump about in the body. Because the lungs inflate and deflate behind the ribs, sudden movements and the inflation of the lungs can cause the injured rib to move. This movement reinjures the rib (you will feel a pop or a jumping in the chest). If this happens too often, you can end up with a rib that takes months to heal (I know this from experience).

4. Icy Hot helps. Use it liberally underneath the Rib Belt.

5. Medications: Doctors will try to just order you an NSAID. I need more than that. Injured ribs are  second only to kidney stones in the severity in pain that I've experienced.

This is what I do:

A. 800 mgs of Ibuprofen upon waking up, repeat in the afternoon and then again at bedtime.

B. Take an opiate every four to six hours religiously for the first two weeks (Percocet or Norco 10's work the best for me).

C. In addition, I recommend a benzodiazepine twice a day (Valium 5 mg). The rib injury usually involves more than a little bit of muscle strain. It is best to keep the muscles relaxed, so a benzo, at least at bedtime, will help you heal quicker and rest better.

D. Given the heavy use of opiates, you will need to take Milk of Magnesium, Mag Citrate and a diet high in bran. This will prevent any uncomfortable constipation.

E. After one to two weeks, taper off the use of opiates first, and then the Ibuprofen. If the rib is broken, it will take six weeks to heal; if the injury is intercostal, it will take four weeks to heal.

6. Since the next month will be devoted to doing, essentially, nothing, make sure you have lots of good books and a decent cable subscription.

I am currently on Day 8 of my recovery. So far, so good.


  1. I sympathize with your pain, Allan. It's hard to heal an injury when the bones and muscles have to be able to move to let you breathe. Take good care!

  2. Thanks Woods. I've been amazed at some of the photos in your blog lately. Awesome!