Pathological Rib Fracture

A 77 year old male with no relevant past medical history checked in with back pain. Films showed an abdominal aortic aneurysm and a pathological rib fracture. On incidental findings, the patient also had a pathological hip fracture.


He had a mass in the left lower quadrant that I was quite able to palpate, although I was unable to appreciate the AAA (which, according to assessments, was a "pulsatile midline abdominal mass").


He is a full code---he and his family couldn't wrap their brains around the fact that if he were to code, we wouldn't be able to save him. We would break all his ribs and probably rupture his abdominal aorta, causing certain death.


I think the thing that made me saddest was what Dr J said when I called to get an order for Zofran. "Thanks for taking such good care of this patient."


And I wasn't doing anything different I wouldn't do for any other patient.