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How to treat a chest wall injury

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​This page provides information for patients with any of the following:

  • Fractured (broken) ribs
  • Fractured sternum (breastbone)
  • Chest wall bruising

Injuries of the chest wall can be very painful. Due to movement of the chest wall, deep breathing and coughing will be painful, but it is important to breathe and cough normally. Chest wall injuries often take several weeks to get better. As a rough guide, a patient with one broken/bruised rib can expect to be in pain for three weeks and to be in discomfort for several more weeks and even longer if more than one rib is involved. It may be helpful to sleep sitting upright for the first few nights.

There is no specific treatment for broken ribs and it is not always necessary to X-ray the chest, as the treatment for a broken rib is the same as that for a bruised chest. This is to take painkillers and follow the guidelines below.

The main complication is stagnation of the normal chest secretions leading to chest infection. The risk is greater in smokers and people with chest disease.

To prevent infection, you must:

  • Do regular deep breathing exercises: 10 very deep breaths every hour.
  • If you feel the need to cough, it is vital that you do cough to remove phlegm. You should not suppress it, despite the pain. It will be more comfortable to cough if you support the painful area with a pillow or, after a few days, your hand.
  • Do take regular painkilling tablets, either as prescribed or as bought over the counter (e.g. aspirin or paracetamol). This will make it easier to cough and breathe deeply. Do not take cough linctus.

See your General Practitioner (GP) if:

  • You become short of breath.
  • You start to cough up green, yellow or blood-stained sputum (phlegm).
  • You become unwell with a temperature.

This page gives guidance only. If you have any queries or your symptoms worsen, please contact your GP surgery or the Emergency Department.

If you are unsure of anything, please do not hesitate to phone us. A nurse is always available to give advice and will be happy to help.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002256.

Contact Emergency Department (ED) Related Links (ON Emergency Department & Minor Injuries Unit)

Wound care advice

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How to care for your wound to aid wound healing

Glue

  • A special wound glue has been used. It is designed to hold the wound edges together until it has healed.
  • The glue will need to stay on long enough for this to take place (at least five days).
  • The glue will come off on its own. Do not pick or encourage the glue off. Too early a removal will increase the risk of scarring and may introduce infection.
  • Avoid washing the area. However, water splashing onto the wound after treatment will not affect the glue.
  • Do not put any dressing on the wound. Never use an Elastoplast on the glue as this will make it sweat and the edges will not hold together.
  • Do not use any antiseptic creams over the glue.

Staples

  • Your wound has been closed using special steel wound staples. They are designed to hold the wound together until the wound has healed.
  • You will need to make an appointment with the practice nurse at your GP’s surgery to have the staples removed in 5-7 days or as advised by the health care practitioner who put them in for you.
  • We will provide you with a staple remover that you will need to take with you. It is a painless procedure.
  • You may both shower and wash your hair with staples in. If using a hair dryer it is advised to have it on a cool setting.
  • The staples are designed to stand up proud from the skin and this may, if you are not careful, catch in a comb or brush.

Suture (stitches)

  • If your wound has been closed using stitches, you will need to make an appointment with the practice nurse at your GP’s surgery for them to be removed. Your clinician in ED will advise you on the number of stitches to be removed and how many days before they need to be taken out.
  • Stitches on the face may not be dressed. Apply clean Vaseline to the wound twice a day, but not last thing at night as it will rub off on your bedclothes.
  • If Steristrips have been used you can remove these yourself after seven days by gently moistening the wound and paper strips with warm water.
  • Avoid touching the wound or getting it wet as this will encourage infections.
  • If a plastic finger stall is needed for hygiene purposes, only use for short periods due to them increasing moisture around the wound site.

General wound care advice

Wound infections are always a possibility after an accident.

Please contact your GP if your wound develops any of the following:

  • Increased redness, pain, swelling or heat around the wound.
  • An offensive smell.
  • A thick creamy discharge. However, it is normal for there to be a clear straw coloured fluid weeping from the wound in the first 36 hours.
  • Fever.

If you get any of the above, please go and see your GP or return to the Emergency Department.

Tetanus

We will only give you a tetanus injection if you have the type of wound that is shown to be likely to be infected by tetanus or you have not had the full recommended course of immunisation during your lifetime.

© North Bristol NHS Trust. This edition published April 2024. Review due April 2027. NBT002253.

Contact Emergency Department (ED) Related Links (ON Emergency Department & Minor Injuries Unit)

Macmillan Wellbeing Centre Nutrition and Exercise

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Nutrition

Under this section, you can find out more information around how a dietitian can help with Nutrition and about Dietetic clinics

How can a dietitian help me?

Dietitians are ‘qualified and regulated health professionals that assess, diagnose, and treat dietary and nutritional problems at an individual and wider public health level’.

‘Dietitian’ is a protected title and they are the only legally recognised health professionals who advise on nutrition and dietary intake.

Dietitians translate nutritional science into understandable and practical information tailored to each patient.

We provide personalised and tailored advice for patients with and after a cancer diagnosis which might include

  • Concerns about weight loss.
  • Issues with your gastrointestinal system e.g. bowel habits.
  • Eating well for the future.

Dietetic clinics

Dietetic clinics are run throughout the week to support individuals with nutritional concerns following a cancer diagnosis. This service offers the opportunity for people to self-refer, or to be referred by a professional for 1:1 nutritional advice from a HCPC registered Oncology (Cancer) Specialist Dietitian.

Referrals are accepted at any time following a cancer diagnosis, however, if we are unable to support your nutritional needs, in some cases, your GP may be able to direct you to another dietetic service in your area.

At present, we are able to support individuals with the following nutritional concerns:

  • Coping with a poor appetite, or unintentional weight loss.
  • Urgent nutritional support for cancer/treatment-related side-effects.
  • Altered texture diets due to swallowing difficulty.
  • Making dietary changes as a result of cancers affecting the digestive tract.
  • Managing weight following completion of cancer treatment – acceptance criteria will apply.
  • Eating well to support your health in the future.

We are not currently excepting patients with a diagnosis of upper gastrointestinal malignancy. Please contact your GP for referral to a local dietetic service. 

A variety of support options are available including; face-to-face appointments (if safe and appropriate to do so), video calls, and telephone support. Self-referral forms are available from the NGS Macmillan Wellbeing Centre or the self-referral is available online.

Macmillan Dietitian Abi Nickless

Macmillan Specialist Dietitian

Abi Nickless

I am a Macmillan Cancer Specialist Dietitian, providing a dietetic service to patients with a diagnosis of cancer. I work as part of the Proactive Project: Personalised Prehabilitation and Rehabilitation for people affected by Cancer. The Proactive Project is a team of allied health professionals, technicians and administrative support. 

Eating Well

The Eatwell Guide makes healthy eating easier to understand by giving a visual representation of the types of foods and drinks we should consume and in what proportions to have a healthy, balanced diet.

Healthier diets could help prevent up to one-third of cancers (30%) in the UK. A lot of research is being done into which types of food may affect your risk of developing cancer. Find out more information on the Macmillan Healthy eating and cancer page.

Cancer Nutrition Leaflets

NGS Macmillan Wellbeing Centre leaflet stand

Tips for managing eating problems

Macmillan Cancer Support logo

Exercise

A daily brisk walk can give your body a boost, lift your mood and make everyday activities easier. Try the NHS tools, tips and special offers to move more every day.

Penny Brohn Provides a range of resources. Ranging from exercise guides and lists of local charities to cookery demonstrations and relaxations. 

Dietetics
Self Referral with flyer for Macmillan Dietitian 2023.doc Professional Referral with flyer to Macmillan Dietitian 2023.docx
Macmillain wellbeing centre Nutriton and Exercise .png

Your Physiotherapy Appointment

Submitted by Jessica Knott on

We are undertaking a review of all patients on the Physiotherapy waiting list and would like to understand whether you still need an appointment to be booked.

If you have significant changes in your symptoms relating to your condition, please speak with NHS 111 or your GP.

Please provide these details so we can find your records:

Please tick your waiting list code, this can be found on the letter we have sent you
Do you still need a Physiotherapy appointment?

We will offer an appointment as soon as possible, thank you for your patience.

Whilst you wait for an appointment, have a look at our online information page, with useful links to help you manage your symptoms. This page will be shown once you have submitted this form. 

Please tell us why you no longer need an appointment:

You will be discharged from our service. 

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Please only complete this form if you have a letter asking you to do so. 

Physiotherapy Useful Links

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Online help and local community support to help manage your symptoms.

Get U Better App for musculoskeletal injuries

A free app containing advice, exercises and support to help manage common musculoskeletal injuries. Register for the service here and then download the app to your smartphone.

Local support services for musculoskeletal injuries

Download this Musculoskeletal (MSK) self-help information directory with information on local services that aim to support you to reduce pain and improve functionality.

Advice from the Chartered Society of Physiotherapy

The Chartered Society of Physiotherapy has advice, guidance and exercises to help manage your pain.

Living well with rheumatology conditions

This directory has useful information and resources for patients with rheumatology conditions.

Information on pelvic, obstetric & gynaecological physiotherapy

These webpages have health advice for patients who need pelvic, obstetric & gynaecological physiotherapy.

The Bladder & Bowel Community

The Bladder & Bowel Community help support the millions of people in the UK who are living with conditions that affect their bladder or bowel.

Mental Health resources

Looking after your mental health is just as important as your physical health. Here is a directory of local mental health services.

Mrs Dominika Kruszynska

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Mrs Dominika Kruszynska

I am a Research Administrator at Bristol Speech and Language Therapy Research Unit. I completed my degree from Catholic University of Lublin in 2007 and joined BSLTRU at Southmead Hospital in 2022.  I support the team to ensure studies are successfully initiated in a timely manner, recruit to time and target and are organised, managed and delivered to a high standard.

 

Epilepsy Surgery Programme

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What is epilepsy?

Our brain is a maze of very complex circuits: each cell uses actual electricity to release small molecules for communication!

A seizure happens when either the electrical or the chemical communication is disrupted.

When the abnormal activity happens in the brain as a whole, the epilepsy is called generalised, but if it starts in a specific part of the brain it is called focal.

How we can help

In most cases, medications succeed in controlling seizures.

Some people continue to have seizures despite the standard treatments (Drug-resistant Epilepsy, DRE). In these cases, we can often identify the problem by running an in-depth evaluation with complex investigations and tests. Eventually, we would be able to offer a personalised treatment, which may include surgery.

The aim is to get the seizures mitigated, controlled or even make them disappear.

What do we do for understanding your type of epilepsy?

After your referral is checked and accepted, you will get to know your neurologist with an initial visit with clinical examination and assessment of seizures features.

  • Initial tests include high resolution imaging and video EEG. Neuropsychology and Neuropsychiatry assessments may also happen at this stage.
  • If the source of epilepsy cannot be found with these preliminary investigations, CT PET / SPECT / MEG / ESI analysis may be required.
  • If the full picture is still unclear, further clarification can come from the implantation of depth electrodes (stereo-EEG +/- Radio-Frequency-Thermo-Coagulation)

The diagnostic process may be lengthy, and may require multiple visits or hospital admissions. We try to arrange as many of the test together as possible to prevent multiple journeys.

Epilepsy Surgery Programme FAQs

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Am I a candidate for the Epilepsy Surgery Programme?

You can be considered for epilepsy surgery if:

  • you have tried two or more anti-epileptic drugs and they have not stopped or significantly reduced your seizures
  • you are experiencing focal seizures (seizures that begin in a specific area of the brain).

If you think you meet these criteria, speak to your GP or local neurologist.

How long does the whole process take?

It depends on when you were enrolled on the programme. A member of the team will be able to provide you with a projected timing.

Generally speaking, it may take up to one year from the initial assessment to surgery. Your journey with us may be longer if the epilepsy generator is difficult to find and a stereoEEG is deemed necessary.

Can I have the tests performed at my local hospital?

No, unfortunately these tests have to be performed within our trust to ensure we get the necessary information to gather a full picture.

Can I leave my room whilst having video EEG?

No, as you may undergo a medication reduction / withdrawal to provoke a seizure and you will need to be monitored during this time.

Please bring items to keep you entertained whilst you are in the room. TV and Wifi are available.

How long will I be in the telemetry room for my EEG?

Normally it is a two-week admission but you may be asked to stay longer, until sufficient data have been collected.

What does "advanced imaging" mean?

3T MRI and fMRI

Used to obtain very detailed pictures of the brain and its functional areas. It usually takes 30 to 45 minutes and you can go home straight after.

PET

It uses a dye that can highlight brain regions that use energy in an abnormal way. This is done in Cheltenham.

SPECT

A dye is injected at the beginning of a seizure and remains in those areas most involved in a seizure. This test requires an admission.

MEG

This is a complex kind of brain activity scan and requires travelling to Birmingham.

WADA test

It is done only in uncommon cases where it is unclear where language and memory functions areas are. The procedure involves temporarily putting asleep one side of your brain by injecting an anaesthetic  medication in your groin, while running some tests. It requires an admission, but you can go home the same day.

What is the difference between EEG, VT and sEEG?

EEG

It is a painless procedure where small probes are attached to the scalp for analysing the brain’s activity by looking at its electrical waves. It usually takes up to one hour.

VT, or video EEG telemetry

This is like a normal EEG but with a camera recording. It lasts longer, typically one or two weeks. You will stay in a dedicated comfy bay room with bed, chair, TV, Wifi and en-suite bathroom. Friends and family can come and visit.

If seizures are not very frequent, medications may be reduced to allow seizures to happen. It is important to stay in the room as much as possible, to avoid missing a seizure. Skilled nurses will maintain your safety in case of seizures.

sEEG, or stereo-EEG

When information from normal EEG are inconclusive, some small probes are placed into specific areas of your brain with an ultra-precise robotic arm. It requires an admission similar to the VT investigation, but may rarely require to stay in longer.

In selected cases, the electrodes can also be used to disrupt the seizure network (RFTC) with a temporary beneficial affect on seizures frequency. Although temporary, this effect would give precious information on the chances of a successful surgery.

At the end of the recording, electrodes will be removed at the bedside and you can go home next day.

What is the difference between neuropsychology and neuropsychiatry assessments?

Neuropsychology

This assessment takes three to four hours to complete and involves completing a variety of paper and pencil and computerised tests, to evaluate brain functions such as concentration, language and memory.

It will show areas of strengths and weakness in your thinking and memory which can be associated with certain seizure generators. It can also show if the part of your brain that is likely to be removed is responsible for any functions that other parts of your brain cannot take over. This helps predict whether your daily reasoning would be at risk with surgery.

Neuropsychiatry

This assessment would clarify if your epilepsy is causing any other problems that you may not be aware of. 

The psychiatrist will be able to tell if surgery may help these problems as well, and if you would need any extra support after surgery (for example, mood swings and anxiety can temporarily effect 1 in 5 people after surgery).

You will also be able to discuss the changes you hope for as a result of surgical treatment.

What happens after surgery?

The hospital stay varies from person to person, but the average length of stay is five days.

The first follow-up will be with your GP / local practitioner nurse, to make sure the wound is healing well and there are no outstanding issues.

You will be contacted by our specialist nurses one month after surgery and will see the neurosurgeon at 6-8 weeks post-operatively. Your neurologist will continue to see you at 3, 6, 9, 12 months.

Post-operative imaging and neuropsychologist / neuropsychiatry reviews are also part of post-operative assessment, but their timeframes may change from case to case.

How should I expect to feel after my surgery?

It is normal to feel tired. You can expect to have some pain and nausea/vomiting initially after surgery but these will go within a few days, and the pain should reduce over the first week leaving a bit of discomfort for the following weeks.

How long is the recovery after surgery?

This varies from person to person but we would advise three months off work and then a phased return to work. 

When can I come off my antiepileptic drugs after resective surgery?

You will not be taken off any of your medications (AEDs) for the first year after surgery, allowing time for you brain to recover and heal; this also gives your neurologist a clear picture on how surgery has affected your epilepsy.

When can I resume driving after a successful surgery?

The DVLA regulations state that your peripheral vision is good (it will need to be tested one year after surgery) and that you must be seizure-free for at least one year before being able to drive a car or motorcycle.

Special considerations apply when the process of tapering medications down starts.

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