Flail Chest Case: Ventilator Protocols and Respiratory Manifestations

Vocabulary flashcards covering key terms and concepts related to flail chest, ventilator management, and associated pulmonary pathophysiology from the case notes.

Flail chest

A chest wall injury with double fractures of multiple adjacent ribs causing a free-floating segment and paradoxical movement; typically treated with analgesia, stabilization, and prolonged mechanical ventilation with PEEP.

Paradoxical movement

Inspiration causes the fractured chest segment to move inward and expiration causes it to move outward, opposite to normal chest wall motion.

Pendelluft

Gas movement between lung regions due to paradoxical chest wall motion, leading to ventilation-perfusion mismatch.

Venous admixture

Mixing of deoxygenated venous blood with oxygenated arterial blood in the lungs, reducing PaO2.

Atelectasis

Collapse or inadequate expansion of alveoli causing reduced gas exchange and increased radiographic opacity.

Pneumothorax

Air in the pleural space causing lung collapse; can occur with flail chest and may require chest tube placement.

Bronchopleural fistula

An abnormal connection between a bronchus and the pleural space, causing a persistent air leak.

Chest tube air leak

Continuous bubbling in the chest tube indicating ongoing air drainage from the lung into the pleural space.

PEEP

Positive end-expiratory pressure; keeps alveoli open at end expiration to improve oxygenation and stabilize the chest wall.

FiO2

Fraction of inspired oxygen; the percentage of oxygen delivered by the ventilator.

ABG (arterial blood gas)

Laboratory analysis of arterial blood to assess acid-base status and oxygenation (pH, PaO2, PaCO2, HCO3-).

PaO2

Partial pressure of oxygen in arterial blood; indicator of oxygenation status.

PaCO2

Partial pressure of carbon dioxide in arterial blood; reflects alveolar ventilation.

Sputum Gram stain and culture

Laboratory testing of expectorated material to identify infecting organisms and guide antibiotic therapy.

ARDS (acute respiratory distress syndrome)

Severe inflammatory lung injury with refractory hypoxemia; often requires high PEEP and advanced ventilatory support.

Lung Expansion Therapy

Techniques to prevent or treat atelectasis and promote lung re-expansion in chest trauma.

Oxygen Therapy Protocol

Guidelines for delivering supplemental oxygen to correct hypoxemia while considering shunt and lung pathology.

Mechanical Ventilation Protocol

Standardized ventilator settings (tidal volume, rate, PEEP) to maintain ventilation and chest stability.

Tidal volume (Vt)

Volume of air delivered to the lungs with each ventilator breath; example given as 8 mL/kg.

Vecuronium bromide

Neuromuscular blocking agent used to paralyze the patient to facilitate controlled ventilation.

Airway Clearance Therapy

Suctioning and other therapies to clear bronchial secretions and obtain sputum for culture.

BUN (blood urea nitrogen)

Blood test value that can rise with trauma-related stress and volume changes; later normalizes.

Creatinine

Kidney function marker; may be elevated after trauma and gradually return toward normal.

Rib fractures 2–10 (double fractures)

Double fractures of ribs 2 through 10 on the right side, contributing to a severe flail chest.

Sputum (yellow, thick)

Pulmonary secretions described as yellow and thick, often indicating infection or inflammation.