Air Everywhere

​"Wow! That is massive," I said. "What happened?"The patient had a long-term trach. I had sent her to the ICU earlier after she arrested and ROSC was obtained. Her post-code radiograph revealed a right-sided pneumothorax. A chest tube was placed. A little while later, there was air everywhere. Could there have been a tracheal injury or lung injury during CPR or a problem with the chest tube placement? I didn't know, but I did know it was getting much harder to ventilate her and her skin soft tissues were becoming tense. Respiratory embarrassment and circulatory collapse were real possibilities. Compression of the vascular neck could also cause death.This was truly a massive subcutaneous emphysema, and intervention was warranted. "Blowholes," I said, like it was some kind of boards word association answer. I couldn't remember all the details. A quick consult with Dr. Google produced a reassuring video that a couple of infraclavicular cuts would do the trick. (https://bit.ly/3d9oAbs.)Later investigation revealed that regular angiocatheters stuck in various places around the chest wall had the advantages of being low-cost, simple, quick, high efficacy, and well tolerated. I wish I would have known that angiocatheter placement was effective. I wouldn't have hesitated to take that step.Tip to Remember: Massive subcutaneous emphysema can kill. One can relieve some pressure by sticking an IV needle into the subcutaneous tissue or making i...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs