Editing Subcutaneous emphysema


Subcutaneous emphysema

* Indicates ongoing air leak, which is following path of least resistance to subfascial and subcutaneous planes of chest wall
* If spreading to neck:
** Firstly - assess and protect airway - may require intubation. Can also be haemodynamically unstable due to cardiac tamponade or reduced venous return
** In an emergency, they need a new ICC, which should be apically directed
** Suction can allow rapid clearance of air leak, but risks barotrauma to lung and persistent air leak - so increase suction to 20-40mmHg
* Needs thoracics consultation
** Consideration of VATS + pleurodesis to stop air leak (medical pleurodesis also an option)
** Consideration of infraclavicular blowhole incision (down to pectoral fascia) with negative pressure applied - can help clear subcutaneous emphysema
* Indications for intervention
** Severe patient discomfort
** Respiratory distress
** Ongoing large air leak
* Management options
** Increase suction on existing pleural catheter (quite effective)
** Infra-clavicular blow-hole incision
** Insertion of new drain into the emphysema

[[Category:Thoracics]]