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