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Traumatic occurrence of chest wall tamponade secondary to subcutaneous emphysema

Published online by Cambridge University Press:  21 May 2015

Michael Perraut ,
Daniel Gilday  and
Gordon Reed
Michael Perraut*
Affiliation:
Department of Emergency Medicine, Christiana Care Health System, Newark Department of Internal Medicine, Christiana Care Health System, Newark
Daniel Gilday
Affiliation:
Department of Emergency Medicine, Christiana Care Health System, Newark Department of Internal Medicine, Christiana Care Health System, Newark Olympia Emergency Services at Providence St. Peter Hospital, Olympia, Wash
Gordon Reed
Affiliation:
Department of Emergency Medicine, Christiana Care Health System, Newark
*
Department of Emergency Medicine, Christiana Care Health System, 4755 Ogletown-Stanton Rd., Newark DE 19718; mperraut@christianacare.org

Abstract

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Subcutaneous emphysema is a physical finding that itself is usually perceived as benign yet rarely may, in and of itself, be life-threatening. We present an unusual case of a 67-year-old woman who developed delayed severe subcutaneous emphysema and tension pneumothorax from a rib fracture subsequent to a fall. We review the pathophysiology, manifestations and management options of this disorder. In patients whose clinical condition allows it, chest tube placement prior to intubation should be considered. Furthermore, positive end-expiratory pressure should be minimized. We present a case that illustrates how subcutaneous emphysema itself can be a potential cause of respiratory failure and tamponade physiology. In our case, a patient with traumatic subcutaneous emphysema developed respiratory failure and clinical deterioration after the introduction of positive pressure ventilation. In such rare scenarios, care should be taken to consider the absolute need for positive pressure ventilation without surgical decompression.

Keywords

subcutaneous emphysemarespiratory failuretraumatube thoracostomy
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 10 , Issue 4 , July 2008 , pp. 387 - 391
Copyright
Copyright © Canadian Association of Emergency Physicians 2008

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