[The skin incisions (blow holes) for treatment of massive subcutaneous emphysema]. / Blow holes metoda leczenia masywnej odmy podskórnej .
Anestezjol Intens Ter
; 43(2): 93-7, 2011.
Article
em Pl
| MEDLINE
| ID: mdl-22011870
ABSTRACT
BACKGROUND:
Subcutaneous emphysema (SE) is rarely life-threatening, although it may create significant discomfort to patients. It may impede eye opening, movement of the limbs and sometimes causes stridor and respiratory distress. We describe two cases of SE, in which small incisions in the skin helped to relieve symptoms. CASE REPORTS Case 1. A 64-year-old male was admitted to ITU, having been intubated after blunt chest trauma during a traffic accident. Initial presentation included respiratory failure, massive SE of the face, neck and chest, and fractured ribs with bilateral pneumothorax and bilateral lung contusion. Ventilation with BiPAP with 15 cm H2O PEEP was commenced and a right chest drain was inserted. This resulted in rapid improvement of gas exchange, but SE became progressively larger. On the second day, several 2 cm skin incisions were made bilaterally in the subclavicular regions; immediately a loud hiss of escaping air was heard and the patient's condition improved rapidly. He was extubated after seven days and made a full recovery. Case 2. A 42-yr-old male was admitted to ITU three days after a street fight because of rapidly progressing SE, extending to the head, neck, chest, abdomen and legs. He was suffering from pneumomediastinum, pneumopericardium, and broken ribs, hyoid bone and Th10 spinous process. An emergency tracheostomy was performed and blow holes were made in both subclavicular regions. This resulted in rapid improvement and he was discharged home after two weeks in hospital. DISCUSSION ANDCONCLUSION:
Several methods of treatment for severe SE have been described, including pleural drainage, subcutaneous insertion of pig-tail drains, iv cannulas or large bore drains. The method described, albeit not always successful, is simple and can be applied in every setting.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Enfisema Subcutâneo
/
Drenagem
/
Intubação Intratraqueal
Tipo de estudo:
Etiology_studies
Limite:
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
Pl
Ano de publicação:
2011
Tipo de documento:
Article