title: Traumatic occurrence of chest wall tamponade secondary to subcutaneous emphysema.
abstract: 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.
authors.affiliation: Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware 19718, USA. mperraut@christianacare.org
authors.forename: Michael
authors.initials: M
authors.lastname: Perraut
authors.forename: Daniel
authors.initials: D
authors.lastname: Gilday
authors.forename: Gordon
authors.initials: G
authors.lastname: Reed
mesh_terms: D000368:Aged; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011175:Positive-Pressure Respiration / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012253:Rib Fractures / Q000150:complications; D013352:Subcutaneous Emphysema / Q000150:complications* / Q000175:diagnosis; D013907:Thoracostomy