title: Management of subcutaneous emphysema with "gills": case report and review of the literature.
abstract: BACKGROUND
  Subcutaneous emphysema is often a symptom of a serious pathologic condition but rarely requires direct treatment. Subcutaneous emphysema itself occasionally may interfere with effective cardiopulmonary resuscitation and require direct intervention.
  
  
  OBJECTIVE
  The aim of this article is to present a case of subcutaneous emphysema during cardiac arrest and to describe a therapeutic technique that we call the "gills" procedure, as well as the background and rationale for this and other similar techniques.
  
  
  METHODS
  A 56-year-old man sustained cardiac arrest in the setting of a perforated duodenal ulcer with massive subcutaneous emphysema and pneumomediastinum that interfered with effective cardiopulmonary resuscitation. A "gills" procedure consisting of bilateral skin incisions over the clavicles was performed, with the return of spontaneous circulation.
  
  
  CONCLUSIONS
  Subcutaneous emphysema and pneumomediastinum can cause tension physiology, impairing normal cardiovascular and pulmonary function. Only with release of this tension can normal cardiopulmonary function return. The gills procedure is one of several possible therapeutic options.
authors.affiliation: Department of Emergency Medicine, Alameda County Medical Center - Highland Hospital, Oakland, California.
authors.forename: Matthew V
authors.initials: MV
authors.lastname: Kiefer
authors.forename: Colin M
authors.initials: CM
authors.lastname: Feeney
mesh_terms: D002968:Clavicle; D062109:Dermatologic Surgical Procedures; D004381:Duodenal Ulcer / Q000150:complications; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D008297:Male; D008478:Mediastinal Emphysema / Q000150:complications; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000150:complications; D013352:Subcutaneous Emphysema / Q000150:complications / Q000601:surgery*
keywords: blow holes; gills; pneumomediastinum; subcutaneous emphysema; tension physiology