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Venting subcutaneous emphysema

Mark Mazer trauma-list@trauma.org
Tue, 8 Jan 2002 20:13:15 -0500 

> A 48 yo woman victim of MVC. Has multiple rib fx, pulm contusions, R
> pneumothorax for which a chest tube was placed. Patient now several days
> out chest tube still has small airleak, lung is up on chest xray. She
> has over the last few days developed significant subcut emphysema of her
> chest and face. My collegue wants to place a mediastinal "vent" (small
> incision above the manubrium to allow the air to escape). This does not
> make sense to me but in trying to be open minded i'm wondering if this
> is a described treatment. As far as i'm concerned as long as the chest
> tube is controlling the leak, the SQ air is unsightly and has no adverse
> effects unlike making a connection between the mediastinum and the

In general I concur with you...is she oxgenating okay, is there any thoracic
ct data (ie pneumo not seen on CXR), what mode of ventilation (ie vcv vs
pcv)?, etc.
Marquo