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Wed, 09 Jan 2002 11:43:35 +1000

Venting subcutaneous air through cutaneous incisions used to be called 'dea=
th by a thousand cuts' and is not indicated.
Check to make sure the drain is actually in the right place and draining co=
rrectly. Ignore the subcut air - it'll go away in its own good time once th=
e lung leak seals.=20
Regards,
Chris Anstey
Australia

----------------------------------------------------------------
Chris Anstey
Director, ICU
Sunshine Coast Health Services District
Queensland
Australia

Ph     +617 5470 6600
Fax    +616 5470 6841
Email  chris_anstey@health.qld.gov.au

>>> Ronald Simon <Traumamd@nyc.rr.com> 01/09/02 10:05am >>>
I have a case i'd like your opinion on. Sorry for the multi listing but=20
this problem crosses specialties.

A 48 yo woman victim of MVC. Has multiple rib fx, pulm contusions, R=20
pneumothorax for which a chest tube was placed. Patient now several days=20
out chest tube still has small airleak, lung is up on chest xray. She=20
has over the last few days developed significant subcut emphysema of her=20
chest and face. My collegue wants to place a mediastinal "vent" (small=20
incision above the manubrium to allow the air to escape). This does not=20
make sense to me but in trying to be open minded i'm wondering if this=20
is a described treatment. As far as i'm concerned as long as the chest=20
tube is controlling the leak, the SQ air is unsightly and has no adverse=20
effects unlike making a connection between the mediastinum and the=20
outside world.
Thanks for your input
Ron Simon, MD
Jacobi Medical Center
Bronx, NY

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Venting subcutaneous emphysema