Venting subcutaneous emphysema

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If you have worsening SQ emphysema your CT is not controlling the leak.  Look 
for a bronchial injury/tracheal injury.  You may consider placing another 
chest tube, the one in place may be intermittently occluding from lung 
parenchyma or chest wall.  A common, but missed source of an Intermittently 
functioning chest tube is dependent loops in the tubing filling with fluid.  
The fluid in the loops of "rubber hose" builds up back pressure and will not 
let the air escape until the pressure in the chest is higher than the length 
of fluid in the tubing.  I have seen patients code from tension pneumos from 
this that were recovered when the tubing was emptied or the tubes 
disconnectioned from the pleurovac creating an open pneumo thorax.  It does 
happen.  If you have SQ air, it means that there is air in the chest that is 
not coming out the tube and the pressure is being vented into the SQ. If the 
air is stable but not worsening it will get better over time.  Becky

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