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Thu, 10 Jan 2002 19:18:02 -0000

I was in the coroner's court last week, about a patient who came to ICU
moribund and died. Very sinilar presentation to yours. Found at post mortem
to have hole in diaphragm + hole in stomach. Seems to me she died of sepsis
after the stomach leak was missed. Now, as a simple person, if there is
subcut emphysema, there is a leak from the lung. Full stop. I would look for
the leak and drain it. After last week, I would wonder about the stomach
too. Here, she would be in the CT scanner. CXR is not the answer.
Nick

> -----Original Message-----
> From: trauma-list-admin@trauma.org
> [mailto:trauma-list-admin@trauma.org]On Behalf Of Ronald Simon
> Sent: 09 January 2002 00:05
> To: aast list; CCM list; trauma.org
> Subject: Venting subcutaneous emphysema
>
>
> I have a case i'd like your opinion on. Sorry for the multi listing but
> this problem crosses specialties.
>
> 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
> outside world.
> Thanks for your input
> Ron Simon, MD
> Jacobi Medical Center
> Bronx, NY
>
>
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Venting subcutaneous emphysema