Management of acute airway compromise
This article describes the case of a 35-year-old male patient who presented to the emergency department with complaints of swelling around his chest and neck. The swelling appeared two days after an assault-related blunt trauma. The swelling became worse the next day, therefore, bringing him to the emergency. The symptoms were caused by acute airway compromise because of subcutaneous emphysema.
Initial assessment showed the glasgow coma scale as 15, BP 125/66, Heart rate 92 and SpO2 95% on 5 litres per minute oxygen via nasal cannulas. At the time the patient presented to the hospital, physical examination findings were consistent with moderate subcutaneous emphysema. Chest X-ray confirmed subcutaneous emphysema.
Doctors further advised a computed tomography of the chest, abdomen and pelvis which was significant for left-sided pneumothorax and subcutaneous emphysema. Examination also showed significant laryngeal swelling, multiple rib fractures, a lacerated scalp and Grade 1 liver laceration. The CT scan of the patient indicated potential pleural adhesions. The CT scan was consistent with pneumothorax for the degree of subcutaneous emphysema, indicating potential pleural adhesions. The patient was referred to a level 1 trauma centre after 30 minutes of arrival.
A cervical spine collar was contraindicated for transport to a referral facility because of the extent of subcutaneous emphysema.
The patient’s cervical spine was immobilized with towel rolls. His vital signs were stable throughout transit. He arrived at the trauma centre awake, alert and breathing on supplemental oxygen. The patient was assessed by the trauma surgery and thoracic team.
A few hours later the patient’s condition deteriorated and he was admitted to the trauma nursing unit. In addition, he was held under observation of the emergency department. 7 hours after the initial presentation the swelling around the patient’s neck became more prominent. He was, therefore, intubated with surgical standby.
Although, the patient’s requirement for oxygen increased in the operating room with desaturation on 10 litres per minute via a face mask. The patient also appeared extremely agitated. Doctors advised a bronchoscopy which did not show any proximal tracheobronchial injury. He remained in the intensive care unit for 21 days. He had complications of ventilator-associated pneumonia and delirium because of substance withdrawal. On the 18th day, a bronchoscopy was repeated and he was weaned off the ventilator. The subcutaneous emphysema resolved after 14 days and he was discharged on day 28.
References
A Case Report of Acute Airway Compromise due to Subcutaneous Emphysema https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286736/
