A 26-Year-Old Man with Substance Abuse, Agitation, and Pneumomediastinum

On physical examination, he was a febrile with a pulse of 136, BP 135/68, respiratory rate 20, SpO2 96% on 3 liters nasal cannula. He was agitated and having visual hallucinations. His voice was muffled. He had abrasions on his hip and shoulder and marked crepitus throughout the neck and upper chest. Trachea was midline. There was a small skin defect overlying the larynx consistent with minor trauma. Lung fields were clear and abdomen was benign. One examiner thought that there may have been a Haman’s crunch, but because of extensive crepitus over the thorax this could not be confirmed. Neurological examination was grossly non-focal.