Tension pneumothorax and diffuse subcutaneous emphysema as a complication of cardiopulmonary resuscitation.

Sharayah A, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-223530 Description A 65-year-old man, with a medical history of interstitial lung disease and a recently diagnosed lung adenocarcinoma with known metastases to the bone, was brought to the emergency department after an episode of cardiopulmonary arrest and resuscitation by emergency medical services (EMS). The patient had a recent hospitalisation for bronchoscopic lung biopsy. It was complicated by a pneumothorax, and he was treated with chest tube insertion. The tube was removed 2 weeks prior to the current encounter and no residual leak was found. On the day of arrival, early morning, the patient’s wife found him unresponsive with a temperature of 101 degrees Fahrenheit (38.3 Celsius). EMS was called and the patient was found in pulseless electrical activity. Advanced cardiac life support was initiated and he had a return of spontaneous circulation after two doses of 1 mg epinephrine over approximately 6 min of cardiopulmonary resuscitation (CPR). The patient was intubated in the field and brought to the emergency department. On initial evaluation, the patient was hypotensive, for which he was started on vasopressors and aggressive intravenous fluid resuscitation. On physical exam, the patient was unresponsive, and had diffuse swelling and crepitus extending from his face down to his thighs. On chest auscultation, no breath sounds were audible on the right side.As the incidence rate of tension pneumothorax secondary to invasive lung procedures is 0% to 4% a chest X-ray (figure 1) was done which showed diffuse subcutaneous emphysema and a large right lung lucency suggestive of tension pneumothorax. The diffuse granular opacities on the left side were unchanged from the previous study and represented his diagnosis of interstitial lung disease. The patient had an emergent insertion of a right-sided chest tube, to allow lung reexpansion of the lung and to imrpove ventilation, Tension pneumothorax and diffuse subcutaneous emphysema as a complication of cardiopulmonary resuscitation Ahmad Sharayah, Dileep Unnikrishnan, Prem Shanker Shukla, Douglas Livornese Images in...