Subcutaneous Emphysema - Treatment

[rickydazla]

Hi

In administering an examination for a student I came across an answer that I was aware of but that I was unable to provide an explanation for: In a leadership-level test the question reads "The best treatment for subcutaneous emphysema is:" - the correct answer (according to the answer key) is "Time".

My question is: what would happen in this 'time'? Where will the air bubble(s) go and how exactly will they dissipate?

Thanks


Rick

 

[Saturation]

Unfortunately, that question is a bit 'loaded' as treatment can only be done by a skilled healthcare practitioner, even the 'time' version.

In simple cases of subcutaneous emphysema, the gas would be absorbed back into the blood and released from the lungs.

In more severe cases, a surgical procedure may be necessary.

To determine which level the patient is, between simple and severe, requires at least a chest X-ray.

 

[cutlass]

Basically, by diffusion of higher to lower concentration, capillary exposure will carry the gas away in solution by the bloodstream. The rates vary by gas component; e.g. oxygen absorbs more readily than nitrogen.

As Saturation points out, the question is "loaded" because the amount and location of exceptional gas inclusions can range from benign to life-threatening. The cause of the gas presence must be determined and treated if necessary. Surgery, penetrating injury, gangrenous infections, and lung diseases (pneumonia, cystic fibrosis, etc.) are "common" reasons, IME. Somewhat unusual but not rare (about 6% by one study*) are people with no other history but have blisters/blebs on the lung. These can subsequently rupture; pressure changes while diving could be a trigger.

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*Chest. 2007; 132:1140-1145

 

[Jim Lapenta]

I thought since it kinda resembles bubble wrap you just pop em!

 

[TSandM]

As previously stated, the treatment for the actual subcutaneous emphysema is simply time, as the gas will slowly dissolve into tissues and be absorbed.

The big issue is the source of the gas that caused the SQ emphysema . . . If it is due to a pneumothorax or a tracheal or laryngeal injury, the underlying problem must be corrected.