A 78 year old woman ventilated in intensive care suddenly develops surgical emphysema over her chest, neck and face. Describe your management.
Resuscitation if required. Is airway OK, is she being ventilated adequately, Is circulation intact?
Work out reason: Is it ventilator, tubing or patient. ie barotrauma, new tracheostomy or CVC, pneumothorax,
So, examine patients, get urgent CXR, insert chest drain if required, consider new ventilation strategy.
The college answer leaves much to be desired.
This question would benefit from a systematic approach.
Thus, one would approach this patient by an immediate attention to the ABCs, whicle simultaneouesly performing a focused physical examination, and retrieving a focused history of recent events from attending nursing and medical staff.
Aghajanzadeh, Manouchehr, et al. "Classification and Management of Subcutaneous Emphysema: a 10-Year Experience." Indian Journal of Surgery(2013): 1-5.
ZIMMERMAN, JACK E., BURDETT S. DUNBAR, and HERMAN C. KLINGENMAIER. "Management of subcutaneous emphysema, pneumomediastinum, and pneumothorax during respirator therapy." Critical care medicine 3.2 (1975): 69-73.
Woehrlen Jr, Arthur E. "Subcutaneous emphysema." Anesthesia progress 32.4 (1985): 161.
Jairo I. Santanilla "The Crashing Ventilated Patient"; Chapter 3 in Emergency Department Resuscitation of the Critically Ill, American College of Emergency Physicians, 2011.