28 year old male presents to the ED complaining of severe coughing, shortness of breath and chest pain. Denies fever or chills. But persistently complains of the severe coughing during history taking. States that only the last two days he has had the chest pain and shortness of breath, which brought him to the ED.
You get a CXR:
Please provide a complete read. What would you do for the patient?
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jwang
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1 Comment
yon.yohannes · December 19, 2014 at 2:59 pm
The above patient has pneumomediastinum with pneumopericardium and subcutaneous emphysema of the neck and L chest wall. In this case likely from increased intra-alveolar pressure, from severe & persistent cough, leading to overdistention and rupture.
– In a stable, young, healthy patient, the goal of therapy would be cough suppression and pain control. OTC dextromethorphan, NSAIDs, and outpatient follow up. No maneuvers that increase intrathoracic pressure, such as valsalva. With controlling cough, sx should resolve in next several days. Return precautions for worsening chest pain, SOB, respiratory distress.
– If hypoxic, pain control in ED and supplemental O2 which may help resorb free air. Observe in ED and dispo pending reassessment. May need admission for pain control if patient is persistently hypoxic, which would likely be due to splinting.