RESPIRATORY
PNEUMOMEDIASTINUM
Prompt
ResponseSevere pain, S/C emphysema, “Hammans crunch” - crunching, rasping sound, synchronous with the heartbeat,[3] heard over the precordium in spontaneous mediastinal emphysema. It is thought to result from the heart beating against air-filled tissues.
Image from google
Image from google
PromptVomiting ++ with pneumomediastinum - Causes
ResponseOesophageal perforation (boerhaave's syndrome)
Valsalva/drug (cocaine) use
Asthma (or other lung disease)
Chest trauma
Idiopathic
Carcinoma (Oesophageal or other significant oesophageal pathology)
Ingested corrosives
FB aspiration
Trauma - “Macklin effect” - blunt rupture of alveoli, ait tracking and spread into mediastinum
Valsalva/drug (cocaine) use
Asthma (or other lung disease)
Chest trauma
Idiopathic
Carcinoma (Oesophageal or other significant oesophageal pathology)
Ingested corrosives
FB aspiration
Trauma - “Macklin effect” - blunt rupture of alveoli, ait tracking and spread into mediastinum
PromptManagement if septic with pneumomediastinum
ResponseAntibiotics to cocer sepsis likely from oesophageal/GI source (amp+Gent OR Taz+Gent)
Fluid resuscitation to treat septic shock 10-20 mL/kg crystalloid - falling lactate or urine output 0.5m L/kg/h
Surgical referral - cardiothoracics for suspected mediastinitis
Symptom control - antiemetics and analgesia + Doses
Note if young/fit/well/asymptomatic can be DC with early follow up.
Fluid resuscitation to treat septic shock 10-20 mL/kg crystalloid - falling lactate or urine output 0.5m L/kg/h
Surgical referral - cardiothoracics for suspected mediastinitis
Symptom control - antiemetics and analgesia + Doses
Note if young/fit/well/asymptomatic can be DC with early follow up.