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Forum Name: Miscellaneous Chest Diseases

Question: Subcutaneous Emphysema


 butterflygirl - Mon Apr 20, 2009 11:47 pm

I am a 24 year old female. Five days ago, I sustained a neck injury at work. I was performing a restraint on a client (client was attacking staff members) when I got the injury. There was two incidents of restraints (safely putting a client in a hold to prevent them from hurting themselves or others). After the first restraint, I experienced severe chest pain and a dry hacking cough. My throat hurt so bad, I had difficulty swallowing and talking. The second restraint occurred about five hours later. During the restraint, my neck felt "frozen" in place. I couldn't move my head to the left or forward, my neck would "spring" back to the right. This lasted about two hours and then I could keep my head straight.
The next day I saw the doctor and told him my symptoms. He ordered an x-ray. For two days, my throat hurt so bad I couldn't swallow anything and even had a change in my voice. My neck was sore, and the pain radiated into the top of my back and shoulders as the days went on.
I went to the ER three days after the incident because I was having abdominal pain in my right side underneath my rib. The x-ray didn't show anything because there was mysterious air pockets in my abdomin.
I saw the doctor today for the x-ray results. I'm feeling better. I have better range of motion in my neck. My throat doesn't hurt and my voice is back. I have a minor sore throat on the back of my throat on the left side. However, the back of my neck, upper back, and shoulders still hurt quite a bit. He said there was a lot of air showing in the soft tissue x-ray. His conclusion was...something could've popped in my lungs causing air to be released in the soft tissues. He said it should go away, but to keep him updated if anything changes.
Later today, I had to go to another doctor regarding the same incident because I was also biten by this client. I told him about the neck injury as an explanation for not starting the antibiotic right away because I couldn't swallow anything. He immediately became frantically concerned when I told him about the x-ray results. He mentioned "????? emphysema" (I looked it up later). He literally barged out of the exam room exclaiming to the nurse that I had a serious neck injury and wanted my company's Safety Coordinator notified to make sure that my other doctor is following up on it, etc.... When he got his answer, he came back in, sat down, stated he was only supposed to treat the bites and the other doctor was going to follow up on the neck injury. I did read up on-line about this, but I don't understand a lot of it. It seems like it really depends on the situation. Should I be worried?
 John Kenyon, CNA - Sun Apr 26, 2009 10:24 pm

User avatar Hello --

I hope by now this has started to resolve on its own, and you most likely did/do have some degree of subcutaneous emphysema. This means, as you noted, air escapes (from an unnatural leak) into the tissues, usually around the upper chest and neck, causing some puffiness or swelling, often neck stiffness, etc., such as you've felt, and usually it is not dangerous, but can be very uncomfortable. Treatment is largely aimed at fixing the underlying injury or lesion. In your case it would be an injury, and it's difficult to tell, from here, whether you suffered a spontaneous pneumothorax ("collapsed" lung or at least a small hole, ruptured bullus, in the lung) or possibly a separation in the cartiligenous rings of your trachea. Either could cause the symptoms you describe, although pneumothorax is more common. You mght want to go back and retrace the various stages of the two events, and how you may have been struck, and where. Radiological studies should reveal where the leak took place, although it may have been small enough to have sealed on its own by now.

Sometimes, if there is puffiness or swelling of tissues locally, pressing on the area will produce a characteristic "rice krispies" sound, almost like tiny bubble wrap popping. This is the air bubbles trapped in the tissues popping (and won't do any addiotnal harm, may even relieve some pressure). The goal is to make sure the injury is okay. A "neck injury" in this case, I would think, would suggest a fractured larynx, causing a tiny leak between rings of cartilege, but it's hard to tell, since your symptoms have been fairly nonspecific. These injuries are usually not serious and often will resolve on their own, but should be followed by a physician for sure, with repeat CT scans to make certain the air is dispersing and there's no redsidual leakage. Please follow up with your regular doctor and also keep us updated here. Hope all is well. My best to you.

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