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Pulmonary and Critical Care Pearls |

A 63-Year-Old Woman With Subcutaneous Emphysema Following Endotracheal Intubation*

Bassam Hashem, MD; James K. Smith, MD, FCCP; W. Bruce Davis, MD, FCCP
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine (Drs. Hashem and Davis), Medical College of Georgia, Augusta, GA; and Veterans Affairs Medical Center (Dr. Smith), Augusta, GA.

Correspondence to: W. Bruce Davis, MD, FCCP, Medical College of Georgia, 1120 15th St, Rm No. BBR5513, Augusta, GA 30912-3135; e-mail: bruced@mail.mcg.edu



Chest. 2005;128(1):434-438. doi:10.1378/chest.128.1.434
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Extract

A 63-year-old woman with a history of C5-C6 radiculopathy was admitted to the hospital for elective cervical discectomy and fusion. Her medical history was significant for hypertension and depression. At the time of anesthesia, initial attempts to visualize the vocal cords by direct laryngoscopy were unsuccessful. A second, more experienced, operator was successful in intubating the trachea with a size 7 endotracheal tube. Shortly after intubation, the peak airway pressure increased to 40 cm H2O, and diminished left-sided breath sounds were noted. The endotracheal tube was pulled back 2 cm for repositioning, and bilateral breath sounds were documented. Twenty minutes later, heart monitoring revealed a new T-wave inversion. Because of these new ECG changes, anesthesia was reversed, and the patient was extubated. In the recovery room, the patient developed periorbital swelling and retrosternal chest pain with inspiration.

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