Pneumomediastinum: a complication of reinserting a dislodged tracheostomy

Description 

A 54-year-old woman with a background of obesity and hypertension presented following a pulseless electrical activity (PEA) cardiac arrest. Cardiopulmonary resuscitation (CPR) was commenced on arrival of the paramedics and she was intubated and ventilated (figure 1). Return of spontaneous circulation was achieved in the emergency department following a total of 45 min of CPR. No clear cause of her arrest was identified. She was transferred to the intensive care unit (ICU) for post-arrest management.

Figure 1

Initial chest radiograph following return of spontaneous circulation, with endotracheal tube present (included as a baseline for comparison).

Seizure activity off of sedation necessitated further investigation. Her CT head was unremarkable, but her lumbar puncture showed features in keeping with meningitis. She was therefore treated with antibiotics and antiepileptics. Her cerebrospinal fluid viral PCR and blood HIV tests were negative.

Although appropriate seizure control was achieved,...

https://ift.tt/2NWZUub