Abstract:

Pneumomediastinum is an important and a life-threatening complication of blunt thorax traumas.A 2-year-old male patient was admitted to our local emergency department after a domestic accident. He had breathing difficulty and severesubcutaneous emphysema inthe neck and trunk region bilaterally. Supine chest radiograph and thorax CT revealed extensive subcutaneous and mediastinal air. The patient was tried to referral to a tertiary center due to lack of chest surgery team and pediatric intensive care unit in our local hospital. Unfortunately, referral was not succeeded because of a terrible snowstorm.  The patient's blood oxygen saturation started to decrease just after the imaging tests. A needle subcutaneous drainage with an underwater seal was performed on the sternum in this critical situation. The patient’s breathing difficulty and subcutaneous emphysema in the neck started to resolve after this procedure. The conservative vital sign monitoring and close follow-up were performed until the snowstorm ends. The patient hasn’t had any breathing difficulty or shortness of breath after this procedure and subcutaneous emphysema has been completely resolved within a few hours. We present here a simple and life-saving approach to pneumomediastinum and subcutaneous emphysema in an emergency situation. This procedure can save time for reconsideration and transfer to a referral center in emergent situations.

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