In the management of a patient with respiratory compromise in the emergency department, airway patency and ventilatory support are of high importance. We describe a case of a 34 years old female patient who presented with severe lower airway obstruction secondary to exacerbation of bronchial asthma. She had severe dyspnea, confusion and ABG showed type 2 respiratory failure for which an urgent endotracheal intubation was performed. Later, the patient developed significant subcutaneous emphysema, and was diagnosed with bilateral pneumothoraxes, pneumomediastinum, pneumopericardium, and surgical emphysema. This was treated emergently with supplemental oxygen and bilateral chest drains. A CT scan demonstrated a tracheal laceration, which was managed conservatively in the critical care unit. The patient had a tracheostomy on day 5 to treat an ongoing air leak and later made a full recovery.
Key words: Emphysema, Respiratory failure, Conservative Treatment
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