Mediastinal emphysema

Mediastinal emphysema - Acute
Rahul Soman, M. Pharm

 

Definition  

The presence of air in the mediastinum, also known as mediastinal emphysema and pneumomediastinum

 

Medical History  

* Blunt chest trauma [Blunt chest trauma - Acute]

* Asthma [Asthma - Acute]

* Drug abuse

* Respiratory tract infection

* Childbirth

* Vomiting

* Cough

* Complication of ventilation therapy

* Airway trauma

* Subcutaneous emphysema

* Subcutaneous emphysema resulting from a procedure

* Seizure

* Finding related to exertion

 

Findings  

* Chest pain - Acute

* Dyspnea - Acute

* Difficulty speaking

* Subcutaneous emphysema

* Hamman's sign

* Cardiac dullness to percussion absent

* Dysphagia

 

Tests  

 

Suspected or known pneumomediastinum  

* Plain chest X-ray: A diagnosis of pneumomediastinum is usually confirmed with a plain chest x-ray .

 

Differential Diagnosis  

* Esophageal perforation - Acute

* Acute coronary syndrome

* Pulmonary embolism - Acute

* Pneumothorax - Acute

* Aortic dissection - Acute

* Pneumonia

* Pericarditis - Acute

* Cardiac tamponade - Acute

* Mediastinitis

 

Treatment  

 

Drug Therapy  

 

Pain, acute  

 

ACETAMINOPHEN

Adults (?12 years): 325 to 1000 mg orally every 4 to 6 hours as needed (maximum 4 g/day)

Pediatrics (<12 years): 10 to 15 mg/kg orally every 4 to 6 hours as needed (maximum 75 mg/kg/day or 4 g/day)

 

IBUPROFEN

Adults: 200 to 800 mg orally every 6 to 8 hours as needed (maximum 3.2 g/day)

Pediatrics: 6 to 10 mg/kg orally every 4 to 6 hours as needed (maximum, lesser of 40 mg/kg/day or 2.4 g/day)

 

ACETAMINOPHEN/OXYCODONE HYDROCHLORIDE  

Adults: Oxycodone 5 to 20 mg/acetaminophen 325 to 1000 mg orally every 4 hours as needed (maximum 4 g acetaminophen/day)

Pediatrics: 0.05 to 0.15 mg/kg of the oxycodone ingredient (maximum 5 mg) orally every 4 hours as needed

 

HYDROCODONE BITARTRATE/ACETAMINOPHEN  

Adults: Hydrocodone 5 to 20 mg/acetaminophen 325 to 1000 mg orally every 4 hours as needed (maximum 4 g acetaminophen/day)

 

ACETAMINOPHEN/CODEINE PHOSPHATE  

Adults: Codeine 15 to 60 mg/acetaminophen 300 mg orally every 4 to 6 hours as needed (maximum 360 mg codeine and 4 g acetaminophen/day)

 

MORPHINE SULFATE  

Adults (acute severe pain treated in emergency department): 2 to 10 mg IV every 5 to 10 minutes titrated to effect

Adults (average dose): 10 mg (0.15 mg/kg) IM or subcutaneously every 3 or 4 hours as needed

 

KETOROLAC TROMETHAMINE  

Adults (<65 years): Loading dose 30 to 60 mg IM or IV, then 10 to 30 mg IV or IM every 6 hours (maximum 120 mg/day for ?5 days) OR 10 mg orally every 6 hours (maximum 40 mg/day)

 

HYDROMORPHONE HYDROCHLORIDE  

Adults (acute severe pain treated in emergency department): 1 mg IV every 10 minutes titrated to effect

Adults (usual dose): 1 or 2 mg IM or subcutaneously OR 4 to 8 mg orally every 3 to 4 hours as needed

Pediatrics: 10 to 20 mcg/kg IV every 3 to 4 hours as needed

 

FENTANYL  

Adults: 1 mcg/kg IV slowly every 3 to 5 minutes titrated to effect

Pediatrics: 0.5 to 1 mcg/kg IV every 30 to 60 minutes as needed

 

Procedural Therapy  

 

Respiratory distress  

* Airway management: Airway management must assume the first priority in the management of any seriously ill or injured patient .

 

Non-Procedural Therapy  

 

Mediastinal emphysema  

* Bed Rest

* Oxygen Therapy