What's subcutaneous emphysema, and what are the priority nursing interventions for a patient with this disorder?-S.L., WASH.
Melissa Moye, BSN, RN, CCRN, CLNC, replies: Subcutaneous emphysema (SCE), also known as subcutaneous crepitus and subcutaneous crepitation, occurs when air or another gas such as CO2 is trapped in subcutaneous tissues. Possible causes include a large pneumothorax, orbital fracture, gas gangrene, and rupture of the esophagus, trachea, or bronchus.1 The location of the SCE, as well as patient management, will depend on the underlying cause, but it frequently occurs on the face, neck, or chest.
Your physical assessment will generally reveal edema of the affected area along with subcutaneous crepitus-a crackling sensation under the skin during palpation. While palpating the involved area, use a skin marker to identify its borders. This will help you determine whether the SCE is progressing or resolving.1
Usually the affected tissues will slowly absorb the SCE after the underlying cause is identified and appropriately treated.1 However, supplemental oxygen may be used to facilitate its absorption.2
It's important to remember that if the SCE involves the patient's neck or upper chest, your patient's airway patency may be compromised. Frequently assess the patient for signs and symptoms of respiratory distress, including tachypnea, dyspnea, shortness of breath, tachycardia, decreased or absent breath sounds, and use of accessory muscles of respiration. Edema in the neck or upper chest may compress the trachea, cause airway obstruction, and require emergency endotracheal intubation or tracheostomy.1 If your patient develops respiratory distress, call the rapid response team and be prepared to assist with emergency interventions.
1. Crepitation, subcutaneous (subcutaneous crepitus, subcutaneous emphysema). http://www.wrongdiagnosis.com/e/emphysema/book-diseases-5a.htm.
2. Agarwal IT, Long DE. Radiological Case of the Month Discussion. http://www.medscape.com/viewarticle/406628_4.
Gas gangrene. 2009. http://www.nlm.nih.gov/medlineplus/ency/article/000620.htm.
Handbook of Signs and Symptoms. 4th ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2009.
Stridor. 2008. http://www.nlm.nih.gov/medlineplus/ency/article/003074.htm.
Subcutaneous emphysema. http://www.learningradiology.com/archives05/COW%20180-Subcu%20Emphysema/subcuemp.
Subcutaneous emphysema. 2008. http://www.nlm.nih.gov/medlineplus/print/ency/article/003286.htm.