Dissanaike et al evaluated patients with pneumomediastinum following blunt trauma. Management of the patient depends on accurately identifying the source of the air. The authors are from the University of Washington in Seattle.
Patient selection: pneumomediastinum in blunt trauma patient
Initial study: CT of neck and thorax using intravenous contrast material
Suspect Airway Injury
Suspect Esophageal Injury
Management
no
no
Observe.
yes
no
Perform laryngoscopy and/or bronchoscopy.
no
yes
Perform esophagram and/or esophagoscopy.
yes
yes
Perform (1) laryngoscopy and/or bronchoscopy, and (2) esophagram and/or esophagoscopy.
If a defect is identified on any of the supplemental studies then consider surgical repair.
If no defect is identified on the supplemental studies, then observe.
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