SAQ 65 – Respiratory – pneumomediastinum with chest pain
Model Answer
Question 6. An 18-year-old male presents with chest pain.
a. State two (2) abnormal findings shown in this X-ray. (2 marks)
- Pneumomediastinum.
- Left axillary subcutaneous emphysema and/or neck subcutaneous emphysema.
b. State four (4) likely precipitating causes and the definitive management for each. (8 marks)
Note: oxygen therapy is not supported by evidence for pneumomediastinum in contrast to pneumothorax; no intake limitation is required if the condition is improving; antibiotics minimise complications rather than providing definitive care.
| Precipitating cause | Definitive management option |
|---|---|
| Valsalva, e.g. bong smoking, coughing, sneezing, or forceful inhalation of illegal drugs. | Conservative management with analgesia and rest. |
| Asthma exacerbation. | Treat the underlying asthma and observe carefully. |
| Vomiting / Boerhaave syndrome. | Theatre. |
| Diving related. | Conservative management with analgesia and rest; not recompression. |
c. State two (2) immediate steps in the treatment of this patient. (2 marks)
Evidence of tension:
- Incise the sternal notch.
- Insert a finger into the pretracheal space to decompress.
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