PDF(Pubmed)
Abstract：
A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable; therefore, he was kept under observation for 8 hours and was later discharged. After 5 hours, the patient presented again in emergency department with sudden-onset shortness of breath and chest discomfort. On examination, subcutaneous crepitation around the neck and chest was found. Chest and neck X-ray revealed subcutaneous emphysema and pneumomediastinum. CT neck and chest was done, which revealed subcutaneous emphysema and pneumomediastinum and a linear air density in close approximation to right posterolateral wall of trachea at the level of superior margin of sternum was reported. These findings raised the possibility of tracheal injury which was later confirmed by fiberoptic laryngoscopy. The patient was intubated due to hypercapnic respiratory failure resulting from hypoventilation and respiratory distress. Bilateral chest tube insertion was done due to worsening subcutaneous emphysema, high ventilator parameters and prevention of progression to pneumothorax. He was extubated after 5 days; bilateral chest tubes were removed before discharge and underwent uneventful recovery.
摘要：
一名年轻男子出现在急诊科，意外吸入氯气后呼吸急促和咳嗽。最初的陈述并不引人注目；因此，他被观察了8小时，后来出院。5小时后,患者再次出现在急诊科，突然出现呼吸急促和胸部不适。在检查中，发现颈部和胸部皮下起皱。胸部和颈部X线检查显示皮下气肿和纵隔肺气肿。做了颈部和胸部CT,据报道，皮下气肿和纵隔气肿，并且在胸骨上缘水平上与气管右后外侧壁紧密接近的线性空气密度。这些发现提高了气管损伤的可能性，后来被纤维喉镜检查证实。由于通气不足和呼吸窘迫导致的高碳酸血症性呼吸衰竭，患者被插管。双侧胸管插入是由于皮下气肿恶化，高呼吸机参数和预防进展为气胸。5天后拔管；出院前取出双侧胸管，恢复顺利。
