Management of Surgical Emphysema

Initial Assessment and Management

A calm atmosphere and reassurance are particularly helpful for patients with surgical emphysema as anxiety increases work of breathing 1
Close observation is essential, with monitoring of level of consciousness, respiratory rate, heart rate, blood pressure, oxygen saturation, temperature, and pain score 1, 2
Capnography using a specially designed facemask can aid early detection of airway obstruction 1
Position the patient upright (head of bed elevated 30 degrees) to optimize respiratory mechanics and reduce work of breathing 2, 3

Administer high-flow humidified oxygen to patients with respiratory compromise 1
End-tidal carbon dioxide monitoring is desirable to assess ventilation adequacy 1
For patients with obstructive sleep apnea, a nasopharyngeal airway may overcome upper airway obstruction 1
If the patient uses CPAP at home, ensure it's available for use during recovery and on the ward 1
Avoid factors that would impede venous drainage from the affected area 1
Encourage deep breathing and coughing to clear secretions 1

Adequate analgesia is essential to keep the patient comfortable and facilitate deep breathing 1, 4
Analgesia helps prevent secondary complications like restricted breathing and aids mobilization 4
For severe cases, consider intrapleural bupivacaine (0.25%) if discomfort is significant 4

A patient who is agitated or complains of difficulty breathing should never be ignored, even if objective signs are absent 1
Warning signs requiring immediate attention include stridor, obstructed pattern of breathing, agitation, and signs of mediastinitis (severe sore throat, deep cervical pain, chest pain, dysphagia) 1
Early mobilization and exercise are recommended as soon as the patient is stable 4