Pneumomediastinum: a complication of reinserting a dislodged
A 54-year-old woman with a background of obesity and hypertension presented following a pulseless electrical activity (PEA) cardiac arrest. Cardiopulmonary resuscitation (CPR) was commenced on arrival of the paramedics and she was intubated and ventilated.

Return of spontaneous circulation was achieved in the emergency department following a total of 45 min of CPR. No clear cause of her arrest was identified. She was transferred to the intensive care unit (ICU) for post-arrest management.

Seizure activity off of sedation necessitated further investigation. Her CT head was unremarkable, but her lumbar puncture showed features in keeping with meningitis. She was therefore treated with antibiotics and antiepileptics. Her cerebrospinal fluid viral PCR and blood HIV tests were negative.

Although appropriate seizure control was achieved, as evident on electroencephalogram monitoring, her Glasgow Coma Score (GCS) remained low off of sedation. The decision was eventually made to perform a surgical tracheostomy. This was uneventful. She embarked on a path of respiratory weaning and later was spontaneously breathing on room air. An MRI of her head showed features in keeping with global hypoxic brain injury. The neurology team deemed this to be secondary to her long downtime.

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Dr. M●●●r P●●●l
Dr. M●●●r P●●●l General Medicine
Why was tracheostomy done??
Oct 17, 2018Like