Emergency Cases Northwest Group

007 Okey-cokey

Situation

A young man had an asthma attack. Turned out to be cocaine induced pneumomediastinum.

Background

A 33 year old man had a severe asthma attack and then collapsed in the ambulance. Apparently hypoxic but no wheeze heard, sats stable. Cxr revealed significant pneumomediastinum. CT including barium swallow showed no cause. Patient a few days later admitted to using a large amount of cocaine.

Assessment

He never had an asthma attack. His pneumomediastinum was from cocaine use.

Recommendation

Causes of pneumomediastinum include:

coughing

bearing down to increase abdominal pressure

sneezing

vomiting

rapid rises in altitude, or scuba diving

tearing of the eosophagus

tearing of the trachea

ventilator use

inhaled recreational drugs, such as marijuana or crack cocaine

surgery

trauma

pneumothorax or other diseases

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group