STUDY - Technical - New Dacian's Medicine
Crepitation,
subcutaneous (Classical / Allopathic Medicine)
When bubbles of
air or other gases (such as carbon dioxide) are trapped in
subcutaneous tissue, palpation or stroking of the skin
produces a crackling sound called subcutaneous crepitation.
The bubbles feel like small, unstable nodules and aren't
painful, even though subcutaneous crepitation is commonly
associated with painful disorders. Usually, the affected
tissue is visibly edematous; this can lead to life-threatening
airway occlusion if the edema affects the neck or upper chest.
The air or gas
bubbles enter the tissues through open wounds, from the action
of anaerobic microorganisms, or from traumatic or spontaneous
rupture or perforation of pulmonary or GI organs.
ALERT:
Because subcutaneous crepitation can indicate a life-threatening disorder, you'll need to perform a rapid initial evaluation and intervene, if necessary. (See Managing subcutaneous crepitation.) If the patient's condition permits, perform a focused assessment.
Because subcutaneous crepitation can indicate a life-threatening disorder, you'll need to perform a rapid initial evaluation and intervene, if necessary. (See Managing subcutaneous crepitation.) If the patient's condition permits, perform a focused assessment.
Managing
subcutaneous crepitation
Subcutaneous crepitation occurs when air or gas bubbles escape into tissues. It may signal life-threatening rupture of an air-filled or gas-producing organ or a fulminating anaerobic infection.
Subcutaneous crepitation occurs when air or gas bubbles escape into tissues. It may signal life-threatening rupture of an air-filled or gas-producing organ or a fulminating anaerobic infection.
Organ rupture
If the patient shows signs of respiratory distress - such as severe dyspnea, tachypnea, accessory muscle use, nasal flaring, air hunger, or tachycardia - quickly test for Hamman's sign to detect trapped air bubbles in the mediastinum.
To test for Hamman's sign, help the patient assume a left-lateral recumbent position. Then place your stethoscope over the precordium. If you hear a loud crunching sound that synchronizes with his heartbeat, the patient has a positive Hamman's sign.
Depending on which organ is ruptured, be prepared for endotracheal intubation, an emergency tracheotomy, or chest tube insertion. Start administering supplemental oxygen immediately. Start an I.V. line to administer fluids and medication, and connect the patient to a cardiac monitor.
If the patient shows signs of respiratory distress - such as severe dyspnea, tachypnea, accessory muscle use, nasal flaring, air hunger, or tachycardia - quickly test for Hamman's sign to detect trapped air bubbles in the mediastinum.
To test for Hamman's sign, help the patient assume a left-lateral recumbent position. Then place your stethoscope over the precordium. If you hear a loud crunching sound that synchronizes with his heartbeat, the patient has a positive Hamman's sign.
Depending on which organ is ruptured, be prepared for endotracheal intubation, an emergency tracheotomy, or chest tube insertion. Start administering supplemental oxygen immediately. Start an I.V. line to administer fluids and medication, and connect the patient to a cardiac monitor.
Anaerobic
infection
If the patient has an open wound with a foul odor and local swelling and discoloration, you must act quickly. Take the patient's vital signs, checking especially for fever, tachycardia, hypotension, and tachypnea. Next, start an I.V. line to administer fluids and medication, and provide supplemental oxygen.
In addition, be prepared for emergency surgery to drain and debride the wound. If the patient's condition is life-threatening, you may need to prepare him for transfer to a facility with a hyperbaric chamber.
If the patient has an open wound with a foul odor and local swelling and discoloration, you must act quickly. Take the patient's vital signs, checking especially for fever, tachycardia, hypotension, and tachypnea. Next, start an I.V. line to administer fluids and medication, and provide supplemental oxygen.
In addition, be prepared for emergency surgery to drain and debride the wound. If the patient's condition is life-threatening, you may need to prepare him for transfer to a facility with a hyperbaric chamber.
HISTORY:
Ask the patient if he's experiencing pain or having difficulty breathing. If he's in pain, find out where the pain is located, how severe it is, and when it began.
Ask the patient about recent thoracic surgery, diagnostic testing, and respiratory therapy or a history of trauma or chronic pulmonary disease.
Ask the patient if he's experiencing pain or having difficulty breathing. If he's in pain, find out where the pain is located, how severe it is, and when it began.
Ask the patient about recent thoracic surgery, diagnostic testing, and respiratory therapy or a history of trauma or chronic pulmonary disease.
PHYSICAL
ASSESSMENT:
Palpate the affected skin to evaluate the location and extent of subcutaneous crepitation and to obtain baseline information. Repalpate frequently to determine if the subcutaneous crepitation is increasing.
Check the patient's temperature and vital signs.
If the patient has a wound, assess for drainage, odor, swelling, and discoloration.
Palpate the affected skin to evaluate the location and extent of subcutaneous crepitation and to obtain baseline information. Repalpate frequently to determine if the subcutaneous crepitation is increasing.
Check the patient's temperature and vital signs.
If the patient has a wound, assess for drainage, odor, swelling, and discoloration.
SPECIAL
CONSIDERATIONS:
Because excessive edema from subcutaneous crepitation in the neck and upper chest can cause airway obstruction, be alert for signs of respiratory distress.
Because excessive edema from subcutaneous crepitation in the neck and upper chest can cause airway obstruction, be alert for signs of respiratory distress.
PEDIATRIC
POINTERS:
Children may develop subcutaneous crepitation in the neck from ingestion of corrosive substances that perforate the esophagus.
Children may develop subcutaneous crepitation in the neck from ingestion of corrosive substances that perforate the esophagus.
PATIENT
COUNSELING:
Reassure the patient that the affected tissues will eventually absorb the air or gas bubbles, so the subcutaneous crepitation will decrease. Warn patients with asthma or chronic bronchitis to be alert for subcutaneous crepitation, which can signal pneumothorax, a dangerous complication.
Reassure the patient that the affected tissues will eventually absorb the air or gas bubbles, so the subcutaneous crepitation will decrease. Warn patients with asthma or chronic bronchitis to be alert for subcutaneous crepitation, which can signal pneumothorax, a dangerous complication.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)