Images in emergency medicine
Pneumomediastinum and pulmonary interstitial emphysema after tracheal taser iniurv
A male jail inmate in his 30s presented to the emergency department with shortness of breath after sustaining multiple shocks from a conducted electrical weapon (CEW). His exam revealed normal vitals, crepitus of the upper chest and neck and barb wounds on the abdomen, chest and anterior neck, 2 cm above the sternal notch. CTof the neck and chest (figures 1-3) demonstrated pneumomediastinum, pulmonary interstitial emphysema
Figure 1   Coronal chest CT image showing pneumomediastinum.
Figure 3   Transverse chest CT image showing pulmonary interstitial emphysema of the right lower lobe.
and subcutaneous emphysema from the bilateral chest to the masticator space. As neck swelling increased, intubation was performed fiberoptically.
Pharyngoscopy, bronchoscopy and an esophagram revealed no blood or persistent mucosal defect. Tracheal puncture with subsequent spontaneous closure was the suspected cause. It was thought less likely but also possible that the CEW elicited powerful forced expiration against a closed glottis causing a small tracheal tear.
CEWs, although known to be generally safe in limited exposures, have been associated with rare but frequently controversial reported complications.1 Such complications are often traumatic, and have included pneumothorax and subcutaneous air from pharyngeal perforation. Mild superficial injuries from the barbs used by these weapons are the most common injury. All patients exposed to CEWs should be fully examined to rule out serious traumatic injury.
Patrick Joseph Maher, Niels Beck, Jared Strote
Division of Emergency Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA
Correspondence to Dr Jared Strote, Division of Emergency Medicine, Department of Medicine, University of Washington Medical Center, Box 356123, 1959 NE Pacific Street, Seattle, WA 98195, USA; strote@uw.edu
Contributors PH cared for the patient and contributed to writing the manuscript. NB cared for the patient and contributed to writing and editing the manuscript. JS contributed to writing and editing the manuscript.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.
Figure 2 Transverse chest CT image showing subcutaneous emphysema at the root of the neck.
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To cite Maher PJ, Beck N, Strote J. Emerg Med J 2015;32:90.
Accepted 1 September 2013
Published Online First 20 September 2013
Emerg Med J 2015;32:90. doi: 10.1136/emermed-2013-203160 REFERENCE
1    Pasquier M, Carron PN, Vallotton L, et al. Electronic control device exposure: a review of morbidity and mortality. Ann Emerg Med 2011;58:178-88.
90
Maher PJ, ef al. Emerg Med J January 2015 Vol 32 No 1
BMJ
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