Massive surgical emphysema

This patient was re-intubated and resuscitated following a cardiac arrest in ICU – note the endotracheal tube and the defibrillation pad. Subsequent portable chest x-ray showed a huge volume of air in the soft tissues of the chest, neck and arms. Such ‘massive’ surgical emphysema, in addition to being uncomfortable for patients, can actually contribute to ventilatory failure due to restriction of chest wall excursion.