Facial Swelling in a Patient After Bronchoscopy

Case Study

A rapid response event was activated for a patient who appeared to be in acute distress. On arrival of the rapid response team, the patient was short of breath with visible swelling of the face. Per the bedside registered nurse, the patient was a 40-year-old male with a history of chronic obstructive pulmonary disease, admitted four days ago for right lower lobe pneumonia with a new right hilar mass. During the hospital course, he was seen by pulmonary and oncology teams, and bronchoscopy with ultrasound-guided biopsy of the mass was performed earlier in the day. In the last 4-5 h, the patient had become increasingly dyspneic and developed progressive swelling of the face, which had not improved with IV antihistamines and a dose of IV methylprednisolone.

Vital Signs

  • Temperature: 98.5 °F, axillary

  • Blood Pressure: 140/70 mmHg

  • Heart Rate: 110 beats per min (bpm)

  • Respiratory Rate: 30 breaths per min

  • Oxygen Saturation: 96% on room air

Focused Physical Examination

A quick exam showed a middle-aged male lying in bed in apparent distress; he was tachypneic but not using accessory muscles of respiration. Both lung fields were clear with equal air entry bilaterally. Facial swelling was noticed along with pitting with a crackling sensation under the skin. A crackling sensation was detected on the right side of the chest as well. The remaining physical examination was unremarkable.

Working Diagnosis

Subcutaneous emphysema, angioedema.

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