Subcutaneous emphysema and tension pneumomediastinum

An 83-year-old woman was brought to the emergency department (ED) by the Emergency Medical Services (EMS) due to referred anaphylactic shock. While eating, she started choking and her neck and lips swelled. Upon arrival at the ED she was confused, tachycardic and hypotensive (heart rate 130 bpm, blood pressure 86/40 mm Hg); the hypotension was slightly improved by colloid and dopamine infusion. A …