If subcutaneous emphysema worsens and threatens airway patency, what is the appropriate initial action?

• A. Remove chest tube immediately
• B. Notify clinician; assess tube patency and lung re-expansion; escalate care as directed
• C. Increase nasal oxygen only
• D. Ignore if patient feels fine

Answer: (B)

Worsening subcutaneous emphysema that threatens airway patency means there is an ongoing air leak and the chest tube may not be functioning to re-expand the lung. The first step is to notify the clinician and assess the chest tube for patency and lung re-expansion, then escalate care as directed. Verifying patency involves checking for kinks, occlusions, or disconnections in the tubing, confirming the drainage system is intact and functioning, and assessing whether the lung has re-expanded on exam or imaging. Escalation may include repositioning or replacing the tube, adjusting suction, additional imaging, or consultation with thoracic surgery. This approach targets the source of the problem—an ineffective drainage and persistent air leak—rather than just increasing oxygen or ignoring the situation, which could allow the airway compromise to progress.