Acupuncture as an ancient Chinese treatment has proven effective and is utilized worldwide. Although it is generally believed to be a safe clinical procedure, serious lethal complications including death have been reported. We present a rare case of life-threatening cardiac tamponade due to penetration of an acupuncture needle directly into the right ventricle.

A 2–3-cm blowhole incision in the supraclavicular or infraclavicular area is widely used to eliminate the presence of subcutaneous air in cases of life-threatening subcutaneous emphysema (SE). However, when the patient is supported by mechanical ventilation, it is difficult to eliminate completely such air because mechanical ventilation leads consistently to the formation of large amounts of air. To overcome this, we applied negative pressure wound therapy (NPWT) along with blowhole incisions for the treatment of severe SE. To evaluate the feasibility of NPWT, we retrospectively analysed the clinical outcomes of 10 patients who developed severe SE during ventilator care and were treated with a modified blowhole incision using NPWT from January 2009 to November 2013. All patients showed immediate improvement in SE after NPWT, and no symptom aggravation occurred after NPWT. The mean duration of NPWT was 7.5 ± 5.1 (range, 3–14) days, and the mean number of dressing changes was 1.5 ± 0.7 (range, 1–2). There were no blowhole-incision-related wound infections or any other complications. While it is not necessary to apply a blowhole incision with NPWT in all cases of SE, this therapy can be helpful for patients with severe SE associated with mechanical ventilation requiring rapid decompression.

In patients with tracheal injuries, conservative treatment is an alternative approach when surgical treatment is difficult. However, the success rate of conservative treatment is low when a ventilator is used constantly because of underlying lung disease, and successful conservative treatment requires the maintenance of as much self-respiration as possible without a ventilator. Here, we report a case of lower tracheal injury in which both surgical and conservative treatments were difficult, but conservative treatment with extracorporeal membrane oxygenation was successful while maintaining self-respiration without a ventilator.

Lee S, et al. J Korean Med Sci. 2016 Jun;31(6):932-938. http://dx.doi.org/10.3346/jkms.2016.31.6.932

Lee SK, et al. Korean J Thorac Cardiovasc Surg. 2012 Jun;45(3):199-201. http://dx.doi.org/10.5090/kjtcs.2012.45.3.199