Kindle download - previous pearls
Previous Pearls 2016
Previous Pearls 2015
Previous Pearls 2014
Previous Pearls 2013
Previous Pearls 2012
Previous Pearls 2011
Previous Pearls 2010
Previous Pearls 2009
Previous Pearls 2008
Previous Pearls 2007
Previous Pearls 2006
Previous Pearls 2005
Related Critical Care sites
Email / Contribute / Feedback
About us / Editorial team

Tuesday, May 31, 2016 

Q: 28 year old male presented to ED with chest pain after inhalation of crack cocaine. CXR showed pneumomediastinum which was confirmed by CT scan. What is the modus operandi of pneumomediastinum associated with inhalation of crack cocaine?

Answer: There is a general misconception that pneumomediastinum (and/or pneumothorax) associated with crack cocaine is due to drug itself. Actually, it is  likely due to valsalva maneuver usually performed after inhalation. This is the reason that pneumomediastinum (and/or pneumothorax) is a rare occurrence after intranasal cocaine. It may be interesting to know that it is a common practice among crack cocaine smokers not only to perform a valsalva maneuver after inhalation but partners also exhale forcefully into each other's mouths (to increase uptake of the drug), causing  pneumothorax, pneumomediastinum, or even pneumopericardium due to barotrauma.


1. Maeder M, Ullmer E. Pneumomediastinum and bilateral pneumothorax as a complication of cocaine smoking. Respiration 2003; 70:407. 

2. Alnas M, Altayeh A, Zaman M. Clinical course and outcome of cocaine-induced pneumomediastinum. Am J Med Sci 2010; 339:65.

Tip for finding previous pearl
To find previous pearl - go to 'google', as we archive at google's blogspot.
Type your keyword (like hyperkalemia) followed with icuroom.net

This site is a quick "coffee break" forum for "intensivists" -   trained and dedicated in taking care of  critically ill (ICU) patients !!