What is the likely cause of a crackling sensation over the clavicle area in a patient receiving IPPB treatments via tracheostomy tube?

• A. Secretions in the upper airway
• B. Subcutaneous emphysema
• C. Fractured clavicle
• D. Air embolism

Answer: (B)

The presence of a crackling sensation over the clavicle area in a patient who is receiving intermittent positive pressure breathing (IPPB) treatments via a tracheostomy tube is most consistent with subcutaneous emphysema. This condition occurs when air leaks into the subcutaneous tissue, often due to a rupture in the airways or surrounding structures, and creates a distinct crackling sensation upon palpation. This phenomenon is particularly notable in cases where there is a communication between the airway and the subcutaneous tissue, such as could occur with pressure from mechanical ventilation or an improperly placed tracheostomy tube.

In contrast, while secretions could cause noises in the airway, they would not typically present as a crackling sensation over the clavicle. A fractured clavicle could lead to pain or swelling in that area but would not generate a crackling sensation associated with air in the soft tissue. An air embolism, though serious, would present with different clinical signs, such as respiratory or neurological symptoms, and not merely a localized crackling sensation. Therefore, the correct identification of subcutaneous emphysema aligns with the observed clinical signs in this scenario.