Subcutaneous emphysema is defined by air becoming confined in the soft tissues beneath the skin and it may occur following various surgical procedures and specific penetrating trauma. While treatment is typically conservative and not required in most cases, massive subcutaneous emphysema may cause significant morbidity and sometimes life-threatening complications such as tension pneumomediastinum and respiratory compromise. Notably, no instances of self-inflicted air insufflation into the abdominal cavity have been reported in the literature. This report depicts a case of a self-inflicted air insufflation in a 40-year-old man via penetration of his umbilicus with a manual air compressor leading to widespread subcutaneous emphysema, pneumoperitoneum, pneumomediastinum, pneumopericardium, and pneumothorax. The pathway of possible air movement between body cavities has been theorized, but excluding case reports and anecdotal evidence, treatment of severe subcutaneous emphysema is less clear. This case report intends to record this unique instance of extensive subcutaneous emphysema and to emphasize the necessity for more definitive guidelines in managing these patients.

Background The management of neutropenic fever patients is challenging – from identification to diagnosis to treatment. We hypothesize that patients’ individual baseline body temperature provides diagnostic and prognostic value. Methods This is an analysis of 92 adult patients admitted for neutropenic fever to a tertiary medical center over 1 year period. We modelled the length of stay and the ability to find a definitive diagnosis using the change in body temperature from each patient’s outpatient baseline, the neutropenia level and overall patient acuity on admission, persistence of fever over 48-72 hours, and age. All temperatures were standardized to oral. Refer to Table 1 for the inclusion and exclusion criteria and statistical methods. Table 1.Inclusion and exclusion criteria and statistical methods. Results Refer to Tables 2 and 3 for demographics and descriptive statistics of temperature readings, to Table 4 for advanced statistical analyses. Importantly, the average baseline body temperature was at 36.7C; the average fever on admission was at 38.1C; based on the ≥ 38C cutoff, only 24% of patients had persistent fever over 48-72 hours but based on personalized cutoffs at > 2 standard deviations (SDs) or > 3 SDs above their outpatient baseline, 54% and 34% had persistent fever, respectively; the etiology of fever was identified in 48% of patients, all of which constituted infections; our multiple regression model demonstrated that a longer length of stay (LOS) of ≥ 4 days was predicted by larger deviation from baseline body temperature at admission and independently by fever persistence, after correcting for age, neutropenia level, and need for ICU level of care on admission. A similar model could not predict the ability to identify a fever-explaining diagnosis. Conclusion Given the average outpatient baseline body temperature of 36.7 +/- 0.3C, at 2 standard deviations (SDs) above this baseline, only 3% of patients would be at the 38C cutoff for fever, at 3 SDs, it would be 20%, thus rendering the standard 38C cutoff too high to be useful in identifying many neutropenic fever cases and supporting the use of personalized cutoffs based on patient’s baseline temperature. Further, consideration of the specific deviation from patients’ baseline body temperature could serve as a predictor for hospital LOS in patients admitted with neutropenic fever. Disclosures All Authors: No reported disclosures.