Pneumothorax

Investigations

• CXR: expiratory film (should not be performed if a tension pneumothorax is suspected)
• ABG in dyspneic/hypoxic patients and those with chronic lung disease

Management

• Pneumothorax due to trauma or mechanical ventilation requires a chest drain.

Tension pneumothorax

• Insert a large-bore cannula, into the 2nd intercostal interspace in the midclavicular line on the side of the suspected pneumothorax.
• Do this before requesting a CXR.
• Then insert a chest drain.

Primary pneumothorax

• If there is no SOB and/or rim of air <2cm on CXR
• Consider discharge and outpatient review in 2–4wks
• If there is SOB and/or rim of air >2cm on CXR
• Aspiration
• If successful, consider discharge and outpatient review in 2–4wks
• If failed, Chest drain

Secondary pneumothorax

• If there is SOB or rim of air >2cm on CXR
• Chest drain
• If there is no SOB and rim of air 1–2cm on CXR
• Aspiration
• If successful, admit for 24h observation and O2
• If failed, chest drain
• If Size < 1cm, Admit for 24h observation and O2

Surgical advice: Arrange if:

• Bilateral pneumothoraces
• Lung fails to expand within 48h of intercostal drain insertion;
• Persistent air leak;
• Two or more previous pneumothoraces on the same side; or history of pneumothorax on the opposite side.