Pneumothorax, Emergency Medicine

William Porcaro Reviewed 06/2017
 


Basics

Description

  • Presence of free air in the intrapleural space

  • Spontaneous pneumothorax is due to atraumatic rupture of alveolus, bronchiole, or bleb.

  • Primary spontaneous pneumothorax (2/3 of incidenc...

Diagnosis

Signs and Symptoms

History

  • Severity of symptoms is generally proportional to size of the pneumothorax.

  • Chest pain on the ipsilateral side:

    • Sharp, pleuritic pain

    • Sudden onset

    • Dull ache in delayed p...

Treatment

Pre-Hospital

Unstable patients with a suspected tension pneumothorax require immediate needle thoracostomy. 

Initial Stabilization/Therapy

  • Cardiac monitor

  • Pulse oximetry

  • Oxygen 100% via nonrebrea...

Follow-Up

Disposition

Admission Criteria

  • Tension pneumothorax

  • Chest tube required

Discharge Criteria

  • <15% collapse, no expansion while in the ED or successful aspiration with catheter removed:

    • Discharge ...

Pearls and Pitfalls

  • Delay in chest decompression in the unstable patient leading to rapid hemodynamic compromise

  • Avoid poor tube placement involving kinks or improper depth, which may necessitate repea...

Additional Reading

  • Baumann  MH, Strange  C, Heffner  JE, et al. Management of spontaneous pneumothorax: An American College of Chest Physicians Delphi consensus statement. Chest.  2001;119:590–60...

Codes

ICD9

  • 512.0 Spontaneous tension pneumothorax

  • 512.81 Primary spontaneous pneumothorax

  • 512.89 Other pneumothorax

  • 512.1 Iatrogenic pneumothorax

  • 512.82 Secondary spontaneous pneumothorax

  • 860.0 Traumatic pn...

Subscribe to Access Full Content

Sign Up for a 10-Day Free Trial

Sign up for a 10-day FREE Trial now and receive full access to all content.

 
×