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Pneumothorax, Emergency Medicine

William Porcaro Reviewed 06/2017



  • 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...


Signs and Symptoms


  • 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...



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

Initial Stabilization/Therapy

  • Cardiac monitor

  • Pulse oximetry

  • Oxygen 100% via nonrebrea...



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...



  • 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...

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