Parameters:
(1) size of pneumothorax
(2) clinical symptoms
(3) difficulty with catheter insertion
(4) previous central venous catheter placement
Therapeutic options:
(1) observe
(2) insert small pigtail catheter
(3) insert large chest tube
A large chest tube is inserted if:
(1) the patient is critical (emergency associated with pneumothorax)
(2) a trial of a small pigtail catheter fails
A small pigtail catheter is inserted if:
(1) the size of the pneumothorax is > 30%
(2) the patient is symptomatic but not critical
(3) the insertion of the catheter was difficult
(4) the patient has a history of a previous central venous catheter placement
(5) a trial of observation fails
If neither a large chest tube nor a small pigtail catheter is indicated, then the patient can be observed.
