A patient with a spontaneous pneumothorax can be managed initially according to guidelines from the British Thoracic Society (BTS).
NOTE: This does not apply to a patient with a tension or traumatic pneumothorax.
(1) Does the patient have a chronic lung disease (COPD, cystic fibrosis, etc.)?
(2) How much has the lung collapsed?
(3) Does the patient have significant dyspnea?
Upright Chest Radiograph
Degree of Collapse
small rim of air
lung collapsed half-way to heart border
airless lung, separate from the diaphragm
Step 1: Start oxygen and an intravenous line.
Step 2: Determine initial management.
Chronic Lung Disease
Level of Dyspnea
moderate to complete
in patient observation
small to moderate
(1) Inject a local anesthetic into the and subcutaneous tissue in the midclavicular line just above the third rib.
(2) Insert a 16 gauge intravenous cannula into the second intercostal space (just above the third rib in the midclavicular line).
(3) Remove the needle from the cannula and attach a 3-way valve.
(4) With a large syringe aspirate air, using the 3 way valve to prevent air entry into the lungs.
(5) The endpoint is either (a) patient coughs excessively, or (b) 2.5 liters of air is withdrawn through the syringe.
(6) Take an upright chest X-ray to determine if the lung has expanded.
If aspiration successful, then observe patient (as an inpatient if chronic lung disease present, else as outpatient.
If aspiration unsuccessful, then perform intercostal tube drainage.
NOTE: This would apply to a unilateral pneumothorax. I am not sure if it would also apply to management of a patient with a bilateral pneumothorax.
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Purpose: To determine the initial management for a patient with a spontaneous, non-tension pneumothorax.