What is included in the initial emergency department (ED) care of pneumothorax?

Updated: Apr 28, 2020
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Mary C Mancini, MD, PhD, MMM  more...
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Answer

Immediate attention to the ABCs (airway, breathing, circulation) while assessing vital signs and oxygen saturation is paramount, particularly in patients with thoracic trauma. Evaluate the patency of the airway and the adequacy of the ventilatory effort. Assess the circulatory status and the integrity of the chest wall. Carefully evaluate the cardiovascular system, because a tension pneumothorax and pericardial tamponade can cause similar findings.

ED care depends on the hemodynamic stability of the patient. All patients should receive supplemental oxygen to increase oxygen saturation and to enhance the reabsorption of free air.

Note that ultrasonography is the only radiographic modality that allows patients with nonarrhythmogenic cardiac arrest to continue undergoing resuscitation while clinicians search for easily reversible causes of asystole or pulseless electrical activity (PEA). [62] A protocol (using the acronym CAUSE for cardiac arrest ultrasound exam) in which cardiac arrest patients, concurrent with resuscitation, receive bedside ultrasonography to look for cardiac tamponade, massive pulmonary embolus, severe hypovolemia, and tension pneumothorax has been proposed for further investigation. It is possible that the eventual adoption of ultrasonography in this setting may allow increased "real-time" diagnostic acumen, decreasing the time required to receive appropriate condition-related therapy.


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