What is the initial emergency department (ED) care for spontaneous 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

If the PSP is smaller than 15% (or estimated as small) and the patient is symptomatic but hemodynamically stable, needle aspiration is the treatment of choice.

If the PSP is smaller than 15% and if the patient is asymptomatic, many consider observation to be the treatment of choice. (If the patient is admitted, administer oxygen, as this has been shown to speed resolution of the pneumothorax.)

If the PSP is greater than 15% (or estimated as large) aspiration using a pigtail catheter left to low suction or water seal is recommended. Strong suction should not be used with a spontaneous pneumothorax because of an often-delayed presentation and, thus, an increased risk of reexpansion pulmonary edema (see Complications).

Spontaneous pneumothorax is a life-threatening condition in patients with severe underlying lung disease; thus, tube thoracostomy is the procedure of choice in SSP.

Pleurodesis decreases the risk of recurrence, as does thoracotomy or video-assisted thoracoscopic surgery (VATS) to excise the bullae.


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