Current Guidelines For The Management Of Pneumothorax In The Emergency Department
Pneumothorax is a common condition managed in the emergency department (ED), with etiologies that include traumatic, primary spontaneous, secondary to underlying lung disease, and iatrogenic causes. Primary spontaneous pneumothorax has an incidence of 7.4 to 18 cases per 100,000 persons per year for men and 1.2 to 6 cases per 100,000 persons per year for women.1 Traumatic pneumothorax has been described as being present in up to 1 in 5 live patients with major trauma.2 There have been paradigm shifts in ED management of both traumatic and spontaneous pneumothoraces in both diagnosis and treatment options. The use of point-of-care ultrasound allows for early detection of pneumothorax in patients who are too unstable for even portable chest x-ray, and the multidetector computed tomography (CT) scan detects pneumothorax with very high—perhaps too high—sensitivity. New data and guidelines equip emergency clinicians to diagnose and treat pneumothoraces with an evidence-based, less-invasive approach.
Practice Guideline Impact
- Occult traumatic pneumothoraces can be managed noninvasively, even in the setting of positive pressure ventilation.
- Patients with small, asymptomatic primary spontaneous pneumothorax can be safely discharged home with close follow-up.
- Large or symptomatic primary spontaneous pneumothorax or small secondary spontaneous pneumothorax can be managed with needle aspiration and does not require tube thoracostomy after a successful procedure.