Breathless or Large Pneumothorax (visible rim >2 cm between the lung margin and the chest wall):
. First Line:
. Chest Drain and Hospital Admission: To manage the pneumothorax and monitor the patient.
. Consider:
. Supplemental Oxygen: To aid in the resolution of the pneumothorax.
. Surgery or Pleurodesis: For recurrent cases or persistent air leaks.
Moderate Pneumothorax (visible rim 1-2 cm between the lung margin and the chest wall):
. First Line:
. Percutaneous Aspiration ± High-Flow Oxygen: To remove air and improve oxygenation.
. Consider:
. Chest Drain and Hospital Admission ± Supplemental Oxygen: If aspiration fails or the patient remains symptomatic.
Small Pneumothorax (visible rim <1 cm between the lung margin and the chest wall):
. First Line:
. High-Flow Oxygen + Observation + Hospital Admission: To monitor the patient and facilitate reabsorption of the pneumothorax.
Key Points:
. Secondary Spontaneous Pneumothorax: Occurs in the presence of underlying lung disease, such as COPD or asthma.
. Symptoms: Sudden onset dyspnoea and chest pain, especially in individuals with a history of lung disease.
. Initial Diagnosis: Confirm with a chest X-ray if the patient is stable.
Additional Management Notes:
. Erect Chest X-ray: To confirm the presence and size of the pneumothorax.
. Percutaneous Aspiration: For moderate pneumothoraxes to remove air and prevent progression.
. Chest Drain: For larger pneumothoraxes or if initial aspiration is unsuccessful.
. Supplemental Oxygen: To aid in the resolution of the pneumothorax.
. Surgical Intervention: Considered for recurrent or persistent cases.
| Condition | First Line | Consider |
|---|---|---|
| Breathless or Large Pneumothorax (visible rim >2 cm between the lung margin and the chest wall) | Chest Drain and Hospital Admission To manage the pneumothorax and monitor the patient. | – Supplemental Oxygen To aid in the resolution of the pneumothorax. Surgery or Pleurodesis For recurrent cases or persistent air leaks |
| Moderate Pneumothorax (visible rim 1-2 cm between the lung margin and the chest wall) |
Percutaneous Aspiration ± High-Flow Oxygen To remove air and improve oxygenation. |
– Chest Drain and Hospital Admission ± Supplemental Oxygen If aspiration fails or the patient remains symptomatic. |
| Small Pneumothorax (visible rim <1 cm between the lung margin and the chest wall) |
High-Flow Oxygen + Observation + Hospital Admission To monitor the patient and facilitate reabsorption of the pneumothorax. |
