Management of Pneumothorax

Clinical Presentation and Diagnosis

The patient's presentation strongly suggests pneumothorax with classic findings of shortness of breath, chest pain, tachycardia, absent breath sounds, and hyperresonant percussion note, as recommended by the American College of Cardiology and American Heart Association 1, 2
The American College of Cardiology/American Heart Association guidelines recommend chest radiography to evaluate potential pulmonary causes of chest pain 2
STAT chest x-ray is the appropriate first diagnostic step to confirm pneumothorax before proceeding to treatment, according to the American College of Cardiology 4, 5

If pneumothorax is confirmed and significant, tube thoracostomy should be performed, with tube placement typically in the fourth/fifth intercostal space in the midaxillary line, as recommended by the Military Medical Research 4
For tension pneumothorax with hemodynamic compromise, needle decompression at the second intercostal space in the midclavicular line may be performed before chest tube placement, according to the Military Medical Research 4
Supplemental oxygen should be provided as needed for patients with small pneumothorax 5

Portable ultrasound can be considered if immediately available, but should not delay obtaining a chest x-ray, as recommended by the Military Medical Research 4
Patients should be monitored closely for development of tension pneumothorax, which is a life-threatening emergency requiring immediate intervention, according to the Military Medical Research 4