Pneumothorax A-Z

🗒️ Question 

A 25 year old man presents to the emergency department with sudden onset of sharp, left-sided chest pain and shortness of breath. He has no significant past medical history and denies any trauma.

On examination, he has reduced breath sounds on the left side and is tachypnoeic with a respiratory rate of 28 breaths per minute. His blood pressure is 120/80 mmHg, heart rate is 110 bpm and oxygen saturation is 94% on room air.

A chest X-ray confirms a left-sided pneumothorax with a 3 cm rim of air between the lung margin and the chest wall at the level of the hilum.

What is the most appropriate initial management according to UK guidelines?

(A) Administer 100% oxygen and observe for 4 hours
(B) Needle aspiration
(C) Insert a chest drain
(D) Administer high-flow nasal cannula oxygen and observe for 24 hours
(E) Perform an emergency thoracotomy