Episode 213: Pneumothorax

Pneumothorax management in the emergency department requires a high index of suspicion, especially when differentiating from asthma, COPD, ACS, or pulmonary embolism. Clinical assessment relies on identifying decreased breath sounds and potential trauma history, while point-of-care ultrasound (POCUS) provides rapid, sensitive diagnostic confirmation through the detection of absent lung sliding and the highly specific "lung point." Treatment strategies prioritize patient stability; oxygen therapy suffices for small, stable pneumothoraces, whereas tension physiology necessitates immediate needle or finger thoracostomy. For definitive intervention, small-bore pigtail catheters offer an effective, less invasive alternative to large-bore chest tubes in simple cases, with the latter reserved for patients presenting with hemothorax or complex fluid collections. Disposition decisions depend on the patient's clinical trajectory and institutional protocols for chest tube management.