Pneumothorax medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Emergency Care

Chest wound

Penetrating wounds require immediate coverage with an occlusive dressing, field dressing, or pressure bandage made air-tight with petroleum jelly or clean plastic sheeting. The sterile inside of plastic bandage packaging is good for this purpose; however any airtight material, even the cellophane of a cigarette pack, can be used. A small opening, known as a flutter valve, needs to be left open, so the air can escape while the lung reinflates.

Any patient with a penetrating chest wound must be closely watched at all times and may develop a tension pneumothorax or other immediately life-threatening respiratory emergency at any moment. They cannot be left alone.

Blast injury or tension

If the air in the pleural cavity is due to a tear in the lung tissue (in the case of a blast injury or tension pneumothorax), it needs to be released. A thin needle can be used for this purpose, to relieve the pressure and allow the lung to reinflate.

Pre-hospital care

Many paramedics can perform needle thoracocentesis to relieve intrathoracic pressure. Intubation may be required, even of a conscious patient, if the situation deteriorates. Advanced medical care and immediate evacuation are strongly indicated.

An untreated pneumothorax is an absolute contraindication of evacuation or transportation by flight.

Clinical treatment

Small pneumothoraces often are managed with no treatment other than repeat observation via Chest X-rays, but most patients admitted will have oxygen administered since this has been shown to speed resolution of the pneumothorax.