Sunday, December 27, 2020

Spontaneous pneumothorax

Shaw, Gina. Emergency Medicine News 2020; 42 (12): 26-27
doi: 10.1097/01.EEM.0000724564.10452.46
"Spontaneous pneumothorax is a common presentation in the emergency department, but controversy persists around its management. For small primary spontaneous pneumothoraces—less than 3 cm— the American College of Chest Physicians guidelines recommend observation in the ED for three to six hours followed by a repeat chest x-ray and discharge if the imaging excludes progression.
But for pneumothoraces of 3 cm or greater, the college has long recommended chest tube placement regardless of symptoms or clinical stability, while its European counterparts, the British Thoracic Society and the Belgian Society of Pneumology, recommend simple aspiration as the first-line treatment for primary spontaneous pneumothoraces requiring intervention...
And smaller retrospective studies have suggested that conservative management, regardless of size, leads to no complications, an equal recurrence rate, and a significantly shorter length of stay. (Acute Med Surg. 2014;1[4]:195;"