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The majority of emergency medical service (EMS) providers in the United States have protocols for rapid assessment and treatment of pneumothorax. There are multiple treatment modalities available for use by prehospital providers with varying use by both levels of training and geographic location. No single accepted method is being performed on a national level. This activity reviews the treatment of pneumothorax and highlights the role of the interprofessional team in the management of these patients. Objectives: Describe the pathophysiology of pneumothorax. Summarize the indications for a chest tube. Review the presentation of a patient with pneumothorax. Outline the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients with pneumothorax. Access free multiple choice questions on this topic.

Traumatic pneumothorax is the second most common injury in chest trauma, accounting for 50,000 cases a year in the United States. Pneumothorax management relies on early recognition and treatment by prehospital providers to prevent the development of respiratory failure or obstructive shock from “tension” physiology. The majority of emergency medical service (EMS) providers in the United States have protocols for rapid assessment and treatment of pneumothorax. There are multiple treatment modalities available for use by prehospital providers with varying use by both levels of training and geographic location. No single accepted method is being performed on a national level.[1][2][3][4]

Needle thoracostomy is fraught with complications and is invasive and painful for the patient. Cases report the injury to the thoracic vasculature, lung parenchyma, and cardiac tissues resulting in significant morbidity and mortality. Careful consideration should be had in regards to the proximity of those structures with needle placement. In addition, there have been case reports of infection entering the space and evaluation for overlying cellulitis and other infectious risks should be done before performing decompression. For these reasons, needle decompression should only be performed when necessary. Also, it is important to remember that needle thoracostomy is a temporizing measure, with patients usually requiring tube thoracostomy placement when arriving at the hospital. Other prehospital systems, especially in the United Kingdom, have evaluated the placement of chest tubes in the field. The results have shown similar rates of success with decompression, but delays to transport were greater with tube thoracostomy placement. The complications associated with occlusive dressings are less a product of the procedure and more of a failure for the procedure to achieve an effective one-way flap over the wound.  The most common complications are a loss of adherence to the patient, resulting in a continued communicating pneumothorax, or occlusion of the wound itself, resulting in a closed pneumothorax with the potential to develop tension physiology. The often concomitant hemothorax associated with these injuries furthers the likelihood of either of these possibilities as bleeding may hinder adherence of the dressing to the chest wall and clotted blood may obstruct the tract preventing pleural air to escape the thoracic cavity. Additional complications are rarely life-threatening, but localized allergic reactions have been reported with some adhesives.

The management of a pneumothorax is with an interprofessional team that includes an emergency department physician, trauma surgeon, general surgeon, thoracic surgeon, and a critical care specialist. However, the care of these patients is by a nurse. The nurse is responsible for ensuring the patency of the tube that connects to the chest drainage. In addition, the nurse is responsible to wound care and monitoring vital signs. The majority of patients treated promptly for a pneumothorax have a good outcome. Patients need to be educated about discontinuing smoking, as this habit increases the risk of a pneumothorax.[2][3]