A 66-year-old with severe emphysema has a moderate pneumothorax, RR 30/min, SpO2 88% on baseline oxygen and increased work of breathing. BP is 118/72

Question

A 66-year-old with severe emphysema has a moderate pneumothorax, RR 30/min, SpO2 88% on baseline oxygen and increased work of breathing. BP is 118/72 mmHg and there is no mediastinal shift. What is the most appropriate initial pleural plan?

Accepted Answer

Insert a small-bore catheter or chest drain and admit for monitoring

Answer

Observe without intervention because stable blood pressure excludes pleural risk

Answer

Discharge after oxygen and arrange radiography in two weeks

Answer

Treat with bronchodilators alone because COPD explains the increased work of breathing

Answer

Perform immediate needle thoracostomy because every pneumothorax with hypoxemia is tension physiology

Secondary spontaneous pneumothorax — RCPSC EM MCQ

A 66-year-old with severe emphysema has a moderate pneumothorax, RR 30/min, SpO2 88% on baseline oxygen and increased work of breathing. BP is 118/72 mmHg and there is no mediastinal shift. What is the most appropriate initial pleural plan?