Patient handout

Pneumothorax (PSP / SSP / tension / traumatic)

PRODUCTION

1. Your condition

This handout is for pneumothorax (psp / ssp / tension / traumatic). Your care team identified this based on: sudden pleuritic chest pain ± dyspnea.

Other reasons your team may use this plan: pneumothorax on cxr / lung ultrasound (loss of lung sliding) / ct; tension features — hypotension, tracheal deviation, distended neck veins; copd/cf/marfan/recent procedure/chest trauma raising index of suspicion.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
oxygen	High-flow O2 15 L/min via NRB	inhaled	continuous	Accelerates resorption (4× rate vs RA) and treats hypoxia

Plan: BTS 2023 + ERS/ESTS 2024 — drainage strategy by type, size, symptoms

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Hypotension + dyspnea + decreased breath sounds + tracheal deviation OR ventilated patient with sudden decompensation + raised airway pressures (ATLS 2018)(life-threatening)
Pneumothorax in patient with underlying lung disease (COPD, ILD, CF, lung cancer, prior TB) (BTS 2023)
Second ipsilateral PTX, first contralateral PTX, or bilateral PTX (BTS 2023)
Hemopneumothorax with hemodynamic compromise OR penetrating chest trauma (ATLS 2018)(life-threatening)
Pneumothorax in mechanically ventilated patient — barotrauma; near-universal progression to tension under positive pressure (ACCP 2001; BTS 2023)(life-threatening)
Acute dyspnea + shock + ↑JVD: time-critical 3-way pivot. Tension PTX = tracheal deviation AWAY + absent breath sounds + hyperresonance + absent lung sliding/lung point on POCUS. Massive PE = lung sliding present + acute RV dilation/D-sign + clear lungs. Tamponade = muffled heart sounds + pulsus paradoxus + pericardial effusion with RV diastolic collapse on POCUS (ATLS 2018; ESC 2019 PE; ESC 2015 pericardial)(life-threatening)
Spontaneous PTX in HIV with low CD4 — Pneumocystis jirovecii pneumonia with subpleural cysts/pneumatoceles is the classic substrate (BTS 2023)
Spontaneous PTX during pregnancy or labour (Valsalva) — maternal hypoxia threatens fetus; ionising-radiation minimisation required (BTS 2023; ERS/ESTS 2024)

5. Follow-up

CXR at 2–4 weeks; aviation 1 week post-resolution; absolute lifelong contraindication to scuba diving (BTS); smoking cessation; surgical referral if recurrent; advise re: future PTX symptoms

6. Sources

Guideline: BTS 2023 Guideline for Pleural Disease (Roberts, Thorax 2023) + Joint ERS/EACTS/ESTS 2024 spontaneous pneumothorax CPG + Brown PSP RCT (NEJM 2020) + Hallifax RAMPP RCT (Lancet 2020) + Cochrane aspiration-vs-drain + ATLS 10th