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Old 12-15-2012
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Arrow A 23-year-old man with Pneumothorax

A 23-year-old man is seen in the ED for sud-den-onset, right-sided pleuritic chest pain that developed 30 minutes ago while he was watching television. The patient also complains of difficulty breathing. He has no prior medical history, denies smoking and intravenous drug use, and does not take any medications. His temperature is 37.3 C (99.1F), blood pressure is 130/82 mm Hg, pulse is 92/min and regular, respiratory rate is 20/min and shallow, and oxygen saturation is 98% on room air. He is 196 cm (6 ft 5 in) tall with a body mass index of 18 kg/m2 . Diminished breath sounds, hyperresonance, and decreased tactile fremitus are prominent in the right lung field. The trachea is midline. X-ray of the chest shows a 10% pneumothorax on the right. Which of the fol-lowing is the most appropriate initial manage-ment?

(A) Observation with supplemental oxygen
(B) Open thoracotomy with oversewing of the pleural blebs and scarification of the pleura
(C) Needle decompression
(D) Thoracoscopy with stapling of blebs
(E) Tube thoracostomy with doxycycline pleurodesis
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(C) Needle decompression
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Old 12-16-2012
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(A) Observation with supplemental oxygen
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spontaneous pneumothorax. O2 and observe.
__________________
IT IS GETTING INTENSE !!
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(A) Observation with supplemental oxygen
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A)...observation and supplemental oxygen
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Ya In Primary spontaneous pneumothorax the most appropriate initial management is Observation with supplemental oxygen.
The initial treatment for patients with pneumothoraces occupying > 15% of the hemithorax is Needle decompression
The indications for thoracoscopy include failure of aspiration treatment, failure of lung reexpansion after 3 days of tube thoracostomy, persistence of bronchopleural fistula after 3 days, and recurrent pneumothorax after pleurodesis.
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