What is the management approach for a simple pneumothorax in trauma?

• A. Observation or chest tube
• B. Immediate needle decompression
• C. Immediate surgery
• D. Do nothing

Answer: (A)

In a stable patient who has a simple pneumothorax after trauma, air in the pleural space is small enough that the lung can re-expand without immediate invasive intervention. The management approach is to observe with supplemental oxygen, monitor vital signs, and perform serial exams and imaging to ensure the pneumothorax isn’t enlarging. If the pneumothorax is large or the patient develops symptoms (or if there’s any deterioration), a chest tube is placed to evacuate the air and allow full lung re-expansion. Immediate needle decompression is reserved for a tension pneumothorax, which is a separate and emergent situation. Therefore, observation with oxygen and close monitoring, with chest tube drainage if there’s growth or symptoms, is the appropriate plan for a simple pneumothorax in trauma.