ABSTRACT
Pneumothorax is a surgical emergency and the diagnosis should be made on the basis of clinical evidence. Treatment should not be delayed while waiting for radiological confirmation. The pneumothorax should immediately be decompressed by inserting a large-bore cannula into the second intercostal space of the affected side, along the midclavicular line. Decompression converts the tension pneumothorax into a simple pneumothorax, which should be treated by thoracostomy and chest drain insertion. The site of drain insertion is selected between the anterior and midaxillary lines at the level of the fifth intercostal space. The drain is sutured in position using a silk or Prolene purse-string suture. The chest is auscultated, the tube examined for fogging, and the drainage bottle observed for a swing to the water meniscus or bubbling. A chest X-ray should then be obtained to confirm the position. The emergency-room thoracotomy is indicated in cases of penetrating trauma where there is electrical rhythm but no cardiac output (PEA).
