Pneumothorax — the classification and the management

The classification — primary spontaneous, secondary spontaneous, traumatic or iatrogenic, and tension.^[1]

The management by the type and the size:

• The tension — immediate decompression at the 5th intercostal space with a long device, then chest drain; clinical diagnosis, no CXR delay.^[2]
• The primary spontaneous — size- and symptom-based: small and stable observed, large aspirated first, drain if that fails.^[1]
• The secondary — chest drain given the underlying disease and hypoxia.^[1]
• The traumatic — chest drain, tension decompressed first.^[2]
• The recurrence or the persistent air leak — pleurodesis or VATS surgery.^[1]

^[1]The principles: tension is a clinical diagnosis with immediate decompression; primary managed by size and symptoms; secondary and symptomatic drained; recurrence prevented by pleurodesis/surgery.