🫁 PulmonologyRespiratory / EmergencyStudentInternResident

Pneumothorax

Also known as: collapsed lung · PTX · tension pneumothorax

Air in the pleural space collapsing the lung — sudden breathlessness and pleuritic pain with reduced breath sounds. Tension pneumothorax is immediately life-threatening and is treated BEFORE any imaging.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Tall, thin young men and smokers (primary spontaneous); people with COPD, asthma, TB or interstitial disease (secondary); and after trauma or procedures (central line, ventilation).

Red flags — escalate / refer

Tension pneumothorax — severe breathlessness, hypotension, distended neck veins, tracheal deviation away from the side and absent breath sounds → immediate needle decompression then a chest drain, WITHOUT waiting for an X-ray.

Work-up / diagnosis

1If tension is suspected, treat clinically first — do not delay for imaging.
2Otherwise: erect chest X-ray to confirm and size it; distinguish primary from secondary; point-of-care ultrasound can help.

Management — overview

Tension pneumothorax → immediate decompression.
Small primary pneumothorax with minimal symptoms → oxygen and observation, or simple aspiration.
Large/symptomatic or any secondary pneumothorax → aspiration or an intercostal chest drain.
Advise smoking cessation; refer recurrent or persistent cases for pleurodesis/surgery.

In-depthFull dosing & advanced protocol

Drug dosing

Supplemental oxygen + analgesia

Supportive care (management is procedural)

Adult dose: High-flow oxygen as needed; paracetamol/NSAID for pain
Route: Inhaled / oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Primary vs secondary, and aspirate vs drain

Secondary pneumothorax (underlying lung disease) is less well tolerated and has a lower threshold for a chest drain and admission.
Needle decompression buys time in tension pneumothorax but must be followed by a definitive chest drain.
Size, symptoms and primary-vs-secondary together decide observation vs aspiration vs drainage.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Tuberculosis (drug-sensitive) — NTEPInfection by Mycobacterium tuberculosis. India's National TB Elimination Programme (NTEP) provides free diagnosis and treatment; every case must be notified.Community-Acquired PneumoniaAcute lower-respiratory infection acquired outside hospital — fever, cough, sputum and breathlessness with a new infiltrate on chest X-ray. Streptococcus pneumoniae is the commonest cause.Bronchial AsthmaChronic airway inflammation with variable, reversible airflow obstruction — wheeze, cough, breathlessness and chest tightness. Inhaled corticosteroids are the cornerstone; never treat with a reliever alone.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Supplemental oxygen + analgesia

📈 Primary vs secondary, and aspirate vs drain

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Supplemental oxygen + analgesia

📈 Primary vs secondary, and aspirate vs drain

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Primary vs secondary, and aspirate vs drain

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Primary vs secondary, and aspirate vs drain

References