The patient at this point required the intervention of a chest tube thoracostomy.
The patient gave written and verbal consent for this procedure knowing full well all risks benefits and alternatives.
An appropriate time out was taken documenting proper side and proper patient.

The patient’s ____ right upper extremity was abducted and held in place. The patient’s chest wall was then prepped and cleansed in the usual sterile fashion and properly draped to create a sterile field.
Lidocaine 1% plain was injected into the soft tissues and then around what was felt to be the fourth to fifth intercostal space.

Once the patient was adequately anesthetized, a 15 blade scalpel was used to create a 2 cm incision paralleling the intercostal space.
Blunt dissection was used to dissect down through the soft tissues to the intercostal musculature.
A curved Kelly clamp was used to puncture the intercostal musculature in the standard fashion going just above the rib.
The Kelly clamp was then opened and retracted to create a rent in the intercostal musculature through which the thoracostomy tube to be placed. The rent was digitalized.
A ___ 32 French thoracostomy tube was placed in to the pleural cavity in a posterior and upper direction. The tube was inserted to the apex and then withdrawn slightly. The tube was then rotated 360° to ensure that it was not kinked.
The tube was then sutured into place to secure the tube.
Vaseline gauze and wrapped around the base the tube and for airtight seal. 4 x 4’s were used as a dry sterile dressing along with foam tape.
The chest tube was then attached to a Pleur-evac system to wall suction. The tube was then furthermore secured to the patient using foam tape with foam tape also placed around the connection of the chest tube to the suction tubing.
The patient tolerated the procedure well and there were no complications.

Post-procedural chest x-ray documents excellent chest tube placement.

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PEARLS

• Pneumothorax
  • Recurrent or with underlying disease will often require definitive surgical care
    • Depending on resources may place tube and discharge for urgent follow up vs admit for further pulmonologic studies and potential definitive surgical care