Scenario 2

At the 08.00 handover a 36-year-old alcoholic man is presented to you. He has been the victim of an assault, receiving blows to both head and torso. His observations overnight have been generally unremarkable. His chest x-ray is as demonstrated (click on the x-ray to enlarge).

Is a chest drain indicated?

No – in stable patients with isolated chest injuries and a chest x-ray showing a simple small pneumothorax, a conservative approach (no chest drain, unless clinical deterioration) appears safe [2].

Learning bite

Observation (rather than chest drain) is acceptable in selected patients with a small traumatic pneumothorax.