What is the plan of care for a 22-year-old female patient with a stable 20% pneumothorax (PTX) and mild chest pain after a 12-hour shift?

Management of a 22-Year-Old Female with a Stable 20% Pneumothorax

Observation is the recommended plan of care for this 22-year-old female patient with a stable 20% pneumothorax, mild chest pain, and no past medical history. 1, 2

Assessment of Pneumothorax Size and Patient Status

• This patient has a small primary spontaneous pneumothorax (20%) with mild symptoms and stable vital signs 1, 2
• Primary pneumothoraces occur in patients without underlying lung disease, which appears to be the case in this young patient with no past medical history 2
• The British Thoracic Society (BTS) guidelines define small pneumothoraces as those with less than 2-3 cm rim of air between the lung margin and chest wall 1

Recommended Management Approach

• For clinically stable patients with small primary pneumothoraces and minimal symptoms, observation is the appropriate management strategy 1
• Patients with small primary pneumothoraces who are minimally symptomatic do not require needle decompression or surgical intervention 1, 2
• The American College of Chest Physicians (ACCP) guidelines support observation for clinically stable patients with small pneumothoraces 1

Specific Care Plan Components

• The patient should receive high-flow oxygen (10 L/min) to increase the rate of pneumothorax reabsorption 1
• High-flow oxygen therapy has been shown to result in a four-fold increase in the rate of pneumothorax reabsorption 1
• The natural rate of resolution for spontaneous pneumothoraces is approximately 1.25-1.8% of the volume of hemithorax every 24 hours 1

Hospitalization Considerations

• While some guidelines suggest that stable patients with small primary pneumothoraces may be observed in the outpatient setting 1, others recommend hospitalization for observation 1
• Given that the patient has mild chest pain and just finished a 12-hour shift, a brief period of observation in the hospital would be prudent 1, 2
• The patient should not be discharged without a period of observation to ensure stability 1

Avoiding Common Management Pitfalls

• Needle decompression would be inappropriate for this stable patient with a small pneumothorax and would subject her to unnecessary pain and risk 1, 2
• Surgical consultation for video-assisted thoracoscopic surgery (VATS) is not indicated for a first occurrence of a small, stable pneumothorax 1, 2
• Immediate discharge without observation would be inappropriate given the patient's symptoms and the potential for progression of the pneumothorax 1, 2

Follow-up Recommendations

• If the patient remains stable during observation, a repeat chest X-ray should be obtained to ensure the pneumothorax is not progressing 1, 2
• The patient should be educated about warning signs that would necessitate return to medical care, such as worsening shortness of breath or chest pain 2
• A follow-up chest X-ray should be scheduled within 12 hours to 2 days to document resolution of the pneumothorax 1