Condition Treatment Small primary pneumothorax (<20% or 3 cm apex-cupula and asymptomatic) Observation for >3 h on oxygen, repeat chest x-ray, discharge if no symptoms, and return for check if symptoms recur or in 24 h
Or
Small-size catheter aspiration with immediate catheter removal, then observe for >3 h, discharge if no symptoms, and return for check if symptoms recur or in 24 h
Or
Small-size catheter aspiration or small-size chest tube insertion, Heimlich valve, or water seal and admission
Small secondary pneumothorax Small-size catheter or small-size chest tube insertion, Heimlich valve, or water seal and admission Large pneumothorax, either primary or secondary, or bilateral pneumothoraces Moderate-size chest tube and admission; large-size chest tube if fluid or hemothorax present; water seal and admission Tension pneumothorax Immediate needle decompression followed by moderate or large-size chest tube insertion, water seal drainage, and admission; immediate chest tube placement ideal