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Quick, let's get on with it.

First up, we've got Justin Morganstern on the latest New England journal study on treating

large, spontaneous pneumothoroses without a chest tube.

The PSP trial, conservative management of primary spontaneous pneumothorax. This is an RCT published

in the New England Journal of Medicine February

2020 that I think will change practice for a lot of emergency doctors, although I don't

think it's going to change my practice much. So this is a multi-center, open label, non-inferiority

trial where they took patients aged 14 to 50 years of age with primary, spontaneous pneumothorax

that was bigger than 32% using the Collins method. We'll put a picture in the show notes,

but all you really need to know is they were focusing on larger pneumothorax, not small.

And these patients got randomized to either get a chest tube. They got a small bore, 14 French

or less tube. Unlike Canadian practice, where most of these patients get a chest tube. They got a small bore, 14 French or less tube. Unlike

Canadian practice, where most of these patients get a heimlich valve and are sent home as

outpatients, all of these patients were put on suction. They could get sent home if their

pneumo completely resolved on a one-hour follow-up x-ray and then stayed gone after four hours

of observation with a chest tube clamped.

They compared the chest tube to nothing.

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