Welcome to the Emergency Medicine Cases Podcast. I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC studios in Toronto.

EM cases is part of Shremi, the Schwartz-Riseman Emergency Medicine Institute. That's the nonprofit organization dedicated to improving EM care through high-quality research and education. The opinions expressed on this podcast are intended for general information and educational purposes only and should not be used to diagnose treat or prevent any medical condition, nor should they be used as a substitute for medical advice from a qualified practicing position. Unless stated otherwise, the opinions expressed by the hosts or guests are made in their individual capacity, not on behalf of the Institute nor medicine cases. There's no single diagnosis where I see such a huge practice variation than in the management

of spontaneous pneumothorax.

Even the definition of what a large tube-in-the-chest-worthy pneumothorax is is different

depending on where you practice.

Management options for small and large spontaneous pneumothorax are all over the place.

Observation alone, pigtail catheter hooked up to a heimlich valve, needle aspiration,

large bore chest tube, underwater seal or suction.

What's the best approach?

This is an important question because if you work in a busy ED like where I work,

your ED is likely to see about one to two cases per month.

So let's sort out the best approach to the management of spontaneous pneumothorax with two

new voices to EM cases, Dr. Gilia Hudaf, my EM colleague from North York General, who

knows probably more about spontaneous pneumothorax

management than any EM doc I know, and thoracic surgeon, Dr. Medi Tahiri, from McGill University

in Montreal.

Welcome, gentlemen.

Thank you for having us.

Thanks, Anton.

Let's jump into a quick case.

An otherwise healthy, tall, skinny, 21-year-old male, five-pack-year-smoker,

presents to your ED with mild, non-radiating, sharp, left-sided chest pain and shortness

...