Which of the following methods is the best way to confirm the diagnosis of a pneumothorax?
A. Auscultate breath sounds.
B. Have the client use an incentive spirometer.
C. Take a chest x-ray.
D. Stick a needle in the area of decreased breath sounds.
Correct Answer: C. Take a chest x-ray
A chest x-ray will show the area of collapsed lung if pneumothorax is present as well as the volume of air in the pleural space. Chest radiography, ultrasonography, or CT can be used for diagnosis, although diagnosis from a chest x-ray is more common. Radiographic findings of 2.5 cm air space are equivalent to a 30% pneumothorax.
Option A: Listening to breath sounds won’t confirm a diagnosis. Clinical presentation of a pneumothorax can range anywhere from asymptomatic to chest pain and shortness of breath. A tension pneumothorax can cause severe hypotension (obstructive shock) and even death.
Option B: An IS is used to encourage deep breathing. Do not let a chest radiograph or CT scan delay treatment with needle decompression or thoracostomy tube if the patient is clinically unstable, i.e., tension pneumothorax.
Option D: A needle thoracostomy is done only in an emergency and only by someone trained to do it. If a patient is hemodynamically unstable with suspected tension pneumothorax, intervention is not withheld to await imaging. Needle decompression can be performed if the patient is hemodynamically unstable with a convincing history and physical exam, indicating tension pneumothorax.
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