A case of spontaneous pneumothorax comes to you. What will be the earliest t/t of choice -

Pneumothorax: is the presence of gas in the pleural space. Types : (a) Spontaneous pheumothorax → is one that occurs without antecedent trauma to the thorax (i) Primary spontaneous - Occurs in the absence of an underlying lung disease (usually d/t apical plural blebs). (ii) Secondary spontaneous - d/t an underlying lung disease. Traumatic pneumothorax → results from penetrating or non-penetrating injuries to the chest. Tension pheumothorax → Any pneumothorax in which the pressure in the pleural space is positive throughout the respiratory cycle. In this pt. it's not specified the type of spontaneous pneumothorax; still, let's see the t/t Treatment Primary spontaneous pneumothorax Initial recommended treatment is a simple aspiration If the lung does not expand with aspiration, or if the pt. has a recurrent pneumothorax, thoracoscopy with stapling of blebs and pleural abrasion is indicated (100% success rate) Secondary Spontaneous pneumothorax Sec. spon. pneumothorax can occur in any lung ds but are commonly seen in COPD. Nearly all pts are t/t with tube thoracostomy and the installation of a sclerosing agent such as doxycycline or talc. Pts. with a persistent air leak, an unexpanded lung after 3 days of tube thoracostomy, or a recurrent pneumothorax should be subjected to thoracoscopy with bleb resection and pleural abrasion. Traumatic pneumothorax Traumatic pneumothorax should be t/t with tube thoracostomy unless they are very small. If a hemopneumothorax is present, one chest tube should be placed in the superior part of the hemithorax to evacuate the air, and another should be placed in the inferior part of the hemithorax to remove the blood. Tension pneumothorax It is an emergency situation. A large bore needle is inserted into the pleural space through the Second anterior intercostal space. The needle should be left in place until a thoracostomy tube is inserted. I assume that the pt. has primary spontaneous pneumothorax as there is no past history of any disease.