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Module 4: Thoracic Injuries

Segment 4: Simple & Tension Pneumothorax

References labeled PEDS contain a pediatric element or primary focus.

Topic: Pneumothorax & chest tubes

  • Anderson D, Chen SA, Godoy LA, et al. Comprehensive review of chest tube management: A review. JAMA Surg. 2022;157(3):269-274. doi: 10.1001/jamasurg.2021.7050 https://pubmed.ncbi.nlm.nih.gov/35080596/.
  • Azizi N, Ter Avest E, Hoek AE, et al. Optimal anatomical location for needle chest decompression for tension pneumothorax: A multicenter prospective cohort study. Injury. 2021;52(2):213-218. doi: 10.1016/j.injury.2020.10.068 https://pubmed.ncbi.nlm.nih.gov/34756305/.
  • Bridwell RE, Long B, Gottlieb M. Is chest ultrasonography superior to supine chest radiography in identifying pneumothorax in emergency department trauma patients? Ann Emerg Med. 2021;77(6):646-648. doi: 10.1016/j.annemergmed.2020.09.437 https://pubmed.ncbi.nlm.nih.gov/33121833/.
  • de Moya M, Brasel KJ, Brown CVR, et al. Evaluation and management of traumatic pneumothorax: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2022;92(1):103-107. doi: 10.1097/ta.0000000000003411 https://pubmed.ncbi.nlm.nih.gov/34538823/.
  • Hartman A, Vellekoop L, Van Delft CH, et al. A multicenter retrospective evaluation of treatment variation in patients with a blunt traumatic pneumothorax; noninvasive treatment versus tube thoracostomy (CONSTRAIN-Retro). J Trauma Acute Care Surg. 2026;doi: 10.1097/ta.0000000000005113 https://pubmed.ncbi.nlm.nih.gov/42468511/.
  • Kazemloo M, Rad FN, Goudarzimehr L, et al. Safety and efficacy of chest tube clamping versus non-clamping prior to removal: a systematic review and meta-analysis. Int J Emerg Med. 2026;19(1) doi: 10.1186/s12245-026-01283-1 https://pubmed.ncbi.nlm.nih.gov/42401790/.
  • Koch BW HD, Kahwaji CI,. EMS pneumothorax. StatPearls. StatPearls Publishing; 2026. https://www.ncbi.nlm.nih.gov/books/NBK482161/.
  • Kwiatt M, Tarbox A, Seamon MJ, et al. Thoracostomy tubes: A comprehensive review of complications and related topics. Int J Crit Illn Inj Sci. 2014;4(2):143-55. doi: 10.4103/2229-5151.134182 https://pubmed.ncbi.nlm.nih.gov/25024942/.
  • Latifi A, Wang D, Backer ED, et al. Pleural manometry in pneumothorax: Evaluating tension physiology and predicting outcomes. Chest. 2026;169(3):830-836. doi: 10.1016/j.chest.2025.09.121 https://pubmed.ncbi.nlm.nih.gov/41076067/.
  • Lyng JW, Ward C, Angelidis M, et al. Prehospital trauma compendium: Traumatic pneumothorax care—Position statement and resource document of NAEMSP. Prehosp Emerg Care. 2024:1-21. doi: 10.1080/10903127.2024.2416978 https://pubmed.ncbi.nlm.nih.gov/39499620/.
  • Molnar TF. Thoracic trauma: Which chest tube when and where? Thorac Surg Clin. 2017;27(1):13-23. doi: 10.1016/j.thorsurg.2016.08.003 https://pubmed.ncbi.nlm.nih.gov/27865322/.
  • Patel C, Ruppert SD, Cao H, et al. Use of a digital air leak detection device to decrease chest tube duration. Crit Care Nurse. 2023;43(6):11-21. doi: 10.4037/ccn2023951 https://pubmed.ncbi.nlm.nih.gov/38035619/.
  • Schaefer L, Stein E, Schwarz A, et al. Needle Thoracostomy: Implications of Chest Wall Thickness for Anatomical Location and Needle Length. Ann Emerg Med. 2026;doi: 10.1016/j.annemergmed.2026.06.014 https://pubmed.ncbi.nlm.nih.gov/42383960/.
  • Singer DD, Scott H, Khan A, et al. Emergency department accuracy of point-of-care ultrasound in identifying clinically significant pneumothorax in high-severity trauma patients. J Emerg Med. 2025;77:140-151. doi: 10.1016/j.jemermed.2025.07.009 https://pubmed.ncbi.nlm.nih.gov/40913875/.

Topic: General chest tube concerns

  • Freeman JJ, Asfaw SH, Vatsaas CJ, et al. Antibiotic prophylaxis for tube thoracostomy placement in trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma. Trauma Surg Acute Care Open. 2022;7(1):e000886. doi: 10.1136/tsaco-2022-000886 https://pubmed.ncbi.nlm.nih.gov/36312819/.
  • Long B, Lacy AJ, Mason J, et al. Tube thoracostomy and pleural catheters: A review for emergency clinicians. J Emerg Med. 2025;77:100-116. doi: 10.1016/j.jemermed.2025.07.053 https://pubmed.ncbi.nlm.nih.gov/40896901/.
  • Lyons NB, Collie BL, Cobler-Lichter MD, et al. Thoracic irrigation for traumatic hemothorax: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2025;98(2):337-343. doi: 10.1097/ta.0000000000004479 https://pubmed.ncbi.nlm.nih.gov/39509686/.
  • Maezawa T, Yanai M, Huh JY, et al. Effectiveness and safety of small-bore tube thoracostomy (≤20 Fr) for chest trauma patients: A retrospective observational study. Am J Emerg Med. 2020;38(12):2658-2660. doi: 10.1016/j.ajem.2020.09.028 https://pubmed.ncbi.nlm.nih.gov/33039219/.
  • Niki Veale AL, Martinelli AW, Sethi D, et al. A national evaluation of intercostal chest drain removal strategies. Chest. 2025;doi: 10.1016/j.chest.2025.10.027 https://pubmed.ncbi.nlm.nih.gov/41192553/.
  • Reeves MT, Lee Y, Shalaby M. Ultrasound-guided truncal blocks for tube thoracostomy analgesia in the emergency department. J Emerg Med. 2026;84:92-101. doi: 10.1016/j.jemermed.2025.12.026 https://pubmed.ncbi.nlm.nih.gov/41936304/.
  • Tarantino B, Wood M, Hancock D, et al. Iatrogenic risk of tube thoracostomy: A retrospective trauma database analysis. Am J Emerg Med. 2026;104:135-139. doi: 10.1016/j.ajem.2026.03.018 https://pubmed.ncbi.nlm.nih.gov/41895067/.
  • van Veen TE, Michetti CP, Leichtle SW, et al. Prospective comparison of short vs long chest tube water seal trial for traumatic pneumothorax. J Am Coll Surg. 2025;doi: 10.1097/xcs.0000000000001730 https://pubmed.ncbi.nlm.nih.gov/41384624/.

Topic: Tension pneumothorax

  • Blank JJ, de Moya MA. Traumatic pneumothorax and hemothorax: What you need to know. J Trauma Acute Care Surg. 2025;doi: 10.1097/ta.0000000000004692 https://pubmed.ncbi.nlm.nih.gov/40604368/.
  • Butler FK, Jr., Holcomb JB, Shackelford S, et al. Management of suspected tension pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 17-02. J Spec Oper Med. 2018;18(2):19-35. doi: 10.55460/XB1Z-3BJU. https://pubmed.ncbi.nlm.nih.gov/29889952/.
  • Gomez LP, Tran VH. Hemothorax. StatPearls. StatPearls Publishing; 2023. https://www.ncbi.nlm.nih.gov/books/NBK538219/.
  • Inaba K, Ives C, McClure K, et al. Radiologic evaluation of alternative sites for needle decompression of tension pneumothorax. Arch Surg. 2012;147(9):813-8. doi: 10.1001/archsurg.2012.751 https://pubmed.ncbi.nlm.nih.gov/22987168/.
  • Kheirabadi BS, Terrazas IB, Miranda N, et al. Do vented chest seals differ in efficacy? An experimental evaluation using a swine hemopneumothorax model. J Trauma Acute Care Surg. 2017;83(1):182-189. doi: 10.1097/ta.0000000000001501 https://pubmed.ncbi.nlm.nih.gov/28422911/.
  • Laan DV, Vu TD, Thiels CA, et al. Chest wall thickness and decompression failure: A systematic review and meta-analysis comparing anatomic locations in needle thoracostomy. Injury. 2016;47(4):797-804. doi: 10.1016/j.injury.2015.11.045 https://pubmed.ncbi.nlm.nih.gov/26724173/.
  • Muchnok D, Vargo A, Deeb A-P, et al. Association of obesity with respiratory complications in trauma patients undergoing emergent surgery. JAMA Surg. 2022;doi: 10.1001/jamasurg.2022.3552 https://pubmed.ncbi.nlm.nih.gov/35976642/.
  • Paquette R, Quinene M, Blackbourne LH, et al. Efficacy of commercial chest seal adherence and tension pneumothorax prevention: A systematic review of quantitative studies. J Spec Oper Med. 2021;21(3):78-85. doi: 10.55460/fz33-7rll https://pubmed.ncbi.nlm.nih.gov/34529810/.
  • Roberts DJ, Leigh-Smith S, Faris PD, et al. Clinical presentation of patients with tension pneumothorax: A systematic review. Ann Surg. 2015;261(6):1068-78. doi: 10.1097/sla.0000000000001073 https://pubmed.ncbi.nlm.nih.gov/25563887/.
  • Smith T, Wilbeck J. Finger thoracostomy for tension pneumothorax. Adv Emerg Nurs J. 2024;46(1):44-48. doi: 10.1097/tme.0000000000000503 https://pubmed.ncbi.nlm.nih.gov/38285421/.
  • Sutori D, Erdelyi LS, Uri I, et al. Prehospital emergency finger thoracostomy in compensated obstructive shock: Benefits and outcomes. Injury. 2025;doi: 10.1016/j.injury.2025.112331 https://pubmed.ncbi.nlm.nih.gov/40234110/.