Conservative management of spontaneous pneumothorax. We talked about this in April with first10em. Now a review by the sceptics. This is a 25 minute podcast talking about all the ins and outs of this. Conservative management without chest tube MAY be appropriate but only if close follow up can be arranged. You may want to consider it but all the careful follow up steps must be followed. For most of us in the community, it will involve a referral to ED for conservative management because you can’t confirm adequate follow up especially without cost. You need to carefully consider safety here. They would require an absolute 4 hrs of observation as minimum and then follow up CXR’s. Interesting a 32% pneumothorax would make me nervous! But perhaps this will be the new normal. Remember the exclusions such as pregnancy and air travel. I guess this is a bit like community management of anaphylaxis. Much more an ED protocol. Very important to have safety netting. Can’t be travelling, transient, socially isolated etc.