The air in the pleural space is not under excessive pressure. Absent unilateral breath sounds. Pneumothorax on chest x-ray. Occult pneumothorax seen on CT scan without plain film findings can be treated without chest tube. If patient goes to operating room, is intubated, or is transferred by air ambulance, then a chest tube must be placed.
Fractured ribs are especially serious in the elderly.
Chest wall pain. Fractured ribs on chest x-ray. Remember that the anterior costochondral cartilages can be fractured and not show up on chest x-ray. Pain control epidural, PCA, morphine drip. Drain intrapleural fluid accumulation.