Tension pneumothorax is immediately life-threatening. Recognize early — needle decompression is the treatment.
Steps by Cert Level
EMT: High-flow O2. Seal open chest wounds: vented chest seal (3-sided seal is no longer recommended — use vented device). Monitor for tension pneumo: tracheal deviation, absent breath sounds, JVD, hypotension.
AEMT: IV access. Fluid resuscitation: permissive hypotension for penetrating trauma (SBP 80–90). Monitor closely.
PARAMEDIC: Tension pneumo: immediate needle decompression — 2nd ICS MCL (large-bore 3.25in needle) OR 4th/5th ICS AAL. Bilateral if no improvement. Hemothorax: large-bore IV, permissive hypotension. Flail chest: PPV/CPAP reduces paradoxical motion.