In a casualty with progressive respiratory distress and known or suspected torso trauma, consider a tension pneumothorax and decompress the chest on the side of the injury with a 14-gauge, 3.25 inch needle/catheter unit inserted in the second intercostal space at the midclavicular line. Ensure that the needle entry into the chest is not medial to the nipple line and is not directed towards the heart. An acceptable alternate site is the 4th or 5th intercostal space at the anterior axillary line (AAL).
Consider chest tube insertion if no improvement and/or long transport is anticipated.
Most combat casualties do not require supplemental oxygen, but administration of oxygen may be of benefit for the following types of casualties:
Low oxygen saturation by pulse oximetry
Injuries associated with impaired oxygenation
Unconscious casualty
Casualty with TBI (maintain oxygen saturation > 90%)
Casualty in shock
Casualty at altitude
All open and/or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vented chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression.
Low oxygen saturation by pulse oximetry
Injuries associated with impaired oxygenation
Unconscious casualty
Casualty with TBI (maintain oxygen saturation > 90%)
Casualty in shock
Casualty at altitude
Tactical evacuation care
Emergency Medical Treatment and Active Labor Act
CT brain interpretation
Prehospital protocol pediatric airway management
Tactical field care
Ventriculoperitoneal shunt drainage
Neuro antibiotics
Newborn resuscitation