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Immediate threats and triggers
Time-critical recognition
Tension pneumothorax physiology
Shock with unilateral absent breath sounds
Severe respiratory distress with hypoxemia
Progressive hypotension after positive pressure ventilation
Tracheal deviation as late finding
Open pneumothorax physiology
Large chest wall defect with audible air movement
Worsening ventilation despite oxygen
Rapid deterioration pattern
If peri-arrest with suspected tension, immediate decompression without delay for imaging
Primary survey integration
Airway and ventilation priorities
If respiratory failure, ventilatory support with preparation for immediate decompression
If intubation planned, decompression readiness before or immediately after tube placement
Circulation priorities
If hypotension with thoracic trauma, parallel evaluation for tension pneumothorax and massive hemothorax
If persistent shock after decompression, alternate causes and hemorrhage control pathway
Monitoring and access
Continuous pulse oximetry
Target SpO2 at least 94% unless COPD hypercapnia concern
Cardiac monitoring
Dysrhythmia risk with hypoxemia
Capnography if intubated
Ventilation trend during decompression and tube thoracostomy
Large-bore IV access
Blood product readiness if associated hemothorax
Immediate bedside diagnostics
eFAST extension for lung
If absent lung sliding on symptomatic side, treat as pneumothorax when consistent with physiology
If lung point present, pneumothorax confirmation
Portable supine chest radiograph
If unstable, not required before decompression
Early consultation and escalation
Trauma team activation criteria
Penetrating torso trauma
Blunt trauma with respiratory compromise
Suspected tension physiology
If persistent air leak or failure to re-expand, early thoracic surgery consultation
If major associated injuries, ICU pathway activation
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.