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Immediate threats
Life threats
Tension pneumothorax physiology
Hypotension or shock
Severe respiratory distress
Altered mental status
Cardiac arrest with PEA pattern
Immediate actions
If suspected tension, immediate decompression without imaging
If cardiac arrest, bilateral finger thoracostomy or needle decompression during CPR
Monitoring and access
Continuous SpO2 and ECG
Noninvasive BP cycling
Two large bore IV
Oxygenation and ventilation
Respiratory support
Oxygen targets
SpO2 94-98% if no chronic hypercapnia risk
SpO2 88-92% if COPD with chronic CO2 retention risk
Ventilation risk mitigation
Avoid positive pressure ventilation if possible before pleural decompression
If positive pressure required, immediate chest drain readiness
Imaging timing
If unstable, decompression before radiography
Key concepts
High risk patterns
Secondary spontaneous pneumothorax
Underlying lung disease
Lower physiologic reserve
Iatrogenic pneumothorax
Post procedure dyspnea or chest pain
Higher tension risk with positive pressure ventilation
Recurrence risk
Prior pneumothorax history
Smoking history
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.