Page 18 - ATP-P 11th Ed

d. Surgical cricothyroidotomies should not be performed on unconscious casualties
who have no direct airway trauma unless use of a nasopharyngeal airway and/or an
SECTION 1 5. Respiration / Breathing
extraglottic airway have been unsuccessful in opening the airway.
a. Assess for tension pneumothorax and treat, as necessary.
i. Suspect a tension pneumothorax and treat when a casualty has significant torso
trauma or primary blast injury and one or more of the following:
(a) Severe or progressive respiratory distress
(b) Severe or progressive tachypnea
(c) Absent or markedly decreased breath sounds on one side of the chest
(d) Hemoglobin oxygen saturation <90% on pulse oximetry
(e) Shock
(f) Traumatic cardiac arrest without obviously fatal wounds
• If not treated promptly, tension pneumothorax may progress from respi-
ratory distress to shock and traumatic cardiac arrest.
ii. Initial treatment of suspected tension pneumothorax:
(a) If the casualty has a chest seal in place, burp or remove the chest seal.
(b) Establish pulse oximetry monitoring.
(c) Place the casualty in the supine or recovery position unless he or she is
conscious and needs to sit up to help keep the airway clear as a result of
maxillofacial trauma.
(d) Decompress the chest on the side of the injury with a 14-gauge or a
10-gauge, 3.25-inch needle/catheter unit.
• Either the 5 intercostal space (ICS) in the anterior axillary line (AAL)
th
or the 2 ICS in the mid-clavicular line (MCL) may be used for needle
nd
decompression (NDC.) If the anterior (MCL) site is used, do not insert
the needle medial to the nipple line.
• The needle/catheter unit should be inserted at an angle perpendicular to
the chest wall and just over the top of the lower rib at the insertion site.
Insert the needle/catheter unit all the way to the hub and hold it in place
for 5–10 seconds to allow decompression to occur.
• After the NDC has been performed, remove the needle and leave the
catheter in place.
• If a casualty has significant torso trauma or primary blast injury and is in
traumatic cardiac arrest (no pulse, no respirations, no response to painful
stimuli, no other signs of life), decompress both sides of the chest before
discontinuing treatment.
iii. The NDC should be considered successful if:
(a) Respiratory distress improves, or

8 SECTION 1 TACTICAL TRAUMA PROTOCOLS (TTPs) ATP-P Handbook 11th Edition 9