Page 19 - ATP-P 11th Ed

(b) There is an obvious hissing sound as air escapes from the chest when NDC
is performed (this may be difficult to appreciate in high-noise environ-
ments), or
(c) Hemoglobin oxygen saturation increases to 90% or greater (note that this SECTION 1
may take several minutes and may not happen at altitude), or
(d) A casualty with no vital signs has return of consciousness and/or radial pulse.
iv. If the initial NDC fails to improve the casualty’s signs/symptoms from the sus-
pected tension pneumothorax:
(a) Perform a second NDC on the same side of the chest at whichever of the
two recommended sites was not previously used. Use a new needle/cath-
eter unit for the second attempt.
(b) Consider, based on the mechanism of injury and physical findings whether
decompression of the opposite side of the chest may be needed.
(c) Continue to re-assess!
v. If the initial NDC was successful, but symptoms later recur:
(a) Perform another NDC at the same site that was used previously. Use a new
needle/catheter unit for the repeat NDC
(b) Continue to re-assess!
vi. If the second NDC is also not successful: continue on to the Circulation section
of the TCCC Guidelines.
b. All open and/or sucking chest wounds should be treated by immediately apply-
ing a vented chest seal to cover the defect. If a vented chest seal is not available,
use a nonvented 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.
c. Initiate pulse oximetry. All individuals with moderate/severe TBI should be moni-
tored with pulse oximetry. Readings may be misleading in the settings of shock or
marked hypothermia.
d. Casualties with moderate/severe TBI should be given supplemental oxygen when
available to maintain an oxygen saturation >90%.
6. Circulation
a. Bleeding
i. A pelvic binder should be applied for suspected pelvic fracture
ii. Severe blunt force or blast injury with one or more of the following indications:
(a) Pelvic pain
(b) Any major lower limb amputation or near amputation
(c) Physical exam findings suggestive of a pelvic fracture
(d) Unconsciousness
(e) Shock

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