Page 273 - ATP-P 11th Ed

PNEUMOTHORAX – ACUTE PROTOCOL
(ATRAUMATIC)

SPECIAL CONSIDERATIONS
1. Consider also: anaphylaxis, pulmonary embolism, high altitude pulmonary edema
(HAPE), asthma, myocardial infarction and pneumonia.
2. More common in tall, thin individuals and smokers.

Signs and Symptoms SECTION 2
1. Acute, unilateral chest pain
2. Dyspnea – typically mild
3. No wheezing
4. Decreased or absent breath sounds on affected side
Management
1. Pulse oximetry monitoring
2. Oxygen (use oxygen for all suspected acute pneumothoraces)
3. Consider needle decompression for suspected tension pneumothorax.
4. If needle decompression shows immediate patient improvement, followed by worsen-
ing of condition, consider repeat needle decompression.
5. Consider tube thoracostomy:
a. Recurrence of respiratory distress after 2 successful needle decompressions
b. Evacuation time >1hr with continued respiratory distress
c. Patient requires positive pressure ventilation
6. If at altitude, descend as far as tactically feasible.
7. If evacuation will occur in an unpressurized aircraft, consider decompression for high
altitude evacuation and recommend lowest tactically feasible altitude.
8. Treat per Pain Management Protocol.

Disposition
1. Urgent evacuation for significant respiratory distress despite therapy.
2. Priority evacuation for patients whose respiratory status is stable.

262 SECTION 2 TACTICAL MEDICAL EMERGENCY PROTOCOLS (TMEPs) ATP-P Handbook 11th Edition 263