Page 103 - PJ MED OPS Handbook 8th Ed

3. Sudden onset of pleuritic chest pain (pain on inspiration) with dyspnea may indicate pul-
monary embolism (PE) or spontaneous pneumothorax. Auscultate the lungs. Unilaterally di-
minished breath sounds suggest pneumothorax which may require decompression. Administer
oxygen, establish IV access, administer aspirin 325mg PO for suspected PE, and evacuate as
Urgent.

NOTE: After successful needle decompression for a tension pneumothorax, casualties should
be monitored closely for reoccurrence during flight where decreases in atmospheric pressure
will cause expansion of residual pneumothoraces. If circumstances allow, a chest tube with a
one-way valve should be placed prior to evacuation to eliminate this potential complication.

4. The following signs and symptoms MAY suggest a musculoskeletal etiology: pain isolated to
a specific muscle or costochondral joint pain exacerbated with certain types of movements, no
pain at rest, non-central chest pain reproduced upon palpation. A trial of NSAIDs such as Mobic
or ibuprofen (Motrin) 800mg PO tid or Ketorolac 15mg IM/IV may be useful if evacuation will be
delayed.
5. Chest pain with gradual onset and exacerbated by deep inspiration and accompanied by fever
and productive cough MAY indicate lower respiratory tract infection. Consider treatment per
Bronchitis/Pneumonia Protocol.
DISPOSITION:
1. Urgent evacuation.
2. Evacuation platform should include ACLS certified medical personnel and the equipment,
supplies, and medications necessary for ACLS care.
3. Do not delay evacuation if unsure of chest pain etiology. Strongly consider early contact
with a medical officer or MTF for consultation. Frequently reassess the patient suspected
of a non-cardiac etiology to ensure stability and accuracy of the diagnosis.

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 101