Page 141 - PJ MED OPS Handbook 8th Ed

Pneumothorax – Acute (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:
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 or symptomatic
pneumothorax.
4. If needle decompression shows immediate patient improvement, followed by worsening of con-
dition, consider repeat needle decompression.
5. Use tube thoracostomy:
a. Recurrence of respiratory distress after 2 successful needle decompressions
b. Evacuation time >1 hour 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 respiratory failure and respiratory distress despite therapy.
2. Priority evacuation for patients whose respiratory status is stable.

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 139