Respiration assessment and management is a vital Tactical Field Care skill that includes recognition and treatment of tension pneumothorax, one of the most common causes of preventable death on the battlefield.

We began by reviewing the basic concepts and signs and symptoms of respiratory distress and life-threatening chest injuries. Then we discussed open pneumothorax, focusing on the pathophysiology to understand why chest seals are recommended and how they work. We also talked about the evidence supporting the recommendation to use vented chest seals when they are available.

Afterward, we reviewed tension pneumothorax and how to recognize it, as well as the effects it has on an injured casualty. We talked about treatment with chest seals when present, but also about the importance of needle decompression of the chest and the sites available to us when performing an NDC.

We also discussed what to do for unsuccessful NDC attempts and recurrent tension pneumothorax symptoms, including the use of finger and/or tube thoracostomies by providers trained and authorized to perform those procedures.