Consider the mechanism of injury, such as significant torso trauma or primary blast injury that could cause a tension pneumothorax.

Below, the left picture shows a penetrating chest wall injury, and the picture on the right shows a collapsed lung – both could be caused by primary blast injuries or secondary and tertiary effects causing significant torso trauma.

What’s important is being able to identify the signs and symptoms of a tension pneumothorax and treat it aggressively. When in doubt, place a vented chest seal on the wound. If it’s an open chest wound (picture to the left) or a closed chest wound (picture to the right).

Imagine a balloon inside the chest wall that gets bigger with every breath. Eventually, that balloon gets so big that the lungs, heart, and trachea are compressed to the point that the intact lung cannot inflate properly and the heart will not be able to pump.

Positive air pressure enters from the wound (like a one-way valve) and into the pleural space that consists of negative pressure, between the lung and the chest wall. Pressure then builds up on the injured side, which eventually starts to compress both lungs and the heart.