Tension Pneumothorax
Air accumulates in the pleural space under pressure, collapsing the lung and shifting the mediastinum. Signs include severe dyspnea, absent breath sounds on one side, jugular venous distention, hypotension, and tracheal deviation as a late sign. Needle decompression is the definitive prehospital treatment.
Flail Chest
Two or more adjacent ribs broken in two or more places create a segment that moves paradoxically with respirations. The underlying lung contusion usually causes more respiratory compromise than the chest wall itself. Support oxygenation, consider positive pressure ventilation, and manage pain.
Open Pneumothorax
A sucking chest wound should be covered with an occlusive dressing taped on three sides or a vented chest seal. Monitor for developing tension pneumothorax and release the dressing if symptoms worsen. Transport rapidly to a trauma center.