Figure 3-6. Casualty with a dressed open chest wound positioned on his injured side.
3-12. MONITOR THE CASUALTY
Once your surveys are completed and the casualty has been treated, initiate a
U.S. Field Medical Card and monitor the casualty. Check the casualty's breathing and
his vital signs. Administer oxygen if available. Observe for signs of tension
pneumothorax. Evacuate the casualty as soon as possible.
3-13. TREAT TENSION PNEUMOTHORAX, IF NEEDED
a. Tension pneumothorax is a condition in which air continues to accumulate in
the pleural cavity and increases pressure on the injured lung. Signs of tension
pneumothorax include increased difficulty in breathing, shortness of breath, cyanosis,
and the trachea moving from its normal position toward the uninjured side of the chest.
b. If signs of tension pneumothorax are present, perform a chest needle
decompression. On the battlefield, unilateral penetrating chest trauma with
progressive increases in difficulty breathing is an indication to perform chest needle
decompression since other methods of assessment may be unavailable or impossible
c. If tension pneumothorax is present, perform a chest needle decompression
using the following steps. The decompression is performed on the injured side of the
chest (side of open chest wound). It allows the air that has become trapped within the
chest to escape.
(1) Obtain a 14 gauge needle from the casualty's first aid kit or from your
aid bag. The needle should be two to three and a fourth inches in length to ensure it
penetrates deep enough into the chest cavity. A catheter covers most of the needle,
but does not cover the needle point
(2) Locate the second intercostal space (between second and third rib) on
the mid-clavicular line (figure 3-7) on the injured side of the chest.