1. Rapid Clinical Assesment
- ABCDE Approach
- Monitoring and Oxygenation:
- Put on high flow mask
- Maintain SpO₂ > 95%.
- Place the patient on a cardiac monitor.
- Establish intravenous (IV) access.
2. Identification:
Clinical Presentations:
- Tension Pneumothorax
- Subcutaneous Emphysema
- Hemoptysis
- Cyanosis
High Suspicion Indicators:
i. Continuous Bubbling in Chest Drain:
- Persistent air leak despite chest tube placement.
ii. Incomplete Lung Expansion:
- Lung fails to fully re-expand after chest tube insertion.
3. Immediate Intervention
i. Fiberoptic-Assisted Intubation
Minimizes cervical spine movement & able to identify site of injury.
ii. Multiple Intrapleural Chest Tubes:
- Insert more than one chest tube to ensure adequate drainage of air and blood.
- Helps prevent recurrent pneumothorax and ensures effective decompression.
4. Confirmation and Monitoring
Confirm Injury
- Bronchoscopy: Direct visualization of the airway to identify the extent of injury.
- CT Scan: Detailed imaging to assess tracheobronchial damage.
Continuous Monitoring:
- Vital Signs: Heart rate, blood pressure, respiratory rate, and oxygen saturation.
- Chest Drain Output: Monitor for ongoing air leaks or blood loss.
- Neurological Status: Regular assessment for signs of hypoxia or shock.