👤 By the CinnaEMS Content Team🕐 Updated 2026-09-27🏷️ Trauma🔖 Free to read, print, and share
Also known as: tension pneumothorax · needle decompression · cardiac tamponade · Beck's triad · hemothorax · flail chest · open pneumothorax
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Use this quick-reference guide to recognise, treat and hand over Thoracic Trauma on the NREMT and on the call. Keep it handy during review and on exam day!
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📒 The 1-minute cheat sheet
📌 Tension
Absent sounds + low BP
Needle: 2nd ICS MCL or 4th–5th AAL
📌 Tamponade
Low BP · JVD · muffled sounds
📌 Hemothorax
Absent sounds · flat veins · shock
📌 Wall
Open wound → vented seal
Flail → contusion is the danger
📚 Thoracic Trauma — full study notes
The cheat sheet above is your quick recall card. These notes go deeper — what it is, what to do first, what changes the plan, and what to hand over.
Chest injuries kill quickly through the airway, the lungs or the heart's ability to fill. The examinable skill is telling tension pneumothorax, tamponade and massive hemothorax apart at the bedside and knowing the one intervention each needs.
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Key points
Understand these first
Tension pneumothorax: absent breath sounds, worsening distress, hypotension; tracheal shift is late and JVD may be absent if hypovolemic.
Needle decompression (paramedic): 2nd intercostal space midclavicular or 4th–5th anterior axillary line.
Massive hemothorax: absent breath sounds with flat neck veins and shock.
Flail chest: paradoxical segment; the underlying pulmonary contusion drives the hypoxia.
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Treatment priorities
What to do, in order
Open chest wound: vented or occlusive seal; burp it if the patient worsens.
Positive-pressure ventilation can convert a simple pneumothorax to tension — watch for it.
Rapid transport; tamponade and hemothorax need surgery.
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Red flags — report now
Escalate immediately
Rising ventilation pressure in a bagged trauma patient
Hypotension with distended neck veins
Chest trauma with pulses unequal between arms
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Patient teaching
What patients must know
Neck veins separate them: distended in tension and tamponade, flat in hemothorax.
Sudden collapse after a blow to the chest in sport: commotio cordis — start CPR and use the AED.
❓ Thoracic Trauma: NREMT FAQs
What are the priority actions for Thoracic Trauma in the field?
Open chest wound: vented or occlusive seal; burp it if the patient worsens. Positive-pressure ventilation can convert a simple pneumothorax to tension — watch for it. Rapid transport; tamponade and hemothorax need surgery.
What findings in Thoracic Trauma change your plan or your transport decision?
Rising ventilation pressure in a bagged trauma patient. Hypotension with distended neck veins. Chest trauma with pulses unequal between arms.
What do I need to know about Thoracic Trauma for the NREMT?
Tension pneumothorax: absent breath sounds, worsening distress, hypotension; tracheal shift is late and JVD may be absent if hypovolemic. Needle decompression (paramedic): 2nd intercostal space midclavicular or 4th–5th anterior axillary line. Cardiac tamponade — Beck's triad: hypotension, JVD, muffled heart sounds. Massive hemothorax: absent breath sounds with flat neck veins and shock.
What should the crew communicate or document for Thoracic Trauma?
Neck veins separate them: distended in tension and tamponade, flat in hemothorax. Sudden collapse after a blow to the chest in sport: commotio cordis — start CPR and use the AED.
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Quick Tip
Tension pneumothorax: absent breath sounds, worsening distress, hypotension; tracheal shift is late and JVD may be absent if hypovolemic.