Respiration Assessment and Management in TFC
Chest injuries can stop a casualty from getting air even when the airway is open. You learn to recognize an open chest wound and a tension pneumothorax, seal the wound, and relieve trapped air with a needle.
What to remember
- Respiratory distress means difficulty breathing: breathing that is rapid or abnormally slow, or air that is hard to get in or out. Airway and breathing are handled in TFC, not in Care Under Fire.CLS M08 Slides, PDF p.6-8
- An open (sucking) chest wound shows one or more of: a sucking or hissing sound on inhale, trouble breathing, a puncture wound, froth or bubbles at the injury, or coughing up blood. If unsure whether it went through, treat it as open.CLS M08 Slides, PDF p.9
- Treat an open chest wound quickly with a vented chest seal; use a nonvented seal only if no vented one is available.CLS M08 Slides, PDF p.11
- After sealing a chest wound, put an unconscious casualty in the recovery position and let a conscious one sit up if that makes breathing easier.CLS M08 Slides, PDF p.12
- A tension pneumothorax traps more air in the chest with every breath, squeezing both lungs and the heart. It is the second-leading cause of preventable battlefield death.CLS M08 Slides, PDF p.15
- Suspect tension pneumothorax after major torso trauma or a primary blast injury followed by severe, worsening breathing trouble (over 20 breaths a minute). If a chest seal is on, burp it first.CLS M08 Slides, PDF p.16-17
- Needle decompression (NDC) goes in at the 2nd intercostal space (outside the nipple line) or the 5th intercostal space, and never through a chest seal; use the other site instead.CLS M08 Slides, PDF p.17-18
Skill: Chest seal
Tap each step as you rehearse it.
Skill: Needle decompression of the chest (NDC)
Tap each step as you rehearse it.
Where people go wrong
- Putting a decompression needle through a chest seal instead of using the alternate site.CLS M08 Slides, PDF p.17
- Assuming a chest wound is not open because you are unsure it went through; treat it as an open chest wound.CLS M08 Slides, PDF p.9
- Missing a second wound by not checking the back and armpits with a raking motion.CLS M08 Skill Instructions, PDF p.2
- Pulling the needle out too soon; it must stay in 5-10 seconds before you remove it and leave the catheter.CLS M08 Skills Assessment, PDF p.3
Check yourself
Questions on this module, each with the reason and the slide it came from.
Practice Module 8Official course material
On Deployed Medicine, the Defense Health Agency’s training site. Some items ask you to sign in.
- VideoRespiration Assessment and Management in TFC Overview (opens Deployed Medicine in a new tab)
- VideoChest Seal How-to (opens Deployed Medicine in a new tab)
- VideoNeedle Decompression of the Chest (NDC) How-to (opens Deployed Medicine in a new tab)
- PDFSlides (didactic presentation) (opens Deployed Medicine in a new tab)
- PDFSpeaker notes (opens Deployed Medicine in a new tab)
- PDFSkill instructions (opens Deployed Medicine in a new tab)
- PDFSkills assessment checklist (opens Deployed Medicine in a new tab)
- CardSkill card: Chest Seal (opens Deployed Medicine in a new tab)
- CardSkill card: Needle Decompression of the Chest (NDC) (opens Deployed Medicine in a new tab)
Course objectives: T9: E51-59 (the Course Plan schedule shows T9:E50-58; the slides number them 51-59)
This program includes clinical facts and medication doses drawn from official guidelines for test preparation only. Nothing on this site is medical advice or clinical guidance, and none of it is a substitute for clinical judgment. For any real-world care, follow current official protocols and your medical direction.