Emergency Interventions
If pressure causes a mediastinal shift (tension pneumothorax), the great vessels will become compressed, causing life-threatening complete cardiovascular collapse and cardiac arrest. Consult the medical team if symptoms worsen or vital signs occur outside of the patient's homeostatic parameters. Call for assistance from the medical or rapid response teams if cardiac or respiratory compromise occurs.
If the patient has a tension pneumothorax, the provider may insert a chest tube emergently. If the patient is experiencing severe symptoms, emergency needle decompression with a large-bore needle into the second intercostal space in midclavicular line is used to release the pressure. By emergently releasing the built-up pressure in the thorax, the mediastinal shift will be relieved and cardiac output will improve. The patient will then require a chest tube placement.
Patients presenting with impaled objects will be stabilized, and the penetrating wound sealed. However, no impaled objects will be removed until the patient can undergo emergent surgery (Strickler 2012).