Treatment of Thoracic Trauma Supportive care Treatment of specific injuries Immediately life-threatening injuries are treated at the bedside at the time of diagnosis: Respiratory distress with suspected tension pneumothorax: Needle decompression Respiratory distress or shock with decreased breath sounds and suspected hemothorax: Tube thoracostomy Respiratory distress with suspected open pneumothorax: Partially occlusive dressing followed by tube thoracostomy Respiratory distress with suspected flail chest: Mechanical ventilation Shock with suspected cardiac tamponade: Pericardiocentesis Suspected hypovolemic shock: Fluid resuscitation Immediate resuscitative thoracotomy can be considered for trauma victims if the clinician is proficient in the procedure and the patient has one of the following indications: Penetrating thoracic injury with a need for cardiopulmonary resuscitation (CPR) of < 15 minutes Penetrating nonthoracic trauma with a need for CPR of < 5 minutes Blunt trauma with a need for CPR of < 10 minutes Persistent systolic blood pressure of < 60 mm Hg due to suspected cardiac tamponade, hemorrhage, or air embolism Pearls & Pitfalls In trauma patients with respiratory distress or shock and decreased breath sounds, tube thoracostomy can be done before imaging studies are obtained.