Breathing

With the patient breathing or now intubated and being ventilated with 100% oxygen, the thorax and neck should be inspected, auscultated, and palpated to detect abnormalities such as a deviated trachea, crepitus, flail chest, sucking chest wound, fractured sternum, and absence of breath sounds on either side of the chest. Possible interventions here include application of an occlusive dressing to a sucking chest wound, withdrawal of the endotracheal tube from the right mainstem bronchus; reintubation of the trachea if no breath sounds are heard, and insertion of large chest tubes (38Fr) to relieve hemopneumothorax. Evacuated blood should be collected in an autotransfusion device. The volume of blood that returns should be noted immediately, since 1500 cc of hemorrhage may require a thoracotomy.

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