Beware of worsening pneumothorax as pressure is applied to the airway. Evaluate for possible chest injury. Chest tubes should be placed prior to the chest x-ray if there is hemodynamic or respiratory compromise. Respiratory compromise due to increased pleural pressure. Hemodynamic compromise due to impaired venous return.
Good lung is affected by mediastinal shift.
Absent unilateral breath sounds. Hypotension with distended neck veins. Needle thoracostomy followed by chest tube. Obtain chest x-ray after chest tube has been placed. Massive bleeding into the pleural space results in hemorrhagic shock.