Thus, most casualties requiring airway control will need a surgical airway or an oral airway. A description of the technique for performing either a cricothyroidotomy or tracheostomy is found in the chapter on neck injuries. It is necessary at this point to comment about cervical spine control. Penetrating cervical cord wounds in salvageable combat casualties are quite unusual. It is essential that misplaced concern about aggravating a possible cervical cord injury should not interfere with life-saving care for real problems.
Second priority is accorded to correcting respiratory problems.
At the unit level, this will mean first and foremost inserting an intercostal drainage tube by means of a closed thoracostomy or, much less commonly, dressing an open chest wound. A chest tube should then be inserted. The technique for inserting a chest tube is described in the chapter on multiple injuries. The essential feature is to make an incision in the chest wall sufficiently large to allow entrance of a finger. By so doing, one assures that the chest tube is in fact placed within the pleural space.