First 30 seconds
- 1DO NOT WAIT for imaging
- 2Needle decompression: 2nd ICS MCL (or 4th–5th ICS AAL/MAL)
- 3Then chest drain (5th ICS, mid-axillary line)
One-way valve in pleural space → progressive air accumulation → mediastinal shift → cardiovascular collapse.
A
Airway
- • Patent? Talking? Stridor?
- • Suction, jaw-thrust, adjuncts, definitive airway if needed
B
Breathing
- • RR, SpO₂, auscultate, percuss
- • O₂ to target sats, NIV / intubate as required
C
Circulation
- • HR, BP, cap refill, JVP
- • 2× large-bore IV, bloods, monitor, ECG
D
Disability
- • AVPU/GCS, pupils, glucose, temp
E
Exposure
- • Full exposure, skin, rash, bleeding, lines, infection source
