What immediate management steps should I take for a patient suspected of having a tension pneumothorax before emergency services arrive?

For a patient suspected of having a tension pneumothorax before emergency services arrive, the immediate management steps, as outlined in UK guidelines for pre-hospital settings, focus on critical assessment and intervention by trained professionals.

• Clinical Assessment: A pneumothorax should be diagnosed using clinical assessment for the purpose of triage or intervention ¹.
• Chest Decompression Criteria: Chest decompression should only be performed if the patient has either haemodynamic instability or severe respiratory compromise ¹.
• Decompression Method: If chest decompression is necessary and the expertise is available, open thoracostomy should be used instead of needle decompression, followed by a chest drain in patients who are breathing spontaneously ¹.
• Post-Decompression Observation: After chest decompression, patients should be observed for signs of recurrence of the tension pneumothorax ¹.
• Open Pneumothorax Management: In patients with an open pneumothorax, cover it with a simple occlusive dressing and observe for the development of a tension pneumothorax ¹.