When should I consider referring a patient with a suspected tension pneumothorax to secondary care?

You should consider referring a patient with a suspected tension pneumothorax to secondary care immediately if they present with either haemodynamic instability or severe respiratory compromise ¹. These are critical indicators for urgent intervention ¹.

The optimal destination for patients with major trauma, which often includes conditions like tension pneumothorax, is typically a major trauma centre ¹. In a hospital setting, chest decompression for tension pneumothorax is performed before imaging only if these life-threatening signs are present ¹. Definitive management, such as performing chest decompression using open thoracostomy followed by a chest drain, is a secondary care intervention ¹. Urgent imaging, like chest X-ray and/or eFAST, should be performed and interpreted immediately by a trained healthcare professional in secondary care ¹.