Breathing ventilation and oxygenation

Absent or decreased breath sounds on one side of the chest suggest the presence of a hemothorax or pneumothorax. Although a hemothorax should be dull on percussion and a pneumothorax should be tympanitic, it is often difficult to differentiate between the two without a chest radiograph. The patient should not be hyperventilated vigorously after an endotracheal tube is inserted because this decreases venous return and increases the chances of a pneumothorax or air embolism, particularly if the lung is injured.

If an arrhythmia, hypotension, and/or changes in the central nervous system occur during or immediately after endotracheal intubation, the presence of an increasing pneumothorax or air embolism should be suspected.

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