What is indicated for torso trauma or polytrauma casualties with no pulse or respirations?

• A. Perform bilateral needle decompression
• B. Begin chest compressions
• C. Administer analgesia
• D. Apply tourniquet to both limbs

Answer: (A)

When a torso trauma casualty has no pulse or respirations, a tension pneumothorax is a life-threatening reversible cause that must be addressed immediately. Relieving the pressure by needle decompression rapidly restores venous return and improves ventilation, which can restore or stabilize circulation. Doing this on both sides covers the possibility of a pneumothorax on either side, or bilateral involvement, which is especially important in polytrauma where injuries are widespread and the exact side may be unclear. Analgesia or limb tourniquets don’t address the chest injury causing the arrest, and while chest compressions are important, decompressing a suspected tension pneumothorax takes priority because it directly reverses the primary, life-threatening problem.