> For the complete documentation index, see [llms.txt](https://kam-1.gitbook.io/kam-docs/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://kam-1.gitbook.io/kam-docs/respiratory/02_breathing_injuries.md).

# Breathing & Thorax Injuries

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Thorax injuries cause rapid oxygen saturation (SpO2) desaturation even if the patient's airway is completely clear. Proper inspection and treatment are critical to prevent tension pneumothorax and subsequent cardiac arrest.

## 🩺 Core Breathing Mechanics

* **Thorax Injury Signs:** Conscious patients with a thorax injury will make a coughing sound every 30 seconds.
* **Pneumothorax Progression:** Pneumothorax develops in 4 stages. Once it reaches Stage 4, it can transition into an advanced pneumothorax (Tension Pneumothorax or Hemothorax).
* **Secondary Trauma Warning:** If a patient has an active pneumothorax and is shot again in the chest, it immediately triggers a Tension Pneumothorax (TPTX) or Hemothorax (HPTX).
* **Visual Indicators:** Screen black-flashing indicates low and decreasing SpO2 levels.
* **BVM (Bag Valve Mask):** Slows down SpO2 loss on non-breathing patients, and boosts SpO2 recovery on breathing patients. Can be connected to a Portable Oxygen Tank for enhanced performance.
* **Deep Penetrating Wound:** A notification in the medical overview indicating a chest wound has crossed a damage threshold and has a chance to develop into a thorax injury.

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## 🩺 Thorax Injury Classification

| Injury Type                     | Lung Audio Profile | Required Equipment              | Field Treatment Flow                                                            |
| ------------------------------- | ------------------ | ------------------------------- | ------------------------------------------------------------------------------- |
| **Pneumothorax (PTX)**          | Short Breath       | Chest Seal, NCD Kit, or AAT Kit | Apply Chest Seal → Auscultate. If sound persists, execute Needle Decompression. |
| **Tension Pneumothorax (TPTX)** | Short Breath       | Chest Seal, NCD Kit, or AAT Kit | Execute immediate Needle Decompression (using NCD/AAT Kit).                     |
| **Hemothorax (HPTX)**           | Cracking Sound     | Chest Seal, AAT Kit             | Apply Chest Seal → Perform Fluid Draining (using AAT Kit) → Re-auscultate.      |

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## 🩺 Auscultation & Hardcore Mode

* **Standard Mode:** Chest injuries are listed directly in the patient's chest overview.
* **Hardcore Mode:** To diagnose a thorax injury, medics must equip a **Stethoscope**, select the patient's chest, and use the **"Auscultate"** action to listen to the breath sounds.
* **Diagnosis Tip:** Auscultating twice increases the accuracy of identifying the specific audio profile (e.g. short breath vs. cracking sounds).

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## 🩺 Chest Inspection Diagnostics

Medics can assess breathing quickly using two actions on the patient's chest or head:

### 1. Inspect Chest

* **Chest rise and fall observed:** Regular breathing.
* **No chest movement:** Not breathing (dead, cardiac arrest, or total occlusion/obstruction).
* **Uneven chest rise and fall:** Active Pneumothorax (PTX).
* **Chest sides are uneven:** PTX, TPTX, or HPTX and not breathing.
* **Skin is rigid, looks bruised:** Active Hemothorax (HPTX).

### 2. Check Breathing

* **Normal:** No issues present.
* **Shallow:** Pneumothorax present.
* **None:** The patient has no pulse/is dead, has an occluded/obstructed airway, or has a severe Tension Pneumothorax/Hemothorax.
* **Fruity / Harsh Metallic Breath:** Indicates kidney failure (see **Kidney Function**).

**Glossary of terms:**

* **PTX**: Pneumothorax
* **TPTX**: Tension Pneumothorax
* **HPTX**: Hemothorax / Hemopneumothorax