FIGURE 115.3 A 5-year-old girl fell off and was then kicked in the chest by a horse Upon arrival of the life-flight team, the patient was found to be in both respiratory and cardiovascular distress Chest radiograph demonstrated a left-sided tension pneumothorax The patient was intubated, and a chest tube was placed before the patient was transported After the intubation and chest tube insertion, both the patient’s respiratory and cardiovascular status improved Reported sensitivity of the E-FAST examination in children is lower than that noted in adults In addition, children are less likely to undergo operative repair even when free fluid in the abdomen is identified, therefore the role for FAST testing is different in children than adults Nonetheless, with thoracic trauma, identification of air or blood in the pleural space on avoid confusion may rapidly influence the decision for tube thoracostomy in children with respiratory or hemodynamic compromise Management Needle Decompression