Injuries to the tracheobronchial tree, lungs, chest wall or diaphram can all result in respiratory distress. The healthcare provider should assess for adequate and symmetric chest rise, sucking chest wounds and signs of distress such as nasal flaring, grunting or traction. Auscultate for equal bilateral breath sounds, palpate for crepitus, instability or point tenderness. Emergency interventions that should be performed during the primary survey include assisting ventilation in the child with decreased or ineffective respiration, needle decompression for tension pneumothorax and appropriately dressing sucking chest wounds.