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Persistent or recurrent tension physiology may result from catheter occlusion, malposition, or bilateral pathology. Reassess breath sounds, chest rise, and hemodynamics. If signs persist, repeat needle decompression on the affected side, then evaluate and decompress the contralateral side if indicated. Use appropriate landmarks and catheter length; consider that wounds and chest seals can re-accumulate air. Oxygen supports but does not address obstructive shock. Spinal shock is possible but should not distract from life-threatening thoracic causes in the MARCH sequence. Diuretics are contraindicated in trauma resuscitation. Continue hemorrhage control, prevent hypothermia, and expedite evacuation. Document times, sites, and responses. Transition planning should anticipate definitive chest tube placement at the next echelon and possible need for ventilatory support in prolonged field care scenarios.