Pulse has an occlusive dressing that can be applied as part of treating an external tension pneumothorax – I assume this is equivalent to a non-vented chest seal. In real life, a non-vented chest seal may need to be “burped” occasionally (e.g., if hypoxia increases).
- Is this something that can happen in pulse (increasing hypoxia after a tension pneumothorax is properly treated)?
It is possible for hypoxia to increase after a tension pneumothorax depending on other factors, like what other insults are applied. I think it’s doubtful hypoxia will increase after tension pneumothorax interventions without the presence of other insults.
My initial thought is that “burping” can be mimicked by removing the occlusive dressing action for a short time and then reapplying it.
- Is there an equivalent of a vented chest seal in pulse?
Not currently, but a vented chest seal could be modeled by adding a valve (diode in the electrical analog) to the chest leak path (pleural to environment) in the respiratory circuit.
Ok. It might be nice to have a vented chest seal in the future, but it certainly isn’t holding anything up on my end. I’m actually already modeling the burping as you suggest 
My medical SME says that the reason you need to burp (or use a vented chest seal) is if air is able to leak into the cavity some way, or it didn’t all get out in the first place. I don’t think it’s possible for pulse to have an imperfect seal or another leak, but perhaps it is possible to do a needle decompression for too short a time?
You are correct that the current implementation assumes a perfect seal. A leak severity would be pretty easy to add to the chest occlusive dressing action, but isn’t there at the moment.
I haven’t really tested it, but I would assume it’s possible to do a needle decompression for too short a time before removing enough air from the pleural space.