- High index of suspicion
- Site of surgical procedure
- Subcutaneous emphysema of the neck and thorax
- Increased end-tidal carbon dioxide and reduced end-tidal carbon dioxide with hypotension
- Decreased oxygen saturation
- Increased peak airway pressures
- Hypotension
- Unequal chest expansion and air entry
- Bulging of hemidiaphragm seen through the endoscope
- Confirmed on thoracic ultrasound and/or chest x-ray
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