A 22-year-old tall, thin man presents with sudden right-sided pleuritic chest pain and severe dyspnea. He is tachycardic at 128 per minute, hypotensive at 85/50 mmHg, and the trachea is deviated to the left. Neck veins are distended. The right chest is hyperresonant with absent breath sounds. What is the immediate management?
- A Emergency chest X-ray to confirm the diagnosis
- B Needle decompression at the 2nd intercostal space, midclavicular line ✓
- C Intercostal tube drainage at the 4th to 5th intercostal space, midaxillary line
- D High-flow oxygen and close observation
Correct answer: B. Needle decompression at the 2nd intercostal space, midclavicular line
Explanation
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression before imaging. The standard site is the 2nd intercostal space in the midclavicular line. Chest X-ray delays definitive treatment. Intercostal tube placement follows needle decompression. Observation is inappropriate with hemodynamic compromise.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.