In the ATLS primary survey, a trauma patient has decreased breath sounds and hyperresonance on the right with hypotension and distended neck veins. Chest X-ray is unavailable. What is the correct immediate action?
- A Immediate needle decompression followed by intercostal drain insertion ✓
- B Obtain urgent CT chest before any intervention
- C Perform pericardiocentesis via subxiphoid route
- D Administer intravenous fluids and reassess breath sounds
Correct answer: A. Immediate needle decompression followed by intercostal drain insertion
Explanation
The clinical picture is tension pneumothorax, a clinical diagnosis that must be treated before imaging. ATLS mandates immediate decompression with a large-bore needle in the second intercostal space at the mid-clavicular line (or fifth intercostal space anterior axillary line) followed by definitive chest drain. Waiting for CT or giving fluids alone delays a life-saving manoeuvre, and pericardiocentesis addresses cardiac tamponade, not tension physiology.
Reference: ATLS Student Course Manual, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.