A 30-year-old man with blunt chest trauma has absent breath sounds on the right, tracheal deviation to the LEFT, and HR 130/min with BP 80/60 mmHg. What is the immediate treatment?
- A Chest X-ray to confirm diagnosis, then intercostal drain
- B Immediate needle decompression of the RIGHT chest, followed by chest drain ✓
- C Immediate needle decompression of the LEFT chest
- D Pericardiocentesis for suspected cardiac tamponade
Correct answer: B. Immediate needle decompression of the RIGHT chest, followed by chest drain
Explanation
This presentation — absent breath sounds on the right, tracheal deviation to the OPPOSITE (left) side, and haemodynamic instability — is a tension pneumothorax on the right. Tension pneumothorax is a clinical diagnosis and life-threatening emergency; CXR must NOT delay treatment. Immediate needle decompression is performed on the affected side (right, 2nd intercostal space, mid-clavicular line or 4th/5th ICS, mid-axillary line), followed by formal chest drain insertion. Cardiac tamponade (Beck's triad) would have muffled heart sounds, not tracheal deviation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.