A 25-year-old motorcyclist is brought to the emergency department after a high-speed collision. Primary survey: airway intact, RR 28/min, bilateral reduced breath sounds on the right with absent breath sounds, SBP 80 mmHg, HR 130 bpm, tracheal shift to the left. The immediate intervention is:
- A Chest X-ray followed by intercostal chest drain
- B Immediate needle decompression of the right pleural space in the 2nd intercostal space, mid-clavicular line ✓
- C Pericardiocentesis for cardiac tamponade
- D Emergency intubation and ventilation
Correct answer: B. Immediate needle decompression of the right pleural space in the 2nd intercostal space, mid-clavicular line
Explanation
The clinical picture — absent right-sided breath sounds, tracheal deviation to the left, hypotension, and tachycardia — is diagnostic of tension pneumothorax. ATLS mandates immediate needle decompression at the 2nd intercostal space, mid-clavicular line on the affected side without waiting for imaging; this is a life-threatening emergency where delay causes death.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.