A 30-year-old motorcyclist is brought following a high-speed collision. On primary survey: GCS 12, BP 90/60 mmHg, HR 120/min, RR 28/min, SpO2 88% on high-flow oxygen, trachea deviated to the right, absent breath sounds on the left with distended neck veins. What is the immediate management?
- A Emergency chest X-ray to confirm diagnosis
- B Endotracheal intubation followed by tube thoracostomy
- C Immediate needle decompression of the left side (2nd intercostal space, midclavicular line) ✓
- D IV fluid resuscitation and portable CXR
Explanation
This presentation is classic for tension pneumothorax: hypotension, tachycardia, tracheal deviation away from the affected side, absent breath sounds, distended neck veins, and low SpO2. Tension pneumothorax is a clinical diagnosis and a life-threatening emergency requiring immediate decompression — do NOT delay for imaging. The ATLS protocol mandates immediate needle decompression at the 2nd intercostal space, midclavicular line on the affected side, followed by definitive chest tube insertion. Delaying for X-ray or intubation when tension pneumothorax is clinically diagnosed can be fatal.
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.