A 30-year-old motorcyclist arrives after a high-speed collision. He is unresponsive (GCS 7), BP 90/60 mmHg, HR 130 bpm, trachea deviated to the right with absent breath sounds on the left and distended neck veins. The FIRST intervention is:
- A Urgent chest X-ray to confirm the diagnosis before intervening
- B Needle decompression of the left chest at the 2nd intercostal space, mid-clavicular line ✓
- C Immediate pericardiocentesis for suspected cardiac tamponade
- D Endotracheal intubation before any chest intervention
Explanation
The clinical triad of absent ipsilateral breath sounds, tracheal deviation away from the affected side, hypotension, and distended neck veins (Beck's triad of tension pneumothorax + haemodynamic collapse) indicates tension pneumothorax. This is a life-threatening ATLS primary survey emergency requiring immediate needle decompression (2nd ICS MCL on the affected side) followed by formal chest drain insertion. Radiological confirmation must not delay treatment. Cardiac tamponade presents with muffled heart sounds and distended neck veins but NOT absent breath sounds with 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.