A 25-year-old male arrives after a high-speed motor vehicle accident. His GCS is 9, BP is 80/60 mmHg, HR 130 bpm, RR 28/min, and SpO2 88% on room air. During primary survey, breath sounds are absent on the right, trachea is deviated to the left, and neck veins are distended. What is the immediate life-saving intervention?
- A Insert a chest drain (tube thoracostomy) in the right 5th intercostal space
- B Emergency intubation and positive pressure ventilation
- C Needle decompression of the right pleural space in the 2nd ICS MCL ✓
- D FAST ultrasound to confirm haemothorax before intervention
Correct answer: C. Needle decompression of the right pleural space in the 2nd ICS MCL
Explanation
The clinical triad of absent breath sounds, tracheal deviation away, and distended neck veins with haemodynamic compromise defines tension pneumothorax — an immediately life-threatening emergency. Immediate treatment is needle decompression at the 2nd intercostal space midclavicular line (or 4th/5th ICS anterior axillary line in ATLS 10th edition update) to convert to simple pneumothorax, followed by chest drain insertion. Waiting for imaging or inserting a chest drain as the first step wastes critical time.
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.