A 24-year-old man develops sudden respiratory distress, distended neck veins, and hyperresonance with absent breath sounds on the right side after blunt chest trauma. You diagnose tension pneumothorax. According to the current ATLS guidelines, needle decompression should be performed at which site?

• A Second intercostal space in the midclavicular line
• B Fifth intercostal space in the anterior axillary line ✓
• C Fourth intercostal space in the midaxillary line
• D Fifth intercostal space in the midclavicular line

Explanation

The tenth edition of ATLS recommends the fifth intercostal space at the anterior axillary line for needle decompression, because the chest wall is thinner there and the needle avoids major internal mammary vessels. The second intercostal space midclavicular line was the older recommendation and has been abandoned due to failure rates from thick chest walls. Finger thoracostomy or immediate tube thoracostomy follows decompression.

Reference: ATLS Student Course Manual, American College of Surgeons, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.