A 26-year-old man develops sudden respiratory distress, distended neck veins, absent right-sided breath sounds, and tracheal shift to the left five minutes after intubation and positive pressure ventilation following blunt chest trauma. The most appropriate immediate action is:
- A Immediate needle decompression in the second intercostal space midclavicular line on the right ✓
- B Chest radiograph to confirm the diagnosis
- C Increase ventilator tidal volume to improve oxygenation
- D Immediate tube thoracostomy in the fifth intercostal space midaxillary line
Correct answer: A. Immediate needle decompression in the second intercostal space midclavicular line on the right
Explanation
This is tension pneumothorax, a clinical diagnosis that must be treated before imaging. ATLS teaches immediate decompression with a large bore needle in the second intercostal space at the midclavicular line or the fourth to fifth intercostal space at the anterior axillary line, followed by definitive tube thoracostomy. Waiting for a radiograph or adjusting ventilation delays treatment and can be fatal.
Reference: ATLS Advanced Trauma Life Support Student Course Manual, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.