A 24-year-old man develops acute respiratory distress and hypotension shortly after a central venous line insertion. You clinically diagnose a tension pneumothorax. According to the current ATLS guidelines, the recommended site for immediate needle decompression in an adult is:

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

Explanation

ATLS 10th edition moved needle decompression from the 2nd intercostal space midclavicular line to the 5th intercostal space at the anterior axillary line in adults. This site has a thinner chest wall, avoids mediastinal structures, and carries less risk of an unsuccessful decompression from a long pleural sleeve. The older 2nd space midclavicular site remains acceptable in children under 15 years. The 4th space midaxillary line is the finger thoracostomy landmark, not needle 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.