A 26-year-old man is struck by a car. On arrival he is severely dyspnoeic, BP 78/50 mmHg, HR 132/min, distended neck veins, absent breath sounds on the right, and hyperresonance to percussion on that side. The nearest portable radiography machine is occupied. What is the correct immediate action?
- A Obtain an urgent portable chest radiograph before any intervention
- B Immediate decompression of the right pleural cavity followed by insertion of an intercostal drain ✓
- C Focused assessment with sonography in trauma (FAST) of the abdomen
- D Rapid infusion of 2 litres of crystalloid through two large-bore cannulas
Correct answer: B. Immediate decompression of the right pleural cavity followed by insertion of an intercostal drain
Explanation
The clinical picture is classic tension pneumothorax: shock, distended neck veins, absent breath sounds and hyperresonance on one side. It is a clinical diagnosis and decompression must precede any imaging; waiting for a radiograph kills the patient. Crystalloids treat the shock but do nothing for the source, and FAST assesses the wrong cavity. After decompression, a definitive intercostal drain is placed.
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.