A 32-year-old man develops sudden respiratory distress and absent right-sided breath sounds with tracheal shift away from the right after a stab wound. Needle decompression of the right hemithorax restores breath sounds and improves saturation. What is the definitive next step in management?
- A Intercostal chest drain insertion in the fifth intercostal space at the anterior or mid-axillary line ✓
- B Repeat needle decompression every 15 minutes
- C Emergency thoracotomy in the emergency department
- D High-flow oxygen with continuous positive airway pressure mask
Explanation
Needle decompression is only a temporizing manoeuvre because the thin needle can kink, dislodge or occlude. Definitive treatment of tension pneumothorax is tube thoracostomy placed in the fifth intercostal space between the anterior and mid-axillary line, which lies safely above the diaphragm and avoids the internal mammary vessels. Current ATLS teaching prefers this safe triangle over the older second intercostal space mid-clavicular route because of a lower failure rate. Thoracotomy is reserved for traumatic arrest or massive haemothorax, not uncomplicated tension pneumothorax.
Reference: ATLS Student Course Manual, American College of Surgeons, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.