Question
A patient presents with acute breathlessness, hypotension, and decreased air entry in the right lung following a road traffic accident (RTA). What is the next best step in management?
| A. |
Needle decompression at the 2nd intercostal space (ICS) in the midclavicular line
|
| B. |
Needle decompression at the 5th intercostal space (ICS) in the midaxillary line
|
| C. |
Fluid resuscitation using a wide-bore intravenous cannula
|
| D. |
Intercostal chest tube insertion at the 5th ICS in the anterior/midaxillary line
|
Show Answer
|
Correct Answer » B
Explanation
|
|
Tension Pneumothorax
– Air trapped under pressure in pleural space → mediastinal shift & ↓ venous return
Causes:
– Trauma (most common in exams)
– Mechanical ventilation
– Spontaneous bleb rupture
Clinical Features:
– Sudden dyspnea
– Hypotension (obstructive shock)
– Tachycardia
– Unilateral absent breath sounds
– Hyperresonance
– Tracheal deviation (late sign)
Management (Stepwise):
1. Immediate needle decompression at 5th ICS midaxillary line
2. Definitive chest tube (intercostal drain) in 5th ICS anterior/midaxillary line
Safe Triangle for Chest Tube Insertion:
– Anterior: Lateral border of pectoralis major
– Posterior: Anterior border of latissimus dorsi
– Inferior: 5th intercostal space
– Superior: Base of axilla
