skip to main content

Tension Pneumothorax Decompression — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

EasyTrauma & Emergency AnaesthesiaTension Pneumothorax DecompressionFRCA Final

A 70-year-old woman develops a right tension pneumothorax following right internal jugular central venous catheter insertion. She has severe hypotension, absent right-sided breath sounds and tracheal deviation to the left. Thoracostomy equipment is being prepared. According to the Association of Anaesthetists Quick Reference Handbook-derived emergency action card used by a UK adult critical care transfer service, which site is specified for immediate needle decompression?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — 2nd intercostal space, midclavicular line, right side

Explanation lettering: D = shown as A · E = shown as D · A = shown as E

A is correct. The cited UK anaesthetic transfer emergency action card specifies a 14G cannula in the second intercostal space at the midclavicular line on the affected side for immediate needle decompression. The cannula is introduced just superior to the third rib to reduce the risk of injury to the intercostal neurovascular bundle. The same card distinguishes this from finger thoracostomy, performed laterally at the fifth intercostal space between the anterior and midaxillary lines. Lateral fourth/fifth intercostal-space needle decompression is accepted in some UK protocols, which made the original generic stem ambiguous. D treats the unaffected side, while E is excessively low and risks diaphragmatic or intra-abdominal injury. Needle decompression is temporary and should be followed promptly by definitive pleural decompression.

Reference: Retrieve Adult Critical Care Transfer Service. Tension Pneumothorax Emergency Action Card, version 1.1, 2024. https://retrieve.nhs.uk/wp-content/uploads/2024/07/tension-pneumothorax-v1.1.pdf