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Tension pneumothorax — MCCQE Part 1 MCQ

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EasyDyspneaTension pneumothoraxMCCQE Part 1

A 24-year-old tall man develops sudden severe dyspnoea and right-sided pleuritic chest pain. He is hypotensive, tachycardic, has tracheal deviation to the left, absent right breath sounds and distended neck veins. Which of the following is the most appropriate next step?

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Correct answer: D — Immediate needle decompression followed by chest tube placement

The findings are classic for tension pneumothorax, a clinical diagnosis requiring immediate decompression before imaging. Waiting for a chest radiograph can be fatal, and positive pressure ventilation can worsen the tension physiology if decompression is delayed. Steroids and outpatient management are not appropriate for haemodynamic instability.

Reference: ATLS principles; Canadian emergency medicine practice standards