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Tension pneumothorax — MCCQE Part 1 MCQ

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EasyTraumaTension pneumothoraxMCCQE Part 1

27-year-old motorcyclist presents with severe dyspnoea after chest trauma. He is hypotensive with distended neck veins, tracheal deviation and absent left breath sounds. Which of the following is the most appropriate next step?

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Correct answer: D — Perform immediate needle/finger decompression followed by chest tube

Perform immediate needle/finger decompression followed by chest tube is best because tension pneumothorax is a clinical diagnosis requiring immediate decompression. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Do not wait for CXR in a clinically obvious tension pneumothorax.

Reference: ATLS Canada principles