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Tension pneumothorax — SCE Acute Medicine MCQ

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ModerateAcute Respiratory PresentationsTension pneumothoraxSCE Acute Medicine

A 76-year-old man presents with acute breathlessness with chest symptoms. Relevant history includes respiratory disease and a relevant acute precipitant. On assessment, respiratory distress is present with abnormal oxygenation. Investigations show hypotension, tracheal deviation and absent unilateral breath sounds after line insertion. What is the most important immediate action?

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Correct answer: E — Perform immediate needle decompression followed by chest drain insertion

The key discriminator is that hypotension, tracheal deviation and absent unilateral breath sounds after line insertion, which makes Perform immediate needle decompression followed by chest drain insertion the single best answer. Give intravenous calcium gluconate immediately is less appropriate because it does not address the dominant acute risk in the vignette; Start acetylcysteine without delay would fit a different presentation or later stage of care. Give intramuscular adrenaline immediately and Call for urgent surgical source control are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: BTS Pleural Disease Guideline