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Tension pneumothorax — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsTension pneumothoraxSCE Acute Medicine

A 36-year-old man is assessed on the acute medical unit. He develops abrupt dyspnoea after central venous cannulation. He is hypotensive, has tracheal deviation away from the affected side and absent breath sounds on the right. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most important immediate action?

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

Perform needle decompression followed by chest drain insertion is the best answer because haemodynamic compromise with unilateral absent breath sounds indicates tension pneumothorax and treatment must precede radiography. Activate the major haemorrhage protocol is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Tension pneumothorax is a clinical diagnosis in an unstable patient.

Reference: BTS Pleural Disease Guideline