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Sport-related concussion — MRCEM SBA MCQ

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HardConcussionSport-related concussionMRCEM SBA

A patient in traumatic cardiac arrest after blunt chest trauma has bilateral absent breath sounds. Endotracheal intubation and blood-product resuscitation are underway. Which chest intervention should be performed immediately?

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Correct answer: E — Perform bilateral finger thoracostomies without waiting for imaging

The best answer is “Perform bilateral finger thoracostomies without waiting for imaging”. Tension pneumothorax is a rapidly reversible cause of traumatic cardiac arrest. Bilateral thoracostomies are performed immediately because examination is unreliable during arrest and bilateral pathology can occur. Finger thoracostomy is faster and more dependable than needle decompression in this context, avoiding failure from chest-wall thickness or catheter kinking; formal drains follow once access is established and resuscitation permits. Imaging and ultrasound must not delay correction of a time-critical reversible cause. Blood products and haemorrhage control proceed alongside, not after, chest decompression.

Reference: Resuscitation Council UK 2025: special circumstances: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines