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Tension pneumothorax on NIV — SCE Acute Medicine MCQ

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EasyAcute Respiratory PresentationsTension pneumothorax on NIVSCE Acute Medicine

A 63-year-old man on acute NIV for COPD suddenly becomes severely distressed. Oxygen saturation falls to 78%, pulse is 142/min and blood pressure is 78/46 mmHg. The right hemithorax is hyper-resonant with absent breath sounds and the trachea is deviated to the left. What is the most important immediate action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Perform immediate needle decompression then insert a chest drain

The patient has clinical tension pneumothorax with shock, so decompression must not wait for imaging. NIV can precipitate or worsen pneumothorax by positive pressure. Increasing pressures would worsen the physiology. The pearl is that tension pneumothorax is a clinical diagnosis when there is obstructive shock and unilateral chest signs.

Reference: BTS Pleural Disease Guideline 2023; Resuscitation Council UK ALS