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Tension pneumothorax during non-invasive ventilation — SCE Acute Medicine MCQ

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HardRespiratory medicineTension pneumothorax during non-invasive ventilationSCE Acute Medicine

A 58-year-old man with pneumonia is receiving NIV for acute hypercapnic respiratory failure. He suddenly becomes distressed and hypotensive with oxygen saturation 78%, tracheal deviation to the left and absent breath sounds over the right hemithorax. His chest drain kit is on the resuscitation trolley but radiology is delayed. What is the most appropriate next step in management?

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

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Correct answer: A — Immediate decompression of the right pleural space

This is a clinical tension pneumothorax with shock during positive-pressure ventilation, and decompression must not wait for imaging. Increasing NIV pressures may rapidly worsen cardiovascular collapse. The key teaching point is that tension pneumothorax is treated on clinical grounds when there is cardiorespiratory compromise.

Reference: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/#acute-medicine-order-84-1