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Tension pneumothorax — SCE Acute Medicine MCQ

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EasyCritical care medicineTension pneumothoraxSCE Acute Medicine

A 72-year-old man admitted with COVID-19 pneumonitis is on CPAP with FiO2 0.70. He becomes acutely hypotensive and tachycardic with distended neck veins and absent breath sounds on the right. Trachea is deviated to the left. What is the most important immediate action?

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Correct answer: B — Perform immediate needle decompression followed by definitive chest drain

This is tension pneumothorax with obstructive shock in a patient on positive-pressure support. Immediate decompression is required on clinical grounds and should not wait for imaging. Increasing CPAP may worsen the tension physiology.

Reference: BTS Pleural Disease Guideline 2023; Resuscitation Council UK