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Tension pneumothorax — MCCQE Part 1 MCQ

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HardTraumaTension pneumothoraxMCCQE Part 1

A 34-year-old man is stabbed in the right chest. He is severely dyspnoeic, BP 78/46 mmHg, trachea deviates left, neck veins are distended, and breath sounds are absent on the right. What is the most appropriate next step in management?

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Correct answer: C — Immediate needle or finger decompression followed by chest tube

This is tension pneumothorax causing obstructive shock; immediate decompression is required before imaging, followed by definitive chest drainage. Chest radiography delays lifesaving care. Pericardiocentesis is for tamponade, which would not cause unilateral absent breath sounds and tracheal deviation. Salbutamol does not treat pleural air under pressure.

Reference: ATLS; Canadian emergency medicine trauma guidance