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Casualty clearing and scene organisation — DIPIMC MCQ

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HardMajor Incident ManagementCasualty clearing and scene organisationDIPIMCDipIMC

Following penetrating chest trauma, a patient becomes severely breathless and hypotensive. Clinical assessment suggests tension pneumothorax; ultrasound is unavailable and transfer would take 25 minutes. A critical-care team with thoracostomy competence is present. What is the most appropriate intervention?

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Correct answer: C — Perform open thoracostomy, then arrange a chest drain while observing for recurrence

The best answer is “Perform open thoracostomy, then arrange a chest drain while observing for recurrence”. Severe respiratory compromise and haemodynamic instability are the clinical indications for immediate decompression without imaging. NICE recommends open thoracostomy rather than needle decompression when the expertise is available, followed by a chest drain in a spontaneously breathing patient, with observation for recurrence. Resuscitation and rapid trauma transfer continue, but delay for imaging or reliance on fluids alone risks untreated obstructive shock.

Reference: NICE NG39, Major trauma: assessment and initial management: https://www.nice.org.uk/guidance/ng39/chapter/Recommendations