What is the immediate intervention for suspected tension pneumothorax?

What is the immediate intervention for suspected tension pneumothorax?

• A. Chest tube placement only.
• B. Oxygen therapy and observation.
• C. Needle decompression followed by chest tube placement.
• D. Endotracheal intubation.

Answer: (C)

In tension pneumothorax, the pressing need is to relieve the trapped air that is compressing the lung and shifting the mediastinum, which impairs venous return to the heart. The fastest way to do this is needle decompression (thoracostomy) to vent the air and rapidly decrease intrathoracic pressure. Once the immediate decompression has occurred and the patient is stabilized, a chest tube is placed for definitive management and ongoing drainage to prevent re-accumulation and allow the lung to re-expand. Imaging isn’t required or appropriate before decompression in an unstable patient. Oxygen helps, but it doesn’t address the underlying pressure issue, and intubation with positive pressure can worsen the condition until decompression has relieved the pressure.

In tension pneumothorax, the pressing need is to relieve the trapped air that is compressing the lung and shifting the mediastinum, which impairs venous return to the heart. The fastest way to do this is needle decompression (thoracostomy) to vent the air and rapidly decrease intrathoracic pressure. Once the immediate decompression has occurred and the patient is stabilized, a chest tube is placed for definitive management and ongoing drainage to prevent re-accumulation and allow the lung to re-expand. Imaging isn’t required or appropriate before decompression in an unstable patient. Oxygen helps, but it doesn’t address the underlying pressure issue, and intubation with positive pressure can worsen the condition until decompression has relieved the pressure.