In tension pneumothorax, what is the recommended emergency treatment?

• A. Chest tube insertion, wait-and-see, diuretics, needle thoracostomy
• B. Needle thoracostomy
• C. Endotracheal intubation only
• D. Observation

Answer: (B)

The main idea here is that tension pneumothorax requires immediate relief of the built-up pressure to restore breathing and blood flow. When air accumulates under pressure in the pleural space, it collapses the affected lung and pushes the heart and great vessels to the opposite side, cutting down return of blood to the heart and rapidly deteriorating the patient. The fastest, most life-saving action is needle thoracostomy, which involves inserting a large-bore needle into the pleural space to vent the trapped air right away. This decompresses the chest space within seconds and buys time for definitive care.

Chest tube placement is the definitive therapy to fully re-expand the lung and prevent reaccumulation, but it takes longer and is preceded by the immediate decompression. Observation or wait-and-see doesn’t address the pressure or the hemodynamic collapse, and diuretics don’t treat the underlying problem. Endotracheal intubation alone can worsen the situation by increasing intrathoracic pressure with positive-pressure ventilation if decompressing relief hasn’t been achieved.