A young trauma patient becomes acutely breathless and hypotensive. Trachea deviated to the right, absent breath sounds on the left. What now?

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Accepted Answer

Tension pneumothorax is a clinical diagnosis — I would not wait for imaging. I'd call for help, give high-flow oxygen and immediately decompress the chest with a large-bore cannula in the 4th-5th intercostal space mid-axillary line, the current ATLS recommendation in adults. I'd then site a formal intercostal drain in the safe triangle, ensure adequate analgesia, repeat observations, request a CXR to confirm position and look for underlying lung pathology. In a trauma context I'd activate the trauma team and follow the primary-secondary survey. Once stable I'd plan ongoing care with the respiratory team — drain management, suction if persistent leak, surgical referral if not resolving in 48-72 hours.

Tension pneumothorax

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