After applying an occlusive dressing to a penetrating chest wound, which sign would indicate possible progression to tension pneumothorax?

• A. Diminished breath sounds on the affected side
• B. Increased color of skin
• C. Signs of tension such as increasing distress and decreased breath sounds
• D. Unchanged condition

Answer: (C)

The main idea is recognizing the progression from a sealed chest wound to a tension pneumothorax by identifying signs of chest compression and ventilation failure. When air continues to enter the pleural space under pressure, it compresses the lung and shifts the mediastinum, causing the patient to become more distressed while breath sounds on the injured side diminish as ventilation worsens. That combination—rising distress with decreasing breath sounds on the affected side—indicates tension physiology, which is more dangerous than a simple pneumothorax or an unchanged condition. Diminished breath sounds alone could occur with a non-tension pneumothorax, and increased skin color or no change don’t specifically signal the evolved, life-threatening tension state.