What is the field procedure for suspected tension pneumothorax?

• A. Needle decompression in the second intercostal space, midclavicular line
• B. Chest tube insertion at the fifth intercostal space
• C. Roll patient onto affected side
• D. Observe and reassess

Answer: (A)

When a tension pneumothorax is suspected, the priority is to relieve the pressure quickly to restore venous return and stabilize circulation. The fastest way to do this in the field is to perform a needle decompression using a large-bore needle or catheter inserted into the second intercostal space at the midclavicular line, directed toward the apex of the chest and just above the rib to avoid the neurovascular bundle. This creates an avenue for trapped air to escape and rapidly reduces intrapleural pressure, buying time for definitive care.

After decompression, chest tube insertion is the definitive treatment and is typically performed in a hospital setting or by trained personnel as soon as feasible. Simply rolling the patient onto the affected side or choosing to observe and reassess does not relieve the life-threatening pressure.