First initial intervention in treatment of tension pneumothorax?

• A. Needle decompression
• B. Chest tube placement
• C. Thoracotomy
• D. Supplemental O2

Answer: (A)

Rapid decompression is the immediate priority because a tension pneumothorax traps air inside the pleural space, causing lung collapse and mediastinal shift that reduces venous return and can lead to shock. The fastest way to achieve this relief is needle decompression with a large-bore needle inserted into the chest to vent the air. The typical sites are the second intercostal space at the midclavicular line (emergency needle thoracostomy) or, if necessary, the fifth intercostal space at the anterior axillary line. After this rapid temporary relief, definitive management with chest tube placement is performed to continuously drain air and re-expand the lung. Supplemental oxygen is helpful but does not treat the underlying pressure buildup. Thoracotomy is not the first step in tension pneumothorax unless there are other indications or failures of initial decompression.