Question

A patient presented with RTA leading to breathlessness and decreased air entry into right lung and patient is hypotensive. What is the next step?

• A. Needle inserted at 2nd ICS in MCL
• B. Needle inserted at 5th ICS in mid axillary
• C. Fluid resuscitation using wide bore cannula
• D. Wide bore needle decompression

Answer 1

The Correct Option is B

The patient presents with symptoms indicative of a tension pneumothorax after a road traffic accident (RTA): breathlessness, decreased air entry into the right lung, and hypotension. This condition requires immediate intervention. The key steps in managing a suspected tension pneumothorax are as follows:

Tension pneumothorax occurs when air enters the pleural space and cannot escape, causing increased intrathoracic pressure, which subsequently leads to compromised venous return to the heart and resultant hypotension. The clinical signs include respiratory distress and decreased breath sounds on the affected side.

The initial management of tension pneumothorax involves rapid decompression to relieve the pressure. The traditional teaching suggests immediate decompression using a needle:

1. Needle Decompression: The recommended site for needle decompression is the 5th intercostal space (ICS) in the mid-axillary line on the affected side. This site is preferred over the 2nd ICS in the mid-clavicular line due to the thicker chest wall anteriorly and the higher chance of successful decompression laterally.

Thus, for this patient, the correct initial step is to insert a needle at the 5th ICS in the mid axillary line. This step will allow trapped air to escape and should stabilize the patient's condition temporarily until a chest tube (thoracostomy) can be inserted for a more definitive solution.