Question

A patient arrived in ER following an RTA with hypotension, respiratory distress and subcutaneous emphysema with no entry of air on one side. What will be the best management?

• A. Needle decompression in 5^th intercostal space in the midaxillary line
• B. Continue PPV
• C. Shift to ICU and incubate
• D. Secure IV line and start fluid resuscitation after insertion of the wide-bore IV line

Answer 1

The Correct Option is A

In this scenario, the patient presents with symptoms indicative of a tension pneumothorax: hypotension, respiratory distress, subcutaneous emphysema, and no air entry on one side. A tension pneumothorax is a critical condition where air becomes trapped in the pleural space and cannot escape, leading to increased pressure that impairs cardiorespiratory function. Immediate intervention is necessary to relieve this pressure.

The best initial management is needle decompression. This procedure involves:

1. Identifying the correct site: The 5^th intercostal space, midaxillary line is used.
2. Preparing the tools: Use a large-bore needle or cannula (often 14-gauge) to ensure adequate decompression.
3. Inserting the needle: Insert perpendicular to the chest wall to penetrate the pleural space and allow air to escape.

After decompression, further treatment often involves the insertion of a chest tube to ensure continued evacuation of air and re-expansion of the lung.