How is a suspected tension pneumothorax treated in the field?

• A. Chest compressions only.
• B. Oxygen therapy and observation.
• C. Immediate needle decompression (14- or 16-gauge) in the second intercostal space, followed by chest tube if available.
• D. Wait for medical evacuation without intervention.

Answer: (C)

When a tension pneumothorax is suspected, the body is under dangerous pressure from air trapped in the chest, which rapidly collapses the lung on that side and can squeeze the heart and great vessels, cutting off blood return to the heart. The urgent priority in the field is to relieve that pressure immediately, not to wait for imaging or perfect stabilization.

The best action is a rapid needle decompression using a large-bore needle (14- or 16-gauge) inserted into the second intercostal space along the midclavicular line. This allows trapped air to escape quickly, decompressing the chest and restoring ventilation and circulation. Once decompression is achieved, proceed with definitive drainage by placing a chest tube if it is available, to maintain ongoing drainage and lung expansion. Provide oxygen as supportive care, but recognize that decompression is the critical first step to survival. Do not delay relief of the pressure while awaiting evacuation.