What is the priority action for a tension pneumothorax?

• A. Needle decompression
• B. Chest tube insertion
• C. Oxygen by mask
• D. Intubation

Answer: (A)

In tension pneumothorax, air builds up under pressure in the pleural space, quickly collapsing the affected lung and shifting the mediastinum. This impairs venous return to the heart and can cause rapid circulatory collapse, so the immediate goal is to relieve the pressure. Needle decompression provides the fastest, life-saving relief by allowing air to escape and lowering intrapleural pressure right away. Once the patient is stabilized, definitive drainage with a chest tube is performed to keep the space evacuated and the lung re-expanded.

Oxygen by mask helps with oxygenation but doesn’t resolve the dangerous pressure buildup quickly enough. Intubation could worsen the situation if it leads to positive-pressure ventilation, increasing intrathoracic pressure. Chest tube insertion is essential after decompression for ongoing drainage, but it isn’t the quickest action to relieve the immediate threat.