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Emergency Medicine

Answer 4
  1. Perform needle decompression of the right pleural space. A tension pneumothorax is an immediate life-threatening emergency. Because the patient can speak, a patent airway can be assumed. Because a clinical diagnosis can be made, it is unacceptable to wait for chest radiography or other studies. Tension pneumothorax requires urgent decompression, which is accomplished by rapid insertion of a large-bore needle into the second intercostal space in the midclavicular line of the affected hemithorax.5 This simple maneuver has few serious consequences, even in the absence of a tension pneumothorax. Definitive treatment of such an injury will mandate a formal tube thoracostomy. All airway and breathing problems should be addressed before focusing on managing the patient’s circulation.5

     American College of Surgeons. Advanced Trauma Life Support course instructor’s manual. 6th ed. Chicago: The College; 1997.

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