What emergency intervention is used for suspected tension pneumothorax before definitive chest tube placement?

• A. Immediate chest tube placement
• B. Needle decompression (needle thoracostomy) followed by chest tube insertion
• C. Observation
• D. Oxygen only

Answer: (B)

When a tension pneumothorax is suspected, the priority is to rapidly relieve the pressure that is compressing the lung and great vessels. Needle decompression provides the fastest temporary relief by letting trapped air escape, which improves venous return and oxygenation immediately. After the momentary decompression, chest tube insertion is performed for definitive management to continuously evacuate air and re-expand the lung. Oxygen alone won’t relieve the pressure, and waiting or observing would delay lifesaving treatment. Directly placing a chest tube without the initial decompression can be slower in a critically unstable patient, so the recommended sequence is decompression followed by chest tube placement.