In suspected tension pneumothorax, what is the recommended sequence of interventions?

• A. Observation and oxygen.
• B. Needle decompression followed by chest tube placement.
• C. Immediate surgical thoracotomy.
• D. Endotracheal intubation.

Answer: (B)

The key idea is to rapidly relieve the pressure building in the chest to restore circulation and lung function. In suspected tension pneumothorax, you must first provide immediate decompression to allow trapped air to escape, which quickly improves venous return and cardiac output. This is done with needle decompression right away, giving rapid relief of the pressure.

After decompression, you place a chest tube (tube thoracostomy) to provide ongoing drainage and to re-expand the lung, making the situation more stable and preventing reaccumulation of air.

Oxygen can be given to improve oxygenation, but it does not address the life-threatening pressure. Observation offers no active treatment in this emergency. Endotracheal intubation can worsen the condition by increasing airway pressures, potentially making the tension worse unless decompression has already been performed. Immediate surgical thoracotomy is not the initial step in this scenario. So the recommended sequence is needle decompression followed by chest tube placement.