Prehospital Trauma Life Support (PHTLS) Practice Test

For a patient with a suspected tension pneumothorax, what is the immediate treatment?

1. Apply continuous positive airway pressure

2. Needle decompression of the chest

3. Administer IV fluids

4. Insert an endotracheal tube

The correct answer is: Needle decompression of the chest

The immediate treatment for a suspected tension pneumothorax is needle decompression of the chest. This procedure is critical because a tension pneumothorax occurs when air enters the pleural space and creates increasing pressure that collapses the lung on the affected side, ultimately compromising respiratory and cardiovascular function. Needle decompression involves inserting a large-bore needle into the second intercostal space at the midclavicular line on the side of the pneumothorax. This alleviates the pressure by allowing trapped air to escape from the pleural cavity, enabling the lung to re-expand and restoring normal respiratory function. While other options, such as administering intravenous fluids or inserting an endotracheal tube, may be relevant for other medical conditions, they do not address the life-threatening nature of a tension pneumothorax in an immediate way. Continuous positive airway pressure is also not an appropriate first-line intervention for this condition, as it could potentially increase intrathoracic pressure further. Therefore, needle decompression is essential and urgent in managing a patient with a suspected tension pneumothorax.