A cyclist has absent breath sounds on the right, hyperresonance, distended neck veins and hypotension. What is the immediate management?

Answer and explanation

Correct answer: C. Immediate needle decompression of the right chest, then a chest drain

  1. Step 1: These are classic features of tension pneumothorax.
  2. Step 2: Tension pneumothorax is a clinical diagnosis and requires immediate decompression.
Answer
Immediate needle decompression of the right chest, then a chest drain.
Why not the others: Oral analgesia and observation on the ward for four hours with repeat vital signs: Observation is unsafe with shock. A high-dose intravenous steroid infusion to reduce inflammation around the lung: Steroids have no role. A chest X-ray, with treatment started once the radiologist has reported it: Waiting for imaging risks cardiac arrest.

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