A 28-year-old male with severe acute asthma exacerbation develops acute respiratory distress, tracheal deviation to the right, and absent breath sounds over the left hemithorax with hypotension (BP 78/48 mmHg). What is the immediate life-saving intervention?

Answer and explanation

Correct answer: B. Immediate needle decompression of the left hemithorax

  1. Step 1: The combination of absent breath sounds, contralateral tracheal deviation, and obstructive shock (hypotension) establishes tension pneumothorax.
  2. Step 2: Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression (second intercostal space midclavicular line or fourth/fifth intercostal space anterior axillary line) without delaying for radiographic confirmation.
Answer
Immediate needle decompression of the left hemithorax.
Why not the others: Awaiting chest radiography risks fatal cardiac arrest; intubation without decompression worsens intrathoracic pressure; steroids treat bronchospasm but do not relieve physical air tension.

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