Tension pneumothorax

Diagnosis: The traumatic tension pneumothorax — the severe respiratory distress, the hypoxia (the 88 per cent), the hypotension (the 82/50), the reduced breath sounds and the hyper-resonance on the right, the distended neck veins, and the tracheal deviation to the left (the opposite side). This is the clinical diagnosis.^[3]

The immediate management — NO chest radiograph:

1. The immediate needle decompression at the 5th intercostal space in the mid-axillary line (the anterior to the mid-axillary) on the right — the large-bore cannula, the rush of the air confirms the diagnosis. (The 2nd intercostal space in the mid-clavicular line is the alternative.)
2. The definitive chest drain (the chest-tube thoracostomy) — the large-bore, the underwater seal, the chest radiograph after.
3. The high-flow oxygen, the IV access, the resuscitation.

The rationale: The tension pneumothorax is the clinical diagnosis — the chest radiograph is NOT awaited (the delay is the fatal). The needle decompression relieves the tension, and the chest drain is the definitive.^[3]

The disposition: The trauma team, the intensive care, the search for the other injuries (the ATLS primary survey).^[3]