A patient came to emergency after RTA, He was conscious, could speak in single words, RR=40/minute, BP=90/40 mm Hg. There is absence of Breath Sounds on Right side. What is your next step immediately?
Intubate the patient
Urgent Fluid infusion
Chest X ray
Needle Insertion in 2nd ICS
Ans. (d) Needle insertion in 2nd ICS.Ref. ATLS Guidelines 10th Edition Page 66, Ref Surgery Sixer 2nd Edition Page 95* A hyper resonant note on percussion, deviated trachea, distended neck veins, and absent breath sounds are signs of tension pneumothorax.* But the Question setter has given an incomplete question, nothing mentioned about breath sounds, tracheal deviation.* But let us take into consideration the Tension pneumothorax which fits with above features and let us proceed with Needle Insertion in 5th ICS in MCL.* Newer Guidelines recommend Needle insertion in Adults in 5th ICS in Mid axillary line nowadays, But Bailey speaks the old method and conventional method, 2nd ICS MCL.
Trauma