Question:medium
A 24-year-old man is brought to the casualty department after a fall from a height. His breathing is laboured and he is cyanotic. No breath sounds can be heard and the right lung field is resonant. The initial management should include
A 24-year-old man is brought to the casualty department after a fall from a height. His breathing is laboured and he is cyanotic. No breath sounds can be heard and the right lung field is resonant. The initial management should include
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Absent breath sounds plus hyper-resonance after chest trauma points to air trapped under pressure - think about what relieves that directly.
Updated On: Jul 16, 2026
- Cricothyroidotomy
- Endotracheal intubation
- Obtaining an X-ray chest
- Tube thoracostomy
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The Correct Option is D
Solution and Explanation
This question is testing recognition of a tension pneumothorax and the priority action needed to save the patient.
- Cricothyroidotomy: this is for a blocked upper airway; there is no evidence of airway obstruction here, only a chest problem.
- Endotracheal intubation: does not relieve the trapped air in the pleural space and can worsen a tension pneumothorax if done before decompression.
- Obtaining an X-ray chest: imaging would only delay a life-saving action in a patient who is already cyanotic - this is a clinical, not a radiological, diagnosis.
- Tube thoracostomy: directly evacuates the trapped air, allows the collapsed lung to re-expand, and reverses the cyanosis and breathing difficulty - this is the correct first step.
Correct answer: Tube thoracostomy.
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