Following A, one patient presented with respiratory distress and franctured ribs. One examination hyper resonant right hemithorax and absent breath sound over same side were found. What is the first line of management.

The above mentioned features suggest Tension pneumothorax. The clinical features of Tension pneumothorax are Tachypnoea, tachycardia, decreased or absent breath sounds, Resonant on percussion with mediastinal/tracheal shift, cyanosis and hypotension, chest pain and distended neck veins may be present. Once clinically diagnosed, a wide bore needle is immediately placed in the second intercostal space in midclavicular line and a sterile glove is kept on the hub(blunt) end of the needle to create a valve so as to prevent inward sucking of air from outside - thoracocentesis. Reference : SRB's Manual of Surgery, 6th Edition, page no = 1102.