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?

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.