What is the first line of management in tension pneumothorax?

Emergency needle decompressionis carried out on the affected side by placing an 18-gauge needle into the hemithorax at the mid-clavicular line in the 2nd anterior intercostal space. This relieves the tension created within the thorax. It does not treat the pneumothorax; subsequent chest tube inseion is required. Tube thoracostomy (chest tube inseion) and underwater seal drainage are the mainstays of treatment for spontaneous pneumothorax.