25-year-old female met with a car accident, her GCS was normal, Heart rate - 150/min, BP - 90/60 mm Hg, Respiratory rate of 20/min. On examination, her JVP was raised, abdomen was not tender and she had ecchymosis over her anterior chest. Breath sounds were absent on one side. Which of the following is the most appropriate diagnosis?

Ans. (b) Tension pneumothoraxRef. Bailey and Love, 27th ed; pg. 367-368.* Patient has sustained blunt trauma to the chest (chest wall ecchymoses) with ongoing cardiopulmonary collapse as evident with Tachycardia, Hypotension with Raised JVP and absent breath sounds on one side.* Pleural effusion is not a possibility and ruled out* Massive hemothorax present with Hypotension, tachycardia, absent breath sounds but JVP won't be raised.* Cardiac tamponade with present with Hypotension, Raised JVP but have normal breath sounds on either side, (also muffled heart sounds - Beck's Triad)* Tension pneumothorax typically starts with tachypnea, air hunger and progresses to Tachycardia, mediastinal shift, raised JVP and finally hypotension. Hence the most probable answer is Tension Pneumothorax