A 34 year old male with chest trauma presents with sudden onset respiratory distress which is increasing. Hyper-resonant note is observed on the left side. Which of the following is the most appropriate immediate emergent management?

Answer is A (Needle puncture and emergent decompression): Sudden Onset Respiratory Distress (which is increasing) and a Hyper-resonant percussion note in a patient with history of chest trauma suggest a diagnosis of Tension Pneumothorax. Needle puncture and emergent decompression is the treatment of choice for Tension Pneumothorax Tension pneumothorax must be treated as a medical emergency and therapeutic intervention should not be delayed while waiting for investigations. Immediate puncture of pleura with a large bore needle through the second intercostal space is the treatment of choice.