American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following describes the management of tension pneumothorax?

1. High-flow supplemental oxygen and observation

2. Needle thoracostomy followed by tube placement

3. Immediate intubation and ventilation

4. Administration of bronchodilators

The correct answer is: Needle thoracostomy followed by tube placement

The management of tension pneumothorax is centered around rapid decompression of the pleural space to relieve pressure that compromises respiratory and cardiovascular function. Performing a needle thoracostomy is a critical first step in this scenario; it allows for immediate decompression by inserting a large-bore needle (usually 14-gauge or larger) into the second intercostal space at the midclavicular line on the affected side. This procedure helps to quickly release trapped air and restore normal thoracic pressure. Following the initial decompression, placement of a tube (tube thoracostomy) is necessary to facilitate ongoing drainage of air and/or fluid from the pleural cavity, which helps prevent recurrence and allows for proper lung expansion. This sequence of interventions is essential for effectively managing tension pneumothorax and stabilizing the patient's condition. Other options do not adequately address the urgent need for decompression that characterizes tension pneumothorax management. While high-flow supplemental oxygen and observation may be used in other circumstances, they do not treat tension pneumothorax and could lead to worsened patient outcomes. Immediate intubation and ventilation may be necessary in severe cases, but it does not directly address the underlying issue of the pneumothorax.