Immediate decompression of the chest is mandatory for tension pneumothorax; otherwise, the patient's hemodynamics will deteriorate. The diagnosis is made clinically and not by a chest radiograph. A long (at least 5 cm) 16- or 18-gauge angiocath can be placed into pleural space at the fifth intercostal space along the midaxillary plane. After air escapes confirming the diagnosis and the tension pneumothorax is converted to an open pneumothorax, a chest tube should be placed.

References

• American College of Surgeons. Advanced Trauma Life Support. 10th ed. American College of Surgeons; 2018:65-67.