Tension Pneumothorax
A clinical diagnosis that kills in minutes. Do not wait for X-ray. Needle decompression buys time; a chest drain (or referral for one) is the definitive treatment.
Checklist— tick steps as you go
0/15 steps done
1Recognise (clinical diagnosis)
2Needle decompression
3After decompression
Decision flowchart
Chest trauma with severe respiratory distress
Absent breath sounds + hyper-resonance on one side, with shock?
Yes
Needle decompression NOW: 2nd ICS midclavicular line (no X-ray)
Improved? (easier breathing, BP recovering)
Yes
Chest drain or urgent referral for one; O2 15 L/min
Monitor closely; re-decompress if tension recurs
No
Repeat with fresh cannula; consider 5th ICS midaxillary site
Chest drain or urgent referral for one; O2 15 L/min
Monitor closely; re-decompress if tension recurs
No
Reassess: haemothorax, open wound, flail chest? Continue ABCDE
Monitor closely; re-decompress if tension recurs
Educational guidance only — adapt to your resources, scope of practice and local policy. Last updated 12 August 2026.