Which of the following is the ONLY action that can prevent eventual death from a tension pneumothorax?

• A. Decompression of the injured side of the chest
• B. Rapid IV fluids
• C. Bag-Valve Mask ventilation
• D. High-flow oxygen

Answer: (A)

In tension pneumothorax, air builds up under pressure in the chest and pushes on the heart and great vessels, cutting off blood return to the heart. The only way to stop this deadly cycle is to relieve that pressure. Decompression of the injured side of the chest—such as needle thoracostomy followed by chest tube placement—immediately lets the trapped air escape, restores lung expansion, and improves venous return and cardiac output. Without relieving the pressure, other measures won’t halt the progression to death, even if they improve oxygen levels or support circulation for a short time. High-flow oxygen helps with oxygenation, but it doesn’t address the life-threatening pressure. Rapid IV fluids may temporarily support blood pressure but won’t relieve the mechanical compression. Bag-valve-mask ventilation can raise intrathoracic pressure and worsen the condition.