NREMT Emergency Medical Technician (EMT) Cognitive ExamAirway, Respiration & VentilationHard
A 68-year-old male presents with sudden onset of severe shortness of breath, diminished lung sounds on the left side, and tracheal deviation to the right. He is hypotensive and tachycardic. Which of the following is the most appropriate immediate intervention?
- AInitiate positive pressure ventilation with a bag-valve mask.
- BAdminister high-flow oxygen via non-rebreather mask.
- CPrepare for needle decompression of the left chest.
- DTransport immediately to the nearest trauma center.
Show answer & explanationAnswer & explanation
Correct answer: C. Prepare for needle decompression of the left chest.
The patient's presentation of sudden severe shortness of breath, diminished lung sounds on one side, tracheal deviation away from the affected side, hypotension, and tachycardia are classic signs of a tension pneumothorax. This is a life-threatening condition requiring immediate needle decompression to relieve pressure on the heart and lungs.
Why the other options are wrong
- A. Positive pressure ventilation can worsen a tension pneumothorax by forcing more air into the pleural space.
- B. While oxygen is important, it will not resolve the underlying pressure buildup of a tension pneumothorax.
- D. Transport is necessary, but immediate life-saving intervention (needle decompression) takes precedence over transport alone.
Tension Pneumothorax
A life-threatening condition where air enters the pleural space but cannot escape, building up pressure that collapses the lung and shifts mediastinal structures, impairing cardiac function.
- Caused by blunt or penetrating chest trauma, or spontaneously.
- Characterized by absent/diminished lung sounds, tracheal deviation, hypotension, tachycardia.
- Requires immediate needle decompression.
Memory trick: Don't let the tension collapse their breath, act fast!