What is the primary treatment for a tension pneumothorax?

The primary treatment for a tension pneumothorax is needle decompression. This condition occurs when air enters the pleural space and cannot escape, leading to increased pressure that compresses the lungs and can severely compromise cardiovascular function.

Needle decompression quickly alleviates the pressure by inserting a large-bore needle into the pleural space, typically in the second intercostal space in the midclavicular line. This procedure allows trapped air to escape, relieving the immediate threat to both respiratory and hemodynamic stability.

While other treatments play significant roles in managing pneumothorax, they are not the first line in the acute setting. Oxygen therapy does not address the underlying pressure problem. Chest tube insertion is necessary for definitive management after decompression, but it is not the immediate intervention in an emergent setting. Intravenous fluids may be necessary in cases of shock or fluid resuscitation, but they do not treat the ventilatory or pressure problems associated with a tension pneumothorax. Thus, needle decompression is the critical intervention needed to stabilize the patient quickly.