What is the primary treatment for a tension pneumothorax?

The primary treatment for a tension pneumothorax involves immediate intervention to relieve the pressure in the pleural space, which is crucial for restoring respiratory function and preventing cardiovascular collapse. Needle decompression is performed first, typically at the second intercostal space in the midclavicular line, to quickly release trapped air. This step is essential as tension pneumothorax can rapidly progress to respiratory failure and hemodynamic instability.

Following needle decompression, the definitive management involves placing a chest tube, which allows continuous drainage of air (or fluid if present) from the pleural space. This two-step approach effectively resolves the underlying issue and helps to re-expand the lung.

Other options are less appropriate in the context of treating tension pneumothorax. Immediate surgical thoracotomy may be necessary in more complex scenarios involving severe injury or when other treatments fail, but it is not the standard immediate response for tension pneumothorax. Administration of intravenous fluids does not address the airway obstruction caused by the accumulation of air in the pleural cavity and would not resolve the tension pneumothorax. Watchful waiting with observation is contraindicated, as tension pneumothorax requires prompt action to prevent severe complications, making timely intervention critical for patient survival.