A 30 year old female comes acute breathlessness, neck vein distention, and absent breath sounds and nediastinal shift. Which of the following should be done immediately?: (A) HRCT is the investigation of choice, (B) ABG analysis should be done, (C) CXR, (D) Large bore needle puncture of pleura
Answer is D. Answer is D (Large Bore needle puncture of pleura): Acute breathlessness absent breath sounds, neck vein distension and mediastinal shift suggests a diagnosis of Tension Pneumothorax. Tension pneumothorax must be treated as a medical emergency and therapeutic intervention should not be delayed while waiting for investigations. Immediate puncture of pleura with a large bore needle through the second intercostal space is the treatment of choice.