This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: FMGE 2019, Subject name: Surgery
A young male met with A, the patient is dyspnoea on auscultation breath sounds are absent on right side and has hypotension. What is immediate next step? 
Select and explain. 
A. Urgent IV fluid administration, B. Intubate the patient, C. Chest X-ray, D. Needle inseion in 5th intercostal space
D: Needle inseion in 5th intercostal space
Answer: D: Needle inseion in 5th intercostal space 
Explanation: Clinical history is suggestive of diagnosis of Tension Pneumothorax Conscious + Speaking Single words Dyspnoea Tachypnea Low BP Absent breath sound on one side Management: Clinical dx with dire emergency: T/t should be never delayed for radiological confirmation. Hence, CXR is not performed. T/t of choice: Intercoastal Chest Tube inseion - 5th ICS (Triangle of Safety) in anterior axillary lines