This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Trauma, Subject name: Surgery
A patient came to emergency after RTA, He was conscious, could speak in single words, RR=40/minute, BP=90/40 mm Hg. There is absence of Breath Sounds on Right side. What is your next step immediately? 
Select and explain. 
A. Intubate the patient, B. Urgent Fluid infusion, C. Chest X ray, D. Needle Insertion in 2nd ICS
D: Needle Insertion in 2nd ICS
Answer: D: Needle Insertion in 2nd ICS 
Explanation: Ans. (d) Needle insertion in 2nd ICS.Ref. ATLS Guidelines 10th Edition Page 66, Ref Surgery Sixer 2nd Edition Page 95* A hyper resonant note on percussion, deviated trachea, distended neck veins, and absent breath sounds are signs of tension pneumothorax.* But the Question setter has given an incomplete question, nothing mentioned about breath sounds, tracheal deviation.* But let us take into consideration the Tension pneumothorax which fits with above features and let us proceed with Needle Insertion in 5th ICS in MCL.* Newer Guidelines recommend Needle insertion in Adults in 5th ICS in Mid axillary line nowadays, But Bailey speaks the old method and conventional method, 2nd ICS MCL.