This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: All India exam, Subject name: Surgery
20 yr old boy is brough to the emergency following an A with respiratory distress and hypotension He has subcutaneous emphysema and no air entry on the right side What is the next best step in the management 
Select and explain. 
A. sta IV fluids after inseion of wide bore iv line, B. Needle decompression in the 5th Ics, C. Shift to Icu and intubate, D. Positive pressure ventilation
B: Needle decompression in the 5th Ics
Answer: B: Needle decompression in the 5th Ics 
Explanation: Hlistory of clinical examination is suggestive of tension pneumothorax according to trauma updates needle decompression in adults should be done in 5th Ics at mid axillary line * in children needle in 2nd ICS at MCL ref : baile and love 27th ed