مريض حادث سيارة يتدهور بسرعة. أي مجموعة علامات تدل على استرواح صدري ضاغط؟

A car-crash victim is deteriorating rapidly. Which set of findings indicates a tension pneumothorax?

1. Tracheal deviation towards the injured side, with normal breath sounds on both sides
2. Tracheal deviation away, absent breath sounds and distended neck veins
3. Chest pain on coughing, temperature 38.5 °C and crackles at the base
4. Mild breathlessness, slightly reduced breath sounds and a normal BP

Answer: B) Tracheal deviation away, absent breath sounds and distended neck veins. In tension pneumothorax trapped air pushes the mediastinum to the opposite side, so the trachea deviates away, breath sounds are absent on the affected side, and impaired venous return distends the neck veins and drops BP. Immediate needle decompression is needed.