شاب عمره ٣١ سنة بعد حادث دراجة نارية، عنده ضيق نفس شديد ومتزايد، والقصبة الهوائية منحرفة لليسار، وأصوات التنفس غائبة في اليمين، والأوردة الوداجية منتفخة. الضغط ٧٨/٤٠، والنبض ١٤٠، والتشبع ٨٢٪. ما التشخيص والإجراء المتوقع؟

A 31-year-old after a motorcycle crash has severe worsening breathlessness, tracheal deviation to the left, absent breath sounds on the right and distended neck veins. BP 78/40, HR 140, SpO2 82%. What is the diagnosis and expected procedure?

1. Cardiac tamponade needing pericardiocentesis
2. Right pleural effusion needing a tap in two days
3. Right tension pneumothorax: immediate needle decompression
4. Simple left pneumothorax: obtain a chest X-ray first

Answer: C) Right tension pneumothorax: immediate needle decompression. Tracheal deviation away from the affected side with absent sounds there, hypotension and raised JVP means tension pneumothorax. It is a clinical diagnosis treated by immediate needle decompression then a chest tube, without waiting for imaging.