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Anaesthesia · Complications: tension pneumothorax under positive pressure ventilation
Sample itemA ventilated patient suddenly has rising airway pressure, falling saturation, hypotension and absent breath sounds on one side. What is the immediate treatment?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Immediate needle or finger decompression of the chest, then a chest drain
Positive pressure ventilation converts a pneumothorax into a tension pneumothorax, with mediastinal shift and obstructive shock. Immediate decompression with a needle or finger thoracostomy is followed by a chest drain. Nitrous oxide is stopped.
Option by option
A. Increase tidal volume
More volume increases pressure.
B. Give a diuretic
Diuretics do not help.
C. Chest physiotherapy
Physiotherapy has no role.
D. Immediate needle or finger decompression of the chest, then a chest drain (correct)
Correct. Decompression relieves the tension and restores venous return.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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