A 36-year-old man presents to the emergency department with sudden shortness of breath. The CT thorax shows evidence of air in the pleural cavity with partial lung collapse. What is the immediate next step in management?

1. A

   Needle decompression

2. B

   Intercostal chest tube insertion

3. C

   Sputum microscopy and culture

4. D

   Thoracic ultrasound

Appeared in: INI-CET EXAM -2025

Explanation

• The patient has a symptomatic pneumothorax with lung collapse, which requires intervention to remove the trapped air.
• Intercostal chest tube insertion is the definitive treatment to evacuate air from the pleural space, allowing the collapsed lung to re-expand.
• This procedure re-establishes the negative intrapleural pressure necessary for normal breathing mechanics.
• While the shortness of breath is sudden, the absence of other signs like hypotension or tracheal deviation points towards a large simple pneumothorax rather than a tension pneumothorax, making chest tube insertion the primary treatment.

Why Other Options Were Wrong

• Option A: Needle decompression is an emergency temporizing measure specifically for tension pneumothorax, not the definitive treatment for a stable pneumothorax.
• Option C: This is a diagnostic test for respiratory infections and has no role in the acute management of a pneumothorax.
• Option D: This is a diagnostic tool. A more definitive CT scan has already confirmed the diagnosis, so further diagnostic imaging is not the immediate management step.

Related Visual

• Visual 1: [object Object]
• Visual 2: [object Object]

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Management of Pneumothorax as background academic context rather than a clinical decision trigger.
• A nurse must be able to rapidly differentiate between a simple pneumothorax and a life-threatening tension pneumothorax. Key signs of tension include severe respiratory distress, hypotension, tachycardia, and tracheal deviation.
• Post-procedure nursing care for a patient with a chest tube involves monitoring respiratory status, checking for air leaks in the drainage system, assessing drainage amount and color, and managing pain.
• What if? If the patient suddenly developed hypotension (BP 80/50 mmHg) and tracheal deviation to the left, the immediate priority would shift. The answer would become 'Needle decompression' as these are hallmark signs of a tension pneumothorax, which is a medical emergency requiring immediate relief of pressure before a chest tube can be placed.

How to Approach the Question

• First, identify the primary diagnosis from the clinical information and imaging results. Here, it is a pneumothorax with partial lung collapse.
• Next, assess the patient's stability and symptoms. The patient is symptomatic ('sudden shortness of breath') but there are no signs of hemodynamic instability (like hypotension) mentioned.
• The question asks for the 'immediate next step in management'. This requires you to choose a therapeutic action, not a diagnostic one.
• Evaluate the options. Rule out diagnostic tests (Sputum culture, Ultrasound) as the diagnosis is already confirmed.
• Differentiate between the two therapeutic options (Needle decompression vs. Chest tube). Recall that needle decompression is for the emergency of a tension pneumothorax, while a chest tube is the standard treatment for a significant simple pneumothorax.
• Since signs of tension are absent, select the standard definitive treatment, which is the intercostal chest tube insertion.

Concept Tested & Keywords

• Concept Tested: Management of Pneumothorax
• Stem keywords: shortness of breath, CT thorax, air in the pleural cavity, partial lung collapse, pneumothorax
• Lead-in keywords: immediate next step, management
• Clinical cues: [object Object]

Question ID

QPdL-5Hf-jjQBMSMZgaDO9

Copy ID