How should a paramedic manage a patient with a suspected tension pneumothorax?

In the management of a patient with a suspected tension pneumothorax, the priority is to relieve the pressure build-up in the thoracic cavity, which is critical for restoring normal respiratory function and preventing cardiovascular collapse. The correct approach is to perform needle decompression, which involves inserting a large-bore needle into the second intercostal space at the midclavicular line. This procedure allows trapped air in the pleural space to escape, alleviating the pressure exerted on the lung and mediastinum.

Following needle decompression, the next step typically involves placing a chest tube, which provides continuous drainage of air or fluid through a catheter, thus allowing the affected lung to re-expand and maintaining intrathoracic pressure balance. This two-step process is essential for effectively managing a tension pneumothorax.

In contrast, continuous oxygen support is necessary for various respiratory conditions but does not address the immediate critical situation of a tension pneumothorax. Likewise, manual ventilation with a bag-mask may worsen the situation by adding further pressure to the thorax, and administration of steroids is not indicated in this acute scenario. Thus, the focus on needle decompression followed by chest tube insertion is vital in this emergency management protocol.