Q:

A 12 year old presents with chest pain. Examination: tachycardia, hypotension, dilated neck veins and the trachea is not centrally placed. What is the next appropriate management?

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A 12 year old presents with chest pain. Examination: tachycardia, hypotension, dilated neck veins and the trachea is not centrally placed. What is the next appropriate management?


  1. Portable XR
  2. Needle thoracocenthesis
  3. Chest drainage
  4. ABG
  5. CTPA

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The key is B. Needle thoracocentesis. [The case may be either pneumothorax or massive pleural effusion. Thoracocentasis is recommended for both].

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