In a child in arrest with suspected tension pneumothorax, what is the immediate action?

• A. Observation and reassessment after 5 minutes
• B. Oral oxygen therapy only
• C. Pericardiocentesis
• D. Immediate needle decompression followed by chest tube placement

Answer: (D)

The critical idea is that tension pneumothorax in a child who is in arrest creates a rapidly life-threatening obstruction of venous return, so relief of the trapped air must happen immediately to restore circulation. That requires quickly decompressing the chest to release the pressure, then establishing a definitive drainage with a chest tube. Needle decompression acts as a fast, life-saving first step to convert a lethal tension physiology into a more manageable state, after which a chest tube provides ongoing drainage and lung re-expansion. Oxygen therapy alone cannot fix the mechanical problem, waiting to reassess isn’t acceptable in arrest, and procedures aimed at tamponade address a different issue. By promptly decompressing and then placing a chest tube, you optimize the chance of return of circulation and stabilize the patient.