Which physical signs suggest tension pneumothorax in a child with pulseless arrest?

• A. Dull chest pain and symmetrical breath sounds
• B. Bradycardia with no signs of respiratory distress
• C. Normal chest radiograph
• D. Jugular venous distention and tracheal deviation

Answer: (D)

The main idea is that tension pneumothorax creates a state of high intrathoracic pressure that rapidly compromises circulation by squeezing the heart and great vessels. The physical signs reflect this pressure buildup: jugular venous distention shows impaired venous return to the heart, and tracheal deviation indicates the mediastinum being pushed away from the affected side. Together, these signs point to a tension physiology that can drive a pulseless arrest in a child. Other descriptions don’t fit this scenario: chest pain with both lungs sounding equal doesn’t indicate a unilateral, pressure-driven collapse; bradycardia without respiratory distress misses the acute airway compromise; and a normal chest radiograph would not explain the sudden arrest. So, jugular venous distention and tracheal deviation are the best indicators of tension pneumothorax in this context.