Prehospital Trauma Life Support (PHTLS) Practice Test

What is the preferred site for needle decompression of a tension pneumothorax?

1. 4th intercostal space, midclavicular line, just over the top of the 5th rib

2. 4th intercostal space, midclavicular line, just below the 4th rib

3. 2nd intercostal space, midclavicular line, just over the top of the 3rd rib

4. 2nd intercostal space, midclavicular line, just below the 2nd rib

The correct answer is: 2nd intercostal space, midclavicular line, just over the top of the 3rd rib

The preferred site for needle decompression of a tension pneumothorax is the 2nd intercostal space along the midclavicular line, just over the top of the 3rd rib. This location is commonly used due to several important factors. Firstly, the 2nd intercostal space is easily accessible and is located in a region that allows for a direct pathway to the pleural space without significant risk to major vessels or structures beneath it. By placing the needle above the rib, the healthcare provider avoids the neurovascular bundle that runs along the inferior aspect of each rib, thereby minimizing the risk of complications. Secondly, the anatomical landmarks are well defined and can be easily located in the majority of patients, making it a reliable site for emergency interventions in prehospital settings. Furthermore, decompressing the pleural cavity at this site effectively reduces intrathoracic pressure, providing immediate relief from the potentially life-threatening condition of a tension pneumothorax. In contrast, other options may place the needle too low or too close to structure risks, leading to injury or ineffective decompression. Therefore, the selection of the 2nd intercostal space at the midclavicular line is considered the best practice in emergency