A 35-year-old unresponsive with rapid, weak carotid pulse, engorged jugular veins, unequal chest movement. What should you do?

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Multiple Choice

A 35-year-old unresponsive with rapid, weak carotid pulse, engorged jugular veins, unequal chest movement. What should you do?

These signs point to a tension pneumothorax. When air builds up under pressure in the pleural space, the lung on that side collapses and the mediastinum shifts, which impairs venous return and causes shock—hence the rapid, weak carotid pulse and engorged jugular veins with unequal chest movement. The priority is to relieve the pressure immediately with pleural decompression (needle thoracostomy or chest tube). This rapidly restores venous return and improves circulation. IV fluids won’t fix the underlying problem and could worsen respiratory status, and CPR or AED isn’t indicated while a pulse is present.

These signs point to a tension pneumothorax. When air builds up under pressure in the pleural space, the lung on that side collapses and the mediastinum shifts, which impairs venous return and causes shock—hence the rapid, weak carotid pulse and engorged jugular veins with unequal chest movement. The priority is to relieve the pressure immediately with pleural decompression (needle thoracostomy or chest tube). This rapidly restores venous return and improves circulation. IV fluids won’t fix the underlying problem and could worsen respiratory status, and CPR or AED isn’t indicated while a pulse is present.

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