List classic signs of a tension pneumothorax in a casualty.

• A. Tracheal deviation, distended neck veins, hypotension, unilateral absent breath sounds, tachycardia, severe respiratory distress
• B. Cough, fever, chest pain, shortness of breath
• C. Bilateral absent breath sounds with normal neck veins
• D. No signs; tension pneumothorax is a non-urgent finding

Answer: (A)

Tension pneumothorax shows signs from the heart and lung being squeezed by rising pressure, which shifts the mediastinum and reduces venous return. The hallmark features reflect both lung collapse on one side and the resulting cardiovascular compromise.

Tracheal deviation away from the affected side occurs because the mediastinum is pushed toward the opposite chest as pressure builds. Distended neck veins come from impaired venous drainage back to the heart, a direct result of increased intrathoracic pressure. Hypotension happens because the heart has less blood to pump due to this reduced venous return. You’ll often hear unilateral absent breath sounds on the side of the collapsed lung, since that lung isn’t expanding well. The body responds with a fast heart rate (tachycardia) and the patient experiences severe respiratory distress due to the combination of lung compression and poor oxygenation.

Other options don’t fit because they describe signs more typical of infection, bilateral or non-urgent findings, or lack of signs altogether, none of which align with the urgent, unilateral, hemodynamically compromising picture of tension pneumothorax.