Which finding is characteristic of a tension pneumothorax?

• A. Decreased JVD
• B. Tracheal deviation/mediastinal shift
• C. Stable vitals
• D. Absence of chest pain

Answer: (B)

Air trapped under pressure in the pleural space pushes the mediastinal structures and trachea away from the affected side. That mediastinal shift, or tracheal deviation, is the hallmark finding of a tension pneumothorax. The rising intrathoracic pressure also impedes venous return, so neck veins are distended and blood pressure can fall with tachycardia. So the key feature is the tracheal deviation/mediastinal shift. Decreased neck vein distention would be misleading—these patients usually have increased JVD. Vital signs are often unstable, not stable, and chest pain can occur but isn’t the defining sign. This condition requires immediate decompression.