<prompt> 20 yr old boy is brough to the emergency following an A with respiratory distress and hypotension He has subcutaneous emphysema and no air entry on the right side What is the next best step in the managementsta IV fluids after inseion of wide bore iv lineNeedle decompression in the 5th IcsShift to Icu and intubatePositive pressure ventilation  <response>: Hlistory of clinical examination is suggestive of tension pneumothorax according to trauma updates needle decompression in adults should be done in 5th Ics at mid axillary line in children needle in 2nd ICS at MCL ref : baile and love 27th ed 