<prompt> A 34 year old male with chest trauma presents with sudden onset respiratory distress which is increasing. Hyper-resonant note is observed on the left side. Which of the following is the most appropriate immediate emergent management?Needle puncture and emergent decompressionTube inseionAntibiotic and oxygenNo treatment needed  <response>: Answer is A Needle puncture and emergent decompression: Sudden Onset Respiratory Distress which is increasing and a Hyper-resonant percussion note in a patient with history of chest trauma suggest a diagnosis of Tension Pneumothorax. Needle puncture and emergent decompression is the treatment of choice for Tension Pneumothorax Tension pneumothorax must be treated as a medical emergency and therapeutic intervention should not be delayed while waiting for investigations. Immediate puncture of pleura with a large bore needle through the second intercostal space is the treatment of choice. 