What should be done initially if a patient presents with a tension pneumothorax?

In the case of a tension pneumothorax, the initial and most critical intervention is needle decompression. A tension pneumothorax occurs when air enters the pleural space and cannot escape, leading to increased intrathoracic pressure that compromises cardiorespiratory function. This condition is life-threatening and requires immediate action.

Performing needle decompression allows for rapid release of the trapped air, thereby alleviating pressure on the thoracic structures, including the lungs and mediastinum. This procedure is typically performed using a large bore cannula, often inserted into the second intercostal space at the midclavicular line on the affected side, to effectively allow the excess air to escape and restore normal lung mechanics.

In contrast, other options such as administering IV antibiotics may be part of the management for infections but are not appropriate for an acute, time-sensitive situation like a tension pneumothorax. Requesting a CT scan could delay life-saving treatment, as imaging is not necessary before addressing the immediate danger. Beginning chest physiotherapy is irrelevant in this emergency situation and would not address the acute issue of pressure buildup in the thorax. Therefore, the priority must always be to relieve the pressure through needle decompression first.